NCLEX-RN CANADA PREP BOOK 2026-2027

Crutch tips sit about 15 cm to the side and in front of the feet, with 2 to 3 finger widths between the axilla and the crutch pad and the elbow slightly flexed. Going up, lead with the good leg; going down, lead with the crutches and the affected leg.

Ask about preferences rather than assuming. Examples include halal, kosher, vegetarian, and fasting practices such as Ramadan, and arrange suitable meals with the dietitian.

Hold the cane on the stronger side, advance it with the weaker leg, and keep the top at the level of the greater trochanter with the elbow flexed about 30 degrees.

Lock the wheels, raise the bed to a safe working height, use a gait belt, have the client dangle first, then pivot toward the stronger side. Assess for dizziness and keep the call bell within reach.

Insert with the volume turned off, remove the battery at night, clean the earmold with a soft cloth, keep it away from moisture and heat, and never use alcohol to clean it.

Record all fluids taken in (oral, IV, tube feeding) and all output (urine, drainage, vomit, liquid stool) in millilitres. Normal urine output is at least 30 mL per hour or 0.5 mL/kg/h in adults.

Increase fluids and fibre, encourage activity, promote a regular toileting routine, and use stool softeners or laxatives as prescribed. Rule out impaction and avoid straining in cardiac clients.

Keep the ankles in a neutral position with high-top sneakers, a footboard, or splints, and perform range of motion regularly. This prevents plantar flexion contracture.

X-ray confirmation is the gold standard before the first use. Check the external length mark and aspirate pH (gastric 5 or lower, or per policy). Air auscultation alone is not reliable.

Position on the side with the head turned, use a soft toothbrush and minimal fluid with suction ready, assess the mouth, and moisturize lips. This reduces aspiration and pneumonia risk.

Use a standardized scale (numeric, FACES, FLACC for non-verbal children, or PAINAD for dementia) and the PQRSTU approach: provoking factors, quality, region and radiation, severity, timing, and understanding. Document the response to treatment.

Use a 30-degree lateral tilt supported with pillows rather than a full 90 degrees. This keeps pressure off the greater trochanter and sacrum.

Bladder training uses timed voiding with gradually longer intervals. Kegel exercises contract the pelvic floor for 5 to 10 seconds, repeated several times a day, and strengthen the muscles used to control urine.

Pressure injury, contractures, muscle atrophy, orthostatic hypotension, DVT, pneumonia, constipation, urinary stasis, bone demineralization, and depression. Early mobility prevents them.

Four-point: alternating, most stable, requires weight bearing on both legs. Three-point: both crutches and the affected leg, then the good leg. Two-point: faster, alternating crutch and opposite leg. Swing-to and swing-through: used with paralysis or no weight bearing.

Limit sodium, potassium, phosphorus, and fluids as prescribed, and restrict protein in pre-dialysis stages. Needs differ in dialysis, so follow the dietitian's plan.

Inspect feet daily, wash and dry well including between the toes, moisturize but not between the toes, never go barefoot, wear well-fitting shoes, and see a foot care professional for nails and corns.

Use strict asepsis for the central line, an infusion pump, and do not stop abruptly (taper to prevent hypoglycemia). Monitor blood glucose, weight, electrolytes, and signs of infection. Hang a new bag and tubing as directed.

Reposition at least every 2 hours, use pressure-redistributing surfaces, keep skin clean and dry, avoid shear and friction, maintain nutrition and hydration, and float heels off the bed.

Replace fluids and electrolytes, protect the perineal skin, monitor stool output, send stool specimens if infection is suspected, and use contact precautions with Clostridioides difficile.

Teach about continuous positive airway pressure (CPAP) use and cleaning, side-lying positioning, weight loss, and avoiding sedatives and alcohol. Untreated sleep apnea raises the risk of hypertension and cardiac events.

Keep the head of the bed at 30 to 45 degrees, flush the tube with water per policy before and after feeds and medications, check tolerance, change tubing as per policy, and monitor for diarrhea, aspiration, and tube blockage.

Ensure privacy and warm water, wash from cleanest to dirtiest and from front to back for perineal care, inspect the skin, promote independence, and check for pressure injuries.

Keep a wide base of support, bend at the hips and knees, keep the load close to the body, tighten abdominal muscles, pivot rather than twist, and push or pull rather than lift.

Check the skin before and during use, limit application to 15 to 20 minutes, and use a cloth barrier. Use extra caution with diabetes, neuropathy, impaired circulation, and altered consciousness.

Thirst, dry mucous membranes, poor skin turgor, concentrated dark urine, tachycardia, and low blood pressure. Encourage oral fluids and give IV fluids as prescribed, watching for overload.

Coughing or choking with meals, wet voice, drooling, and food pocketing. Use texture-modified food and thickened liquids as directed by the speech-language pathologist and keep the client upright.

Stage 1: intact skin with non-blanchable redness. Stage 2: partial thickness with dermis exposed. Stage 3: full-thickness skin loss, fat visible. Stage 4: exposed muscle, tendon, or bone. Also unstageable (covered by slough or eschar) and deep tissue injury.

Passive (nurse moves the joint), active (client moves the joint), and active-assisted. Perform slowly and gently to the point of resistance, never into pain.

Stress: leaks with coughing or sneezing. Urge: sudden strong need. Overflow: bladder full and dribbling. Functional: cannot reach the toilet. Treatment depends on the type.

Sit upright at 90 degrees, tuck the chin, give small bites, check for swallowing before the next, avoid straws if prescribed, and keep upright for 30 to 60 minutes after meals.

Restrict sodium (a common target is under 2,000 mg a day), limit processed foods, and use herbs instead of salt. Daily weights and fluid restriction may also apply.

Risk for pressure injury using six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A lower total score means higher risk (18 or less is at risk).

Clean the eyes with sterile saline from inner to outer canthus, use lubricating drops or ointment, and cover or tape the lids if they do not close. This prevents corneal drying and ulceration.

Wheat, barley, rye, and often oats due to cross-contamination. Gluten-free grains such as rice, corn, quinoa, and buckwheat are safe, and the diet is lifelong.

