Med-Surg Nursing NCLEX-RN Study Guide
Overview
Medical-Surgical nursing encompasses the assessment, diagnosis, and care of adult patients across a wide range of acute and chronic conditions. This study guide consolidates high-yield NCLEX-RN concepts across cardiovascular, respiratory, neurological, renal, endocrine, and gastrointestinal systems. Mastery of these core principles is essential for both clinical practice and exam success.
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Cardiovascular System
Key Concepts
Heart Failure
STEMI Priority Actions (MONA)
1. Morphine (pain relief)
2. Oxygen (if SpO₂ < 94%)
3. Nitroglycerin (if BP allows)
4. Aspirin
Cardiac Biomarkers
| Biomarker | Specificity | Duration Elevated |
|---|---|---|
| Troponin I/T | Most specific | Up to 14 days |
| CK-MB | Moderate | 24–72 hours |
| Myoglobin | Least specific | 24 hours |
Digoxin Toxicity
Peripheral Arterial Disease (PAD)
DVT & Anticoagulation
Key Terms
Watch Out For
> ⚠️ Nitroglycerin is contraindicated if systolic BP < 90 mmHg or patient has taken a phosphodiesterase inhibitor (sildenafil) within 24–48 hours.
>
> ⚠️ Heparin ≠ thrombolytic. A common NCLEX distractor asks what heparin does to a clot — it does NOT dissolve it.
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> ⚠️ Check potassium before giving digoxin every time — hypokalemia is the #1 precipitating factor for digoxin toxicity.
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Respiratory System
Key Concepts
COPD Nursing Priorities
- Reason: COPD patients with chronic hypercapnia rely on hypoxic drive (low O₂, not high CO₂) to breathe; high-flow O₂ eliminates this stimulus
- Inhale through the NOSE → exhale slowly through pursed lips
- Maintains positive airway pressure, prevents alveolar collapse
Tension Pneumothorax — Classic Signs (TATJH)
ABG Interpretation — Respiratory Acidosis
| Value | Normal | Uncompensated Resp. Acidosis |
|---|---|---|
| pH | 7.35–7.45 | < 7.35 |
| PaCO₂ | 35–45 mmHg | > 45 mmHg |
| HCO₃ | 22–26 mEq/L | Normal |
Chest Tube: Water-Seal Chamber
| Finding | Meaning |
|---|---|
| Tidaling (fluctuation with breathing) | Normal — lung not fully re-expanded |
| Continuous bubbling | Air leak — check connections or lung |
| No fluctuation | Lung re-expanded OR obstruction |
| Sudden gush of drainage | Patient position change — usually normal |
Key Terms
Watch Out For
> ⚠️ Never give high-flow O₂ to a COPD patient without orders — this is a frequently tested NCLEX scenario.
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> ⚠️ Tracheal deviation is a LATE sign of tension pneumothorax — don't wait for it to act.
>
> ⚠️ Continuous vs. intermittent bubbling: Continuous = air leak (problem); intermittent during expiration = normal air escaping from lung.
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Neurological System
Key Concepts
Stroke (CVA) — Priority Actions
1. Activate stroke response team IMMEDIATELY
2. Document exact time of symptom onset — tPA eligibility window: 3–4.5 hours
3. Classic signs (FAST): Face drooping, Arm weakness, Speech difficulty, Time to call
Increased Intracranial Pressure (ICP)
- Cushing's Triad = herniation is imminent — medical emergency
Autonomic Dysreflexia
Post-Craniotomy Care
- GCS (Glasgow Coma Scale)
- Pupillary response (size, equality, reactivity)
- Motor/sensory checks
- Monitor for cerebral edema or hemorrhage
Parkinson's Disease — Fall Prevention
Key Terms
Watch Out For
> ⚠️ Time is brain — in stroke care, document symptom onset time before anything else. If symptom onset is unknown, patient is NOT eligible for tPA.
>
> ⚠️ Cushing's Triad is a LATE sign of ICP — LOC change comes first. Don't confuse early vs. late signs.
>
> ⚠️ Autonomic dysreflexia vs. spinal shock: Dysreflexia = hypertension; spinal shock = hypotension. Know the difference.
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Renal & Urological System
Key Concepts
Hyperkalemia Management (K⁺ = 6.8 mEq/L with ECG changes)
Priority order:
1. IV Calcium gluconate — stabilizes cardiac membrane (FIRST — most urgent)
2. IV insulin + dextrose — drives K⁺ into cells
3. Sodium bicarbonate — shifts K⁺ into cells (if acidotic)
4. Kayexalate (sodium polystyrene) — removes K⁺ from body
5. Dialysis — definitive removal
Oliguria Definition
Hemodialysis: Dietary Restrictions
| Restrict | Reason |
|---|---|
| Potassium | Accumulates → hyperkalemia → cardiac dysrhythmias |
| Phosphorus | Accumulates → hyperphosphatemia → renal osteodystrophy, calcifications |
| Sodium | Causes fluid retention → hypertension, edema |
| Fluid | Kidneys cannot regulate fluid balance |
Kidney Transplant Rejection Signs
Post-Surgical Urinary Retention
Key Terms
Watch Out For
> ⚠️ Calcium gluconate does NOT lower potassium — it only protects the heart. Always follow with insulin/dextrose to actually lower K⁺.
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> ⚠️ For transplant patients on immunosuppressants — any sign of infection (fever, WBC changes) must be reported. They cannot mount a normal immune response.
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> ⚠️ AKI vs. CKD: AKI is potentially reversible; CKD is progressive and permanent. Know distinguishing lab trends.
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Endocrine & Metabolic System
Key Concepts
Hypoglycemia in Unconscious Patient
DKA vs. HHS Comparison
| Feature | DKA | HHS |
|---|---|---|
| Diabetes type | Primarily Type 1 | Primarily Type 2 |
| Blood glucose | 250–600 mg/dL | > 600 mg/dL |
| Ketones | Present (ketosis, fruity breath) | Absent or minimal |
| Acidosis | Yes (pH < 7.35) | No |
| Onset | Rapid (hours) | Gradual (days) |
| Dehydration | Moderate | Severe |
Adrenal Crisis (Addison's Disease)
Post-Thyroidectomy Complications
| Complication | Signs | Cause |
|---|---|---|
| Hypocalcemia | Tingling around mouth, Chvostek's sign, Trousseau's sign, tetany | Parathyroid gland damage → ↓PTH → ↓Ca²⁺ |
| Thyroid storm | Hyperthermia, tachycardia, agitation | Sudden release of thyroid hormones |
| Airway obstruction | Stridor, neck swelling, dyspnea | Hemorrhage or edema |
Cushing's Syndrome — Classic Presentation
Key Terms
Watch Out For
> ⚠️ Never give oral glucose to an unconscious patient — this is a priority safety concept on NCLEX.
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> ⚠️ DKA patients may have normal or low glucose initially — always check ketones and pH, not just glucose alone.
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> ⚠️ Keep calcium gluconate and a tracheotomy tray at the bedside post-thyroidectomy — both hypocalcemia and airway compromise are possible.
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Gastrointestinal & Surgical System
Key Concepts
Post-Operative Peritonitis
Stoma Assessment (Post-Colostomy)
| Stoma Color | Meaning | Action |
|---|---|---|
| Beefy red, moist | Normal, well-perfused | Continue monitoring |
| Pale or dusky | Compromised perfusion | Notify physician |
| Dark or black | Ischemia/necrosis | IMMEDIATE report |
Hepatic Encephalopathy