PNC Licensing Examination Medical Surgical Nursing Syllabus

How does stable angina pain differ from MI pain?

Stable angina is provoked by exertion, lasts <5-15 minutes, and is relieved by rest or nitroglycerin; MI pain is more severe, lasts >20-30 minutes, occurs at rest, and is NOT relieved by rest or nitroglycerin.

What is the MONA acronym in initial management of suspected MI?

Morphine, Oxygen (if hypoxic), Nitroglycerin, and Aspirin; aspirin (chewed) and assessment are given first, with morphine reserved for pain unrelieved by nitrates.

What ECG change indicates an acute ST-elevation myocardial infarction (STEMI)?

ST-segment elevation in two or more contiguous leads (and often new Q waves later); NSTEMI shows ST depression or T-wave inversion without ST elevation but with elevated troponin.

What is the normal duration of the PR interval and QRS complex on an ECG?

Normal PR interval is 0.12-0.20 seconds; normal QRS complex is 0.06-0.10 seconds (less than 0.12). Each small box = 0.04 sec.

How do you calculate heart rate on an ECG using the large-box method?

Divide 300 by the number of large boxes between two consecutive R waves (300, 150, 100, 75, 60, 50). Each large box = 0.20 seconds.

What distinguishes atrial fibrillation from atrial flutter on an ECG?

Atrial fibrillation has an irregularly irregular rhythm with no discernible P waves (chaotic baseline); atrial flutter has a regular sawtooth (F-wave) pattern with a typical atrial rate near 250-350 bpm.

Which two rhythms are "shockable" in cardiac arrest, and which treatment is used?

Ventricular fibrillation and pulseless ventricular tachycardia are shockable and treated with defibrillation (unsynchronized shock) plus CPR; asystole and PEA are non-shockable.

What is the difference between defibrillation and synchronized cardioversion?

Defibrillation delivers an unsynchronized shock for pulseless VF/VT; synchronized cardioversion times the shock to the R wave and is used for unstable but perfusing rhythms like AF, atrial flutter, or VT with a pulse.

What is the key nursing care after cardiac catheterization via the femoral artery?

Keep the affected leg straight and apply pressure/keep flat for several hours, monitor the puncture site for bleeding/hematoma, assess distal pulses, color, and sensation, and monitor for vasovagal response and contrast-induced nephropathy (encourage fluids).

What is the priority assessment for a patient after a permanent pacemaker insertion?

Monitor the ECG for pacemaker capture/sensing, assess the incision site for bleeding/hematoma, limit arm movement on the operative side, and watch for pneumothorax (dyspnea, decreased breath sounds).

What is the classic presentation and causative organism of typical community-acquired pneumonia?

Sudden fever, productive cough with rust-colored/purulent sputum, pleuritic chest pain, and crackles/bronchial breath sounds; the most common bacterial cause is Streptococcus pneumoniae.

What is the standard first-line drug regimen and a key teaching point for pulmonary tuberculosis?

RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol for the initial phase. Key teaching: take all medications consistently for the full 6 months, and rifampin turns body fluids orange-red.

What type of isolation precautions are required for active pulmonary tuberculosis?

Airborne precautions: negative-pressure room, and N95 respirator for staff; the patient wears a surgical mask when transported.

What is the difference between asthma and COPD in terms of airway reversibility?

Asthma involves reversible airway obstruction from bronchospasm/inflammation (often returns to normal between attacks); COPD involves largely irreversible, progressive airflow limitation (chronic bronchitis and/or emphysema).

Why must oxygen be administered cautiously (low flow) in COPD patients with chronic CO2 retention?

Some chronic retainers rely on a hypoxic drive to breathe; high-flow oxygen can blunt this drive and cause hypoventilation, though oxygen should still be titrated to a target SpO2 (often 88-92%) and never withheld in true hypoxemia.

What is the medication class and mechanism difference between a rescue and a controller inhaler in asthma?

Rescue: short-acting beta-2 agonists (e.g., albuterol) for quick bronchodilation during attacks. Controller: inhaled corticosteroids (e.g., fluticasone) taken daily to reduce chronic airway inflammation and prevent attacks.

What is the correct order when using an inhaled corticosteroid and a bronchodilator together, and why rinse the mouth?

Use the bronchodilator first (opens airways), wait a few minutes, then the steroid; rinse the mouth after inhaled corticosteroids to prevent oral thrush (candidiasis).

List the approximate FiO2 delivered by a nasal cannula at 1-6 L/min.

Roughly 24% at 1 L, increasing about 4% per liter, up to about 44% at 6 L/min. Flow above 6 L/min via cannula dries mucosa without much added FiO2.

Which oxygen delivery device provides the highest, most precise FiO2 for an unstable hypoxic patient?

A non-rebreather mask delivers up to 60-90% FiO2 (high concentration); a Venturi mask delivers the most precise/controlled FiO2 (e.g., 24-50%) useful in COPD.

What is the recommended head positioning to open the airway and prevent aspiration in an unconscious breathing patient?

Head-tilt/chin-lift to open the airway (jaw-thrust if cervical injury suspected); place a breathing unconscious patient in the recovery (lateral) position to prevent aspiration.