Liquids you can see through that leave minimal residue, such as water, clear broth, tea, and gelatin. It is short term only because it is nutritionally inadequate.

Liquids and foods that are liquid at body temperature: milk, strained soups, ice cream, custard, and puddings. It is used as a transition between clear liquids and soft foods.

A diet low in fibre that reduces stool bulk, used during acute flares of inflammatory bowel disease, diverticulitis, and before or after some bowel surgery. Avoid raw vegetables, whole grains, nuts, and seeds.

Skin damage from prolonged contact with urine or stool. Clean promptly with a pH-balanced cleanser, pat dry, and apply a barrier cream. It differs from a pressure injury but can increase the risk.

Empty the pouch when one-third to one-half full, size the skin barrier to the stoma, assess the stoma (healthy is pink to red and moist), and protect peristomal skin. A dusky or black stoma needs immediate reporting.

Mechanical lifts, ceiling lifts, slide sheets, and transfer boards reduce injury to clients and nurses. Many Canadian employers use no-lift or minimal-lift policies.

Keep regular sleep and wake times, avoid caffeine, alcohol, and heavy meals before bed, limit screens, keep the room dark, quiet, and cool, and exercise earlier in the day.

Heat or cold, massage, repositioning, distraction, relaxation, guided imagery, music, TENS, and acupuncture. They supplement analgesia and do not replace it.

Lift and place the walker forward, step into it with the weaker leg first, and keep the feet inside the frame. Check that the height lets the elbows bend about 30 degrees and that rubber tips are intact.

Massage can damage fragile capillaries and deeper tissue and worsen injury. Relieve pressure by repositioning instead.

Weight, length or height, and head circumference are plotted on WHO growth charts. Newborns lose up to 10 percent of birth weight and regain it by 10 to 14 days. The anterior fontanel closes at 12 to 18 months.

Implants and IUDs are most effective, followed by injectables, then pills, patch, and ring, and then condoms. Condoms also protect against STIs, and emergency contraception can be used after unprotected sex.

Screening generally begins at about age 25 and is repeated every 3 years until about 69 if results are normal, though programs vary by province and are moving to HPV-based testing.

Presbyopia, high-frequency hearing loss, thinner skin, reduced cardiac and renal function, lower bone density, and slower reactions. Confusion, incontinence, and depression are not normal aging.

Young adult: intimacy vs isolation. Middle adult: generativity vs stagnation. Older adult: integrity vs despair.

Infant: trust vs mistrust. Toddler: autonomy vs shame and doubt. Preschool: initiative vs guilt. School-age: industry vs inferiority. Adolescent: identity vs role confusion.

Preconventional (avoiding punishment, seeking reward), conventional (conforming to rules and social expectations), and postconventional (universal ethical principles).

Sensorimotor (birth to 2 years, object permanence), preoperational (2 to 7, egocentric and magical thinking), concrete operational (7 to 11, logic and conservation), and formal operational (12 and older, abstract thought).

Ask about tobacco use, Advise to quit, Assess readiness, Assist with a plan and pharmacotherapy (such as nicotine replacement), and Arrange follow-up.

The Canadian Immunization Guide is the evidence-based vaccine reference published by the Public Health Agency of Canada. NACI (National Advisory Committee on Immunization) advises it, and provinces and territories set their own schedules.

At least 150 minutes of moderate to vigorous activity per week in bouts of 10 minutes or more, plus muscle-strengthening activities on 2 days a week. Children and youth need an average of 60 minutes a day.

Vaginal bleeding, leaking fluid, severe or persistent headache, visual changes, epigastric pain, sudden swelling of the face or hands, decreased fetal movement, fever, and persistent vomiting.

Cognitive (knowledge), affective (attitudes and values), and psychomotor (skills). Teaching is most effective when the nurse assesses readiness and uses methods matched to the domain.

Exclusive breastfeeding for 6 months, then continued breastfeeding with solid foods up to 2 years or beyond. Breastfed infants need a vitamin D supplement of 400 IU daily.

Magical thinking, imagination, associative play, constant questions, fears of the dark and body mutilation, and hopping on one foot at about age 4. Offer simple choices and explanations.

Concrete thinking, cooperative play, peer groups, industry and competence, fears of failure, and loss of primary teeth. Physical activity and hobbies support healthy development.

Walking and running, two-word phrases by age 2, parallel play, negativism and temper tantrums, ritualism, separation anxiety, and readiness for toilet training at about 18 to 24 months.

Identity formation, peer acceptance, body image, and independence, with risk-taking behavior. Ensure confidentiality and use a HEADSS assessment (Home, Education, Activities, Drugs, Sexuality, Suicide).

Social smile at 2 months, steady head at 4 months, rolling at 4 to 6 months, sitting alone at 8 months, pincer grasp at 9 to 10 months, and walking at about 12 months. Birth weight doubles by 5 to 6 months and triples by 1 year.

Consistent condom use, HPV and hepatitis B vaccination, routine screening for chlamydia, gonorrhea, and HIV, and partner notification through public health. Chlamydia is the most commonly reported bacterial STI in Canada.

MMR, varicella, rotavirus, live intranasal influenza, and yellow fever are live vaccines. They are avoided in pregnancy and severe immunosuppression, and given on the same day or separated by at least 4 weeks.

Provincial programs offer screening mammography, commonly every 2 years for ages 50 to 74, with some provinces beginning at 40. Intervals and starting ages vary, and clients should know the local program.

Accessibility, public participation, health promotion, appropriate technology, and intersectoral cooperation. Primary health care is the first contact with the health system and emphasizes prevention.

Income and social status, education, employment, housing, food security, early childhood development, social support, Indigenous status, gender, race, disability, and access to health services.

Precontemplation, contemplation, preparation, action, and maintenance. The nurse matches interventions to the client's stage and expects relapse as a possible part of change.

Primary prevention prevents disease before it occurs (immunization, health teaching). Secondary prevention detects disease early (screening). Tertiary prevention limits disability and aids rehabilitation.

Solitary play in infants, parallel play in toddlers, associative play in preschoolers, and cooperative play in school-age children. Therapeutic play helps children express feelings and learn about care.

Half the plate vegetables and fruits, a quarter whole grain foods, and a quarter protein foods, with water as the drink of choice and limited highly processed foods.

No amount of alcohol is risk-free. Risk is low at 2 standard drinks or fewer per week, moderate at 3 to 6, and increasingly high at 7 or more. No alcohol should be used in pregnancy.

A heel-prick blood spot at 24 to 48 hours for metabolic and genetic disorders (such as PKU and congenital hypothyroidism), a hearing screen, and pulse oximetry for heart defects, with panels varying by province.

At least 0.4 mg daily starting 3 months before conception and throughout pregnancy. Higher doses are used for those at higher risk of neural tube defects, such as with a previous affected pregnancy or anticonvulsant use.

The Canadian Task Force recommends against routine PSA screening for average-risk men because of overdiagnosis and harms. Men with symptoms or higher risk should discuss options with a provider.

For average-risk adults ages 50 to 74, a fecal immunochemical test (FIT) every 2 years or flexible sigmoidoscopy every 10 years. A positive FIT is followed by colonoscopy.

Between 20 and 32 weeks of gestation, the fundal height in centimetres is approximately equal to the gestational age in weeks.

Monthly until about 28 weeks, every 2 weeks from 28 to 36 weeks, and weekly from 36 weeks until birth. High-risk pregnancies need more frequent visits.

In girls: breast budding first, then pubic hair, a growth spurt, and menarche at about 12 to 13 years. In boys: testicular enlargement first, then penile growth, pubic hair, and the growth spurt later.

The product, lot number, dose, route, site, date, and administrator, along with giving the client a record. Observe for 15 minutes for anaphylaxis, and report adverse events following immunization to public health.

Td or Tdap every 10 years, Tdap in every pregnancy, annual influenza, pneumococcal vaccine for those 65 and older, recombinant zoster vaccine from age 50, COVID-19 as recommended, and hepatitis B for at-risk adults.

DTaP-IPV-Hib, hepatitis B, pneumococcal conjugate, meningococcal, rotavirus, measles-mumps-rubella-varicella, HPV in school programs, Tdap in adolescence, and annual influenza. Schedules vary by province.

Underweight: 12.5 to 18 kg. Normal weight: 11.5 to 16 kg. Overweight: 7 to 11.5 kg. Obese: 5 to 9 kg. Lower gain in obesity helps reduce complications.

At about 6 months, starting with iron-rich foods such as meat, fish, tofu, legumes, and iron-fortified cereal. Allergens such as peanut and egg are introduced early, and honey is avoided before 12 months.

A rectovaginal swab is done at 35 to 37 weeks. If it is positive, intravenous antibiotics (penicillin) are given during labour to protect the newborn.

To Rh-negative, antibody-negative women at about 28 weeks and within 72 hours of birth of an Rh-positive baby, and after bleeding, trauma, or invasive procedures during pregnancy.

Between 24 and 28 weeks, with a 50 g glucose challenge test followed by a 75 g oral glucose tolerance test if abnormal. Earlier screening is done for high-risk women.

Severe allergy to a vaccine component, live vaccines in severe immunosuppression or pregnancy, and moderate to severe acute illness are reasons. A mild illness with low fever is not a contraindication.

A minor who understands the nature and consequences of the treatment may consent under the mature minor doctrine, though rules vary by province. In Quebec a minor aged 14 or older may consent to care.

Draw a single line through an error, write error, and initial and date it, without erasing or covering it. Label a late entry as a late entry with the current date and time.

They set the expected level of care for a reasonably prudent nurse. Failing to meet them can lead to liability or professional discipline, regardless of the nurse's intent.

Use them only when necessary, write the order down, read it back to the prescriber to verify, and have it co-signed according to policy.

Physiological needs (airway, breathing, circulation, fluids, nutrition, elimination) come first, then safety and security, love and belonging, esteem, and self-actualization. Meet lower-level needs before higher ones.

Use the name and pronouns the client identifies, avoid assumptions about identity or relationships, protect privacy, and provide non-judgmental, affirming care.

Through the case manager or discharge planner according to provincial processes, after assessing the client's needs, with client consent and clear information on care needs.

Acuity-based staffing assigns nurses and skill mix according to the complexity and care needs of clients, not just the number of clients.

Assign clients whose needs fit the nurse's competence and orientation, and avoid assigning care that requires skills the nurse has not been trained for.

Gather the facts, identify the values and principles in conflict, consider options and consequences, consult the ethics committee or resources, and act and evaluate, while protecting the client's rights.

Promptly, honestly, and with empathy, usually led by the provider with the nurse's support, with the facts documented. Apology legislation in most provinces limits the use of an apology as an admission of liability.

Record objective facts only, complete it according to policy, and do not refer to it in the client's chart. It is an administrative quality tool, not part of the health record.

Use a professional interpreter, face and speak directly to the client, and avoid using family members, especially children, except in an emergency. Document that an interpreter was used.

Respect the competent adult's informed decision, document it, notify the provider, and explore alternatives. For a minor, the team may seek legal guidance or a court order.

Under provincial privacy laws, clients can access their records and request corrections. The nurse directs requests to the health information or records department.

A sentinel event is an unexpected occurrence resulting in death or serious physical or psychological harm. A near miss is an error caught before it reaches the client; both should be reported and analyzed.

Prioritize by urgency, cluster care activities, delegate appropriately, plan the day, minimize interruptions, and reassess priorities as client conditions change.

The limits that keep the relationship therapeutic and focused on the client's needs. Avoid dual relationships, personal disclosure, and accepting significant gifts, and never engage in a sexual relationship with a client.

Root cause analysis looks for system causes of an adverse event. A just culture balances accountability with learning, treating system errors as improvement opportunities and reserving discipline for reckless behavior.

Autocratic: the leader decides alone (useful in emergencies). Democratic: the group shares in decisions. Laissez-faire: minimal direction, suited to highly skilled, self-motivated staff.

Respect and dignity, privacy and confidentiality, informed participation in decisions, the right to refuse treatment, access to information, and care free of discrimination.

Red is immediate, yellow is delayed, green is minor (walking wounded), and black is expectant or deceased. Red clients are treated first.

Autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.

A duty of care, a breach of the standard of care, harm to the client, and causation linking the breach to the harm. All four must be shown.

Public administration, comprehensiveness, universality, portability, and accessibility. Provinces must meet them to receive full federal health transfers.

Right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Assessment comes first and is the foundation for all later steps.

Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. This model underlies the Next Generation NCLEX case studies.

Functional (tasks assigned by role), team nursing (RN leads a team), total patient care (one nurse for all needs), primary nursing (RN accountable from admission to discharge), and case management.

Reporting suspected child abuse or neglect, reportable communicable diseases to public health, and, in some provinces, abuse of vulnerable adults or elder abuse. Know the rules of your province or territory.

Accurate, factual, objective, timely, legible, and complete, with the date, time, and signature. Do not chart ahead of time or use vague terms such as appears to be.

Registered nurses (RNs), licensed or registered practical nurses (LPNs or RPNs), nurse practitioners (NPs), and registered psychiatric nurses (RPNs) in the western provinces. Scope of practice is set by each province or territory.

Do not post or share client information, images, or stories, even without names, and do not take photos on personal devices. Follow facility policy and privacy law.

Use your own unique login, never share passwords, log off when leaving a workstation, and access only the records of clients you care for. Audit trails track access.

Providing safe, compassionate, competent, and ethical care; promoting health and well-being; promoting and respecting informed decision-making; preserving dignity; maintaining privacy and confidentiality; promoting justice; and being accountable.

Distance, limited providers and transport, weather, cost, and fewer specialist services. Telehealth, nursing stations, and medical transport help to bridge the gaps.

Several provinces protect people who give emergency aid in good faith from liability, except in cases of gross negligence. Quebec's Charter instead imposes a duty to assist a person in peril.

Supporting the client's rights, values, and choices, ensuring the client has the information needed to decide, and speaking up when care does not meet the client's needs.

Situation, Background, Assessment, and Recommendation. It is a structured format for communicating concisely with the healthcare team, especially about a change in a client's condition.

Airway first, then Breathing, then Circulation. Threats to airway take priority over breathing problems, which take priority over circulation problems, unless the question states otherwise.

Emergency department patients into five levels: I resuscitation (immediate), II emergent (15 minutes), III urgent (30 minutes), IV less urgent (60 minutes), V non-urgent (120 minutes), by the time to physician assessment.

Limited, temporary health coverage for refugees, refugee claimants, and some other groups who are not yet eligible for provincial or territorial health insurance.

An experienced nurse who orients and mentors a new nurse or student, teaches skills, and evaluates competence during the transition into practice.

A written statement of a client's wishes about future care, used if the client cannot decide. In Canada it may be called an advance care plan, personal directive, or representation agreement, depending on the province.

Case management coordinates services across the continuum of care to meet client needs efficiently. Discharge planning begins on admission and involves community and home care resources.

A lifelong process of self-reflection and learning from clients, in which the nurse recognizes personal bias and power imbalances rather than claiming expertise about another culture.

Care that results from respectful engagement and recognizes and addresses power imbalances in the health system. The client decides whether care is culturally safe.

The ability to understand the information and appreciate the consequences of a decision. Adults are presumed capable. If a client lacks capacity, a substitute decision-maker is used following provincial law.

Making false statements that harm a person's reputation. Libel is written (including social media posts), and slander is spoken.

Integrating the best available research evidence with clinical expertise and client values and preferences to make care decisions.

Unauthorized disclosure of or access to a client's information, or intruding on the client's private affairs, such as photographing a client without permission or snooping in records.

A lawful option under the Criminal Code for eligible clients, assessed and provided by physicians or nurse practitioners. Nurses may assist within scope and may decline for reasons of conscience, but must not abandon the client.

Comparing the client's current medications with new orders at admission, transfer, and discharge to prevent errors. A best possible medication history is gathered from at least two sources.

A complete handover (such as SBAR), transfer of documents and current medication list, confirmation that the receiving unit is ready, and safe transport with appropriate monitoring.

Collaboration: private, respectful, assertive communication focused on the issue, not the person, aiming for a win-win outcome, with a manager or mediator if it is not resolved.

Assault is a threat or act causing fear of unwanted contact. Battery is unconsented touching. False imprisonment is confining or restraining a person without legal justification.

Delegation is transferring responsibility for a task to another competent person while the nurse stays accountable for the outcome. Assignment is the routine allocation of care tasks that fall within a worker's job description and scope.

Comfort, symptom control, and quality of life for clients with a life-limiting illness and their families. It may begin early and be given alongside disease-directed treatment.

Report the concern through the chain of command, and to the regulator or other body when required, with objective documentation. The CNA Code of Ethics supports speaking up, and employers must not retaliate against good-faith reports.

Follow a written order from the provider and ensure it is on the chart. Without an order, a client is a full code and CPR is started.

Follow the facility's disaster plan and the Incident Command System, report as directed, triage and care within competence, and communicate, instead of self-deploying.

To support conversations about the client's values and wishes, encourage naming a substitute decision-maker, document discussions, and make sure documents are on the chart.

Plan, Do, Study, Act. A small change is planned and tested, results are studied, and the change is adopted, adjusted, or abandoned.

A meeting of the client, family, and interdisciplinary team to share information, set goals, and agree on the plan of care.

Ensure the student works within the level of training, is directly supervised for new skills, and has client consent. The supervising nurse remains accountable for client safety.

They protect the public by registering nurses, setting standards of practice, handling complaints, and disciplining unsafe practice. Examples include the College of Nurses of Ontario and the BC College of Nurses and Midwives.

Use only approved secure platforms. Do not send identifiable client information or orders through personal, unencrypted messaging.

The TRC calls for equitable Indigenous health outcomes and respect for traditional healing. Joyce's Principle (after the death of Joyce Echaquan) demands equitable access to health services without racism or discrimination.

Asking clients to explain instructions in their own words to confirm understanding. If they cannot, the nurse re-teaches in a different way.

LPNs and RPNs care for stable clients with predictable outcomes, perform focused assessments, give medications, and reinforce teaching. RNs perform the initial assessment, plan care, and manage unstable or complex clients.

The client has capacity, receives information about the procedure, risks, benefits, and alternatives from the provider, understands it, and agrees voluntarily. The nurse may witness the signature and clarify.

The Tri-Council Policy Statement (TCPS 2) and research ethics boards require voluntary informed consent, minimal risk, confidentiality, and the right to withdraw without penalty or loss of care.

The nurse must generally be registered in the province or territory where the client is located and follow the regulator's virtual care standards and privacy requirements.

Ensure client safety first, report the concern through the chain of command and, where required, to the regulator, and document facts. Nurses must not ignore the risk to clients.

Do not carry it out until it is clarified with the prescriber. If it is not resolved, use the chain of command and document the actions taken.

Report it right away to the privacy officer or manager according to policy, document the facts, and cooperate with the investigation. Examples include discussing clients in public or snooping in records.

Respect the decision after ensuring the client understands the risks, inform the provider, document the refusal and the information given, and continue to provide other care.

Explain the risks, notify the provider, ask the client to sign the form (document refusal if unwilling), and give discharge information. The nurse cannot detain a competent client.

Client identity, diagnosis and reason for admission, current status and recent changes, pending tests and treatments, safety risks, and the plan of care. Bedside handover includes the client.

Activities of daily living for stable clients, such as bathing, feeding, positioning, ambulation, taking routine vital signs, and recording intake and output. They do not do assessment, teaching, or sterile procedures.

When there is a clear, serious, and imminent risk of death or serious harm to an identifiable person or group (the public safety exception recognized in Smith v. Jones). Disclosure is limited to what is necessary.

In a life-threatening emergency when the client cannot consent, no substitute decision-maker is available, and the client's known wishes do not oppose treatment. The team proceeds with necessary care.

Assess first in most situations to collect data before intervening. If a client is in immediate danger, such as an airway obstruction or cardiac arrest, intervene right away.

When a concern about client safety is not resolved at the first level. Escalate from the charge nurse to the manager and up, according to policy, until the issue is addressed.

Unstable, acute, life-threatening, new or sudden-onset problems come before stable, chronic, expected, or long-standing ones. Actual problems come before potential problems.

Physicians, pharmacists, physiotherapists, occupational therapists, speech-language pathologists, dietitians, social workers, respiratory therapists, and spiritual care providers.

Initial and ongoing assessment, care planning, evaluation, client teaching, interpreting data, nursing judgment, and care of unstable clients.

The provider who will perform the procedure. The nurse may witness the signature, confirm the client understands, and notify the provider if the client has questions or doubts. Consent must be obtained before sedation.

Only members of the circle of care who need it to provide care, or others with the client's consent or legal authority. Provincial health privacy laws and PIPEDA protect personal information.

The delegating nurse remains accountable for the decision to delegate and for supervision. The person who accepts the task is accountable for performing it competently.

The Controlled Drugs and Substances Act applies. Store them locked, count at each shift change, witness and document any waste, and report discrepancies immediately.

Isotonic (0.9% sodium chloride, Ringer's lactate) expands the extracellular volume. Hypotonic (0.45% sodium chloride) moves water into cells. Hypertonic (3% sodium chloride, D10W) pulls water out of cells and needs close monitoring.

Health Canada licenses them under the Natural Health Products Regulations, and licensed products carry a Natural Product Number (NPN) or DIN-HM. Always ask about their use because they can interact with prescribed drugs.

Draw up the clear (regular) insulin first, then the cloudy (NPH). Remember the phrase 'clear to cloudy'. Only regular and NPH may be mixed, and rapid-acting insulin should be given right before meals.

They block the angiotensin II receptor and rarely cause cough. They still carry risks of hyperkalemia, hypotension, and fetal harm, so they are avoided in pregnancy.

Confirm the reaction type and history before giving any beta-lactam, document the allergy, and use an alert band. There is a low risk of cross-reactivity with some cephalosporins, so follow the prescriber's and pharmacist's guidance.

Assess and stabilize the client, notify the provider and manager, follow the organization's reporting process, and disclose to the client. Reporting supports learning through programs such as ISMP Canada's reporting system and a just culture.

Multiply the ordered dose per kg by the weight in kg, then compare to the safe range and divide among the doses. Always double-check with a second nurse for high-alert drugs.

Use luer-lock connections, clamp the catheter when open, prime tubing, and have the client perform a Valsalva manoeuvre when changing tubing. If it is suspected, clamp, place the client on the left side in Trendelenburg, give oxygen, and call for help.

Give IV, IM, subcutaneous, or intranasal, titrating to breathing rather than full awakening. Its action is short, so repeat doses or an infusion may be needed, and monitor for withdrawal and pain return.

Agitation, hyperthermia, tremor, hyperreflexia, clonus, diaphoresis, and diarrhea after starting or combining serotonergic drugs such as SSRIs, MAOIs, or tramadol. Stop the offending drugs and give supportive care.

Sit down, place one tablet or spray dose under the tongue every 5 minutes up to 3 doses, and call 911 if pain is not relieved 5 minutes after the first dose. Keep tablets in the original dark glass bottle, and expect headache and hypotension.

Volume in mL multiplied by the drop factor (gtt/mL), divided by the time in minutes. For example, 1,000 mL over 8 hours with a 15 gtt/mL set is about 31 gtt/min.

Total volume in mL divided by the time in hours. For example, 500 mL over 4 hours is 125 mL per hour.

Monitor aPTT (target about 1.5 to 2.5 times control or per protocol). Watch for bleeding and heparin-induced thrombocytopenia (a drop in platelets). The antidote is protamine sulfate.

Monitor INR (usually 2.0 to 3.0, higher for mechanical valves). Keep vitamin K intake consistent, report bleeding, and avoid new drugs or supplements without checking. The antidote is vitamin K, with prothrombin complex concentrate for urgent reversal.

EPS: dystonia, akathisia, parkinsonism, and tardive dyskinesia with antipsychotics. NMS is an emergency: high fever, muscle rigidity, altered mental state, and autonomic instability. Stop the drug and give supportive care.

Type O negative red cells are the universal donor product and AB positive clients are universal recipients. For plasma it is reversed: AB plasma can be given to anyone.

Rapid-acting (lispro, aspart): onset 10 to 15 minutes, peak 1 to 2 hours. Short-acting (regular): onset 30 minutes, peak 2 to 4 hours. Intermediate (NPH): peak 4 to 10 hours. Long-acting (glargine, detemir): minimal peak, up to 24 hours.

Use the forearm veins first, avoiding the antecubital fossa, the affected arm after mastectomy or dialysis access, and sites of infection. Rotate according to policy, assess the site each shift, and use a securement dressing.

Infiltration: non-vesicant fluid leaks into tissue, with coolness, swelling, and pallor. Extravasation: vesicant drug leaks, with possible tissue necrosis. Phlebitis: vein inflammation with warmth, redness, and a palpable cord. Stop the infusion and follow policy for each.

Absorption, distribution, metabolism (mainly in the liver), and excretion (mainly through the kidneys). Liver or kidney disease and older age may change drug levels and increase toxicity.

Grapefruit raises levels of some drugs, St John's wort lowers levels of many drugs, alcohol adds to sedatives, vitamin K affects warfarin, and calcium or iron bind levothyroxine and some antibiotics.

Check the apical pulse for a full minute and hold the dose if below 60 in adults. Monitor the serum level (therapeutic about 0.5 to 2 nmol/L, per lab), potassium, and signs of toxicity: nausea, anorexia, visual changes (halos), and dysrhythmias. Hypokalemia increases toxicity.

Give within the treatment window after excluding hemorrhage and contraindications. Monitor neurological status and vital signs closely, watch for bleeding, and avoid invasive procedures and anticoagulants for the first 24 hours.

They can cause GI bleeding, kidney injury, and raised blood pressure, and they increase bleeding risk. Give with food and avoid in kidney disease, active ulcer, and the third trimester.

They lower blood pressure and afterload. Watch for dry cough, hyperkalemia, angioedema, and first-dose hypotension. Contraindicated in pregnancy.

SGLT2 inhibitors (empagliflozin, dapagliflozin) raise the risk of genital infections, dehydration, and ketoacidosis. GLP-1 agonists (semaglutide, liraglutide) cause nausea and slow gastric emptying, with a risk of pancreatitis.

Hyperglycemia, infection risk, osteoporosis, fluid retention, mood changes, and adrenal suppression. Never stop abruptly; taper, take with food, and monitor blood glucose.

Ototoxicity and nephrotoxicity. Monitor peak and trough levels, creatinine, urine output, and hearing, and keep the client well hydrated.

An antiarrhythmic with serious toxicities: pulmonary fibrosis, thyroid dysfunction, liver injury, photosensitivity, and corneal deposits. Monitor lung, thyroid, and liver function, and use sun protection.

They reduce platelet aggregation and prevent clots in coronary and cerebrovascular disease. Monitor for bleeding and GI upset, and do not stop before procedures without direction.

They cause sedation, falls, confusion in older adults, and respiratory depression with alcohol or opioids. Avoid abrupt stopping, since withdrawal can cause seizures. The antidote is flumazenil.

Check pulse and blood pressure before giving and hold if heart rate is below 60 or per order. Do not stop abruptly. They can mask signs of hypoglycemia and are used with caution in asthma.

Monitor blood pressure and heart rate, and watch for peripheral edema, constipation (verapamil), and bradycardia. Avoid grapefruit juice with some of these drugs.

A loop diuretic that causes hypokalemia, hyponatremia, hypotension, and ototoxicity with rapid IV push. Monitor daily weights, intake and output, and potassium; give in the morning.

Risk of hepatotoxicity and peripheral neuropathy. Give with pyridoxine (vitamin B6), avoid alcohol, monitor liver enzymes, and teach adherence for the full course. Public health authorities supervise tuberculosis treatment.

Give on a regular schedule, report dyskinesias and orthostatic hypotension, and avoid high-protein meals that compete with absorption. Do not stop suddenly.

Give on an empty stomach 30 to 60 minutes before breakfast and separate it from calcium and iron. Lifelong therapy; monitor TSH, and report chest pain, palpitations, and weight loss from overdose.

A narrow therapeutic range (about 0.6 to 1.2 mmol/L). Maintain consistent sodium and fluid intake, avoid dehydration, and report toxicity signs: coarse tremor, vomiting, diarrhea, and confusion. NSAIDs and thiazides raise levels.

Take with meals. Hold before iodinated contrast and in acute kidney injury, because of the risk of lactic acidosis. It rarely causes hypoglycemia when used alone.

Monitor the serum level (about 40 to 80 micromol/L total, per lab), gingival hyperplasia, and skin rash. IV doses must be given slowly in normal saline, with cardiac monitoring.

Give 30 minutes before meals. Long-term use raises the risk of Clostridioides difficile infection, fractures, and low magnesium and B12.

An isotonic fluid with electrolytes used for dehydration, burns, and surgery. Use caution in liver failure (lactate is metabolized by the liver), and do not give it in the same line as blood.

They lower LDL cholesterol. Report unexplained muscle pain (rhabdomyolysis risk), monitor liver enzymes, and avoid in pregnancy. Large amounts of grapefruit juice interact with some statins.

They cause hypokalemia, hyponatremia, hyperglycemia, hyperuricemia, and hypercalcemia. Monitor blood pressure, electrolytes, and blood glucose.

Only the client presses the button (no PCA by proxy). Verify the pump settings with a second nurse, and monitor respiratory rate, sedation, and pain. Know the lockout interval and keep naloxone available.

Assess pain, respiratory rate, sedation, and bowel function before and after. Hold and notify if the respiratory rate is below 10 to 12 or the client is difficult to arouse, and keep naloxone available. Give laxatives for constipation prevention.

Obtain consent and a baseline set of vitals, have two nurses verify the client, blood product, and ABO and Rh. Use an 18 to 20 gauge catheter and 0.9% sodium chloride only. Begin slowly (about 2 mL per minute), stay with the client for the first 15 minutes, and finish within 4 hours.

A serotonin antagonist that can prolong the QT interval and cause constipation and headache. Give before chemotherapy or as ordered, and monitor ECG and electrolytes in high-risk clients.

They need no routine INR monitoring but raise the risk of bleeding, especially with renal impairment. Do not skip doses, and know the reversal agents: idarucizumab for dabigatran and andexanet alfa for factor Xa inhibitors where available.

A potassium-sparing diuretic. Monitor for hyperkalemia, avoid potassium supplements and salt substitutes, and watch for gynecomastia.

Right client, drug, dose, route, time, and documentation, plus the right reason and the right to refuse. Check the label three times and verify with two client identifiers.

Use an oral syringe, dose by weight, never call medicine candy, and do not mix it in a full bottle of formula. Check the dose with a second nurse for high-alert drugs, and limit IM volumes (vastus lateralis in infants).

Fever, chills, flank or back pain, chest tightness, hypotension, and dark urine. Stop the transfusion, keep the vein open with new tubing and saline, stay with the client, notify the provider and blood bank, and return the bag and tubing.

Absent deep tendon reflexes, respiratory rate below 12, urine output below 30 mL per hour, and decreased level of consciousness. The antidote is calcium gluconate.

Shake, breathe out, seal lips around the mouthpiece or use a spacer, press and inhale slowly, hold the breath for 10 seconds, and wait about a minute between puffs. A spacer improves delivery.

Packed red cells for anemia and bleeding, platelets for thrombocytopenia or bleeding, fresh frozen plasma for clotting factor deficiency, cryoprecipitate for low fibrinogen, and albumin as a volume expander.

Intradermal: 5 to 15 degrees. Subcutaneous: 45 or 90 degrees depending on tissue and needle length. Intramuscular: 90 degrees, using the ventrogluteal, vastus lateralis, or deltoid site. Use the Z-track technique for irritating drugs.

Tendon rupture, QT prolongation, and CNS effects. Avoid with dairy or antacids at the same time, and report tendon pain.

Avoid tyramine-rich foods such as aged cheese, cured meats, soy sauce, and tap beer. Combining them can cause a hypertensive crisis.

Onset is when the drug effect begins, peak is when the effect is strongest, and duration is how long the effect lasts. Knowing these guides timing of assessment, for example checking blood glucose at the peak of insulin.

Half-life is the time for the serum drug concentration to fall by 50%. Steady state is reached after about 4 to 5 half-lives with regular dosing.

Respiratory rate, sedation, blood pressure, motor and sensory block level, bladder retention, and the insertion site. Report headache, back pain, fever, or new leg weakness at once.

A flushing and hypotension reaction from rapid infusion, not a true allergy. Infuse over at least 60 minutes, and monitor trough levels or AUC as directed, plus kidney function.

Dose desired divided by dose on hand, multiplied by the quantity (the amount of the form it comes in). Check that units match, and verify the answer is sensible.

Salbutamol is the name used in Canada (brand Ventolin). It is a short-acting bronchodilator for rescue, causing tachycardia and tremor, and is given before inhaled corticosteroids when both are due.

A side effect is a predictable secondary effect. An adverse reaction is any harmful unintended response. An allergy is an immune-mediated response. An idiosyncratic reaction is an unexpected response unique to the individual.

Epinephrine 0.3 to 0.5 mg of 1 mg/mL intramuscularly into the anterolateral thigh, repeated every 5 to 15 minutes as needed. Call emergency services, lay the client flat with legs raised, and give oxygen and fluids.

Orally absorbed drugs go through the liver before reaching systemic circulation, where part is metabolized. Drugs with high first-pass metabolism, such as nitroglycerin, are given sublingually or by other routes.

Acetaminophen (called paracetamol in many other countries). The adult maximum is generally 4 g a day, and many guidelines advise less, with caution in liver disease and alcohol use.

A list of error-prone abbreviations to avoid, such as U for unit (write 'unit'), QD, trailing zeros (5.0 mg), and a missing leading zero (.5 mg). Write 0.5 mg and 5 mg.

The ratio between a toxic and a therapeutic dose. Narrow range drugs, such as digoxin, lithium, phenytoin, warfarin, and aminoglycosides, require monitoring of blood levels.

Observe the client for 15 minutes (30 minutes if there is a history of allergic reaction), keep epinephrine available, and report adverse events following immunization to the local public health unit.

Febrile non-hemolytic (fever, chills), allergic (urticaria, itching), anaphylaxis, transfusion-associated circulatory overload (dyspnea, crackles), and TRALI (acute respiratory distress). Stop the transfusion and report all of them.

Never give by IV push or undiluted. Dilute it, use a pump, follow maximum rates (commonly 10 mmol per hour peripherally), and check urine output and potassium first. Concentrate is removed from nursing units under ISMP Canada guidance.

Used for volume replacement, as the priming fluid for blood transfusions, and for many medication infusions. Rapid or large volumes risk fluid overload in heart failure and kidney disease.

Insulin, anticoagulants (heparin), opioids, concentrated electrolytes, chemotherapy, and neuromuscular blockers. Use independent double checks, standard concentrations, and careful pump programming.

Enteric-coated, extended-release (ER, SR, XL, CR), sublingual, and buccal forms. Crushing can cause overdose or irritation. Ask the pharmacist for an alternative form.

To prevent oral candidiasis (thrush) and hoarseness. Teach the client to rinse, gargle, and spit out the water.

Hypocalcemia: tingling, muscle spasms, tetany, positive Chvostek and Trousseau signs, and prolonged QT. Hypercalcemia: weakness, constipation, kidney stones, confusion, and shortened QT. Treat the cause and monitor the ECG.

Arterial: painful, pale, punched-out, on toes or feet, with weak pulses and cool, hairless skin; keep the limb dependent. Venous: shallow, irregular, with brown skin and edema; elevate the legs and use compression if arterial flow is adequate.

Rheumatoid: symmetrical, systemic autoimmune disease with morning stiffness over an hour and warm swollen joints. Osteoarthritis: wear-related, asymmetrical, with pain after activity and Heberden nodes.

SIADH: too much ADH, causing water retention, low sodium, and concentrated urine; treat with fluid restriction. Diabetes insipidus: too little ADH, causing large dilute urine, thirst, and high sodium; treat with desmopressin and fluids.