What does continuous bubbling in the water-seal chamber of a chest drainage system indicate?

It indicates an air leak in the system or the patient (e.g., loose connection or persistent pneumothorax); intermittent bubbling with respiration is normal, but continuous bubbling must be investigated.

What is "tidaling" in a chest tube water-seal chamber and what does its absence suggest?

Tidaling is the rise and fall of fluid in the water-seal chamber with respiration, confirming patency; absence of tidaling suggests the lung has re-expanded OR the tube is obstructed/kinked.

What should the nurse do if a chest tube becomes disconnected from the drainage system?

Immediately submerge the end of the chest tube in a bottle of sterile water/saline to re-establish a water seal, then obtain a new system; if the tube is pulled OUT of the chest, cover the site with an occlusive dressing taped on three sides.

What is the cardinal symptom timing that differentiates a gastric from a duodenal peptic ulcer?

Gastric ulcer pain typically worsens with eating (30-60 min after meals); duodenal ulcer pain occurs 2-3 hours after meals and at night and is relieved by eating or antacids.

What organism and what drug class are central to peptic ulcer disease treatment?

Helicobacter pylori is the main causative organism; treatment uses triple therapy: a proton pump inhibitor plus two antibiotics (e.g., clarithromycin and amoxicillin/metronidazole).

How do you distinguish upper from lower GI bleeding by stool/emesis appearance?

Upper GI bleed: hematemesis (bright red or coffee-ground emesis) and melena (black, tarry stools). Lower GI bleed: hematochezia (bright red blood per rectum).

What are the classic clinical signs of liver cirrhosis with portal hypertension?

Ascites, esophageal varices, splenomegaly, jaundice, spider angiomas, palmar erythema, caput medusae, and bleeding tendency; advanced disease causes hepatic encephalopathy with elevated ammonia.

What drug lowers ammonia in hepatic encephalopathy and how does it work?

Lactulose; it acidifies the colon to trap ammonia as ammonium and acts as a laxative to excrete it. The therapeutic goal is 2-3 soft stools per day.

How are hepatitis A and hepatitis B distinguished by route of transmission?

Hepatitis A spreads via the fecal-oral route (contaminated food/water); hepatitis B (and C) spread via blood and body fluids (sexual contact, needles, perinatal). Vaccines exist for A and B but not C.

What are the classic signs of mechanical small-bowel obstruction?

Colicky abdominal pain, abdominal distension, vomiting (often bilious/feculent), high-pitched then absent bowel sounds, obstipation (no stool/flatus); priority nursing care is NPO status and nasogastric decompression.

What is the difference in stoma output and care between an ileostomy and a colostomy?

An ileostomy produces frequent, liquid, enzyme-rich effluent that irritates skin (needs careful skin protection, no routine irrigation); a sigmoid colostomy produces more formed stool, can sometimes be irrigated/regulated, and has lower skin-breakdown risk.

What stoma color indicates healthy tissue versus a complication requiring urgent reporting?

A healthy stoma is pink to brick-red and moist; a dusky, purple, blue, or black stoma indicates ischemia/necrosis and must be reported immediately.

What is TPN, its primary access route, and a major nursing precaution?

Total Parenteral Nutrition delivers complete nutrition IV; because of its high dextrose concentration/osmolarity it must be given through a central line. Monitor blood glucose closely and never abruptly stop it (risk of rebound hypoglycemia).

How is acute kidney injury (AKI) distinguished from chronic kidney disease (CKD)?

AKI is an abrupt, often reversible decline in renal function (rising creatinine/BUN over hours-days, often with oliguria); CKD is a gradual, irreversible loss of nephrons over months-years, classified by GFR stages 1-5.

What defines end-stage renal disease (CKD stage 5) by GFR, and what is the treatment?

GFR less than 15 mL/min/1.73 m2; treatment is renal replacement therapy: dialysis (hemodialysis or peritoneal) or kidney transplant.

What are the three phases of acute kidney injury and the urine output in each?

Oliguric phase (urine <400 mL/day, fluid overload and hyperkalemia risk), diuretic phase (large urine output with fluid/electrolyte loss risk), and recovery phase (gradual return of function).

What is the priority nursing assessment for an AV fistula used in hemodialysis?

Palpate for a thrill and auscultate for a bruit to confirm patency; do NOT take blood pressure, draw blood, or start IVs in the fistula arm.

What are the classic signs and most common organism of a lower urinary tract infection (cystitis)?

Dysuria, urinary frequency and urgency, suprapubic pain, and cloudy/foul-smelling urine; the most common causative organism is Escherichia coli (E. coli).

How does pyelonephritis (upper UTI) present differently from simple cystitis?

Pyelonephritis adds systemic signs: high fever, chills, flank/costovertebral angle (CVA) tenderness, nausea/vomiting, and malaise, indicating kidney involvement rather than just bladder irritation.

What are key patient teaching points to prevent recurrent urinary tract infections?

Drink plenty of fluids, void regularly and after intercourse, wipe front to back, avoid irritants/bubble baths, wear cotton underwear, and complete the full antibiotic course.