Very high glucose (often above 33 mmol/L) with severe dehydration and altered consciousness but no significant ketosis. It occurs in type 2 diabetes and older adults. Treat with fluids, insulin, and potassium.

Colicky pain, vomiting, distention, and absent flatus. Keep NPO, place a nasogastric tube to suction, give IV fluids, and monitor for strangulation and perforation.

Blood pressure above about 180/120 mmHg with or without organ damage. Lower it gradually with IV agents in a monitored setting, since too rapid a drop can cause stroke or ischemia.

Hydration, oxygen, aggressive pain control with opioids, warmth, and rest. Avoid triggers such as dehydration, cold, and infection, and monitor for acute chest syndrome and stroke.

Sit upright, give oxygen and inhaled short-acting bronchodilators (salbutamol), systemic corticosteroids, and monitor peak flow and saturation. Silent chest and fatigue indicate impending respiratory failure.

Signs include hematemesis, melena, and hypotension. Establish IV access, give fluids and blood products, monitor vital signs, and prepare for endoscopy and proton pump inhibitors.

Fever, headache, nuchal rigidity, photophobia, and positive Kernig and Brudzinski signs. Use droplet precautions, obtain cultures, give antibiotics promptly, and keep the room quiet and dim.

Stabilize the heart with IV calcium, shift potassium into cells with insulin and dextrose, salbutamol, or sodium bicarbonate, and remove it with diuretics, binders, or dialysis. Monitor the ECG and stop potassium supplements.

Suspected infection plus organ dysfunction: fever or hypothermia, tachycardia, tachypnea, altered mental status, and low blood pressure. Obtain cultures and lactate, give broad-spectrum antibiotics, and IV fluids within the first hour as per the bundle.

It spreads by airborne droplet nuclei, so use an airborne infection isolation room and an N95 respirator. Treatment requires multiple drugs for months, directly supervised, and public health notification is required.

Iron deficiency: pallor, fatigue, and spoon nails; give iron on an empty stomach with vitamin C and warn about dark stools. Pernicious anemia: vitamin B12 deficiency with neurological signs; needs lifelong B12 injections.

Causes include water loss, inadequate intake, and diabetes insipidus. Manifestations are thirst, dry mucous membranes, irritability, confusion, and seizures. Replace water gradually and monitor neurological status.

Causes include excess water, SIADH, diuretics, and vomiting. Manifestations are headache, confusion, nausea, seizures, and coma. Treat the cause with fluid restriction or careful sodium replacement, and correct slowly to avoid osmotic demyelination.

Causes include diuretics, vomiting, diarrhea, and insulin. Signs are muscle weakness, cramps, constipation, ECG changes (flat T waves, U waves), and dysrhythmias. Replace potassium safely, and never give it as a bolus.

Hypovolemic (volume loss), cardiogenic (pump failure), distributive (septic, anaphylactic, neurogenic), and obstructive (tamponade, pulmonary embolism). Signs include hypotension, tachycardia, altered mental status, cool skin (except early septic), and low urine output.

Crohn: any GI segment, transmural, skip lesions, fistulas, and cobblestoning. Ulcerative colitis: colon and rectum only, continuous mucosal inflammation, and bloody diarrhea. Both need nutritional and medication support.

Facial droop, arm weakness, and speech difficulty (FAST or the Heart and Stroke Foundation of Canada's FAST signs). Call 911 for urgent imaging and consider thrombolysis or thrombectomy within the treatment window.

Severe epigastric pain radiating to the back, nausea, and elevated lipase and amylase. Keep NPO, provide analgesia, IV fluids, and monitor for hypocalcemia and complications.

RSV infection with wheeze, nasal flaring, retractions, and tachypnea. Care is supportive: suction, hydration, oxygen, and contact precautions. Palivizumab or nirsevimab may be used for high-risk infants.

Butterfly facial rash, joint pain, photosensitivity, fatigue, and organ involvement such as nephritis. Teach sun protection, rest, and adherence to immunosuppressive therapy, and watch for flares.

Jaundice, ascites, varices, coagulopathy, and elevated ammonia. Encephalopathy causes confusion and asterixis. Give lactulose, limit protein as directed, and avoid sedatives.

Moon face, truncal obesity, buffalo hump, purple striae, hypertension, hyperglycemia, and bruising. Protect from infection and falls, monitor glucose and blood pressure, and teach about steroid tapering.

Ascending symmetrical weakness with areflexia, often after infection. Monitor respiratory function and vital capacity, and prepare for ventilation. Treatment includes IV immunoglobulin or plasmapheresis.

Relapsing demyelinating disease with fatigue, weakness, visual changes, numbness, bladder dysfunction, and heat sensitivity. Avoid heat, plan rest, and use disease-modifying therapy as prescribed.

Muscle weakness that worsens with activity, ptosis, and dysphagia. Crisis causes respiratory failure and needs airway support. Give anticholinesterase drugs on time and plan activity at peak strength.

An irregular rhythm with no distinct P waves and a risk of stroke. Treatment includes rate or rhythm control and anticoagulation, and monitoring for an apical-radial pulse deficit.

Chronic bronchitis and emphysema with productive cough, wheeze, and barrel chest. Use pursed-lip breathing, low-flow oxygen targeting 88% to 92%, inhaled bronchodilators, smoking cessation, and vaccination.

Fatigue, edema, hypertension, anemia, hyperkalemia, and metabolic acidosis. Control blood pressure, restrict sodium and potassium, avoid nephrotoxins, and prepare for dialysis or transplant when needed.

Hesitancy, weak stream, nocturia, and incomplete emptying. Teach about avoiding decongestants and anticholinergics, and treat with alpha-blockers or 5-alpha-reductase inhibitors or surgery.

Pulmonary congestion: dyspnea, orthopnea, crackles, cough with frothy sputum, and fatigue. Position upright, give diuretics and oxygen, and monitor weight and intake and output.

Systemic congestion: jugular venous distention, peripheral edema, hepatomegaly, ascites, and weight gain. Restrict sodium and give diuretics as ordered.

Use standard precautions, monitor viral load and CD4 count, support adherence to antiretroviral therapy, and watch for opportunistic infections. Treatment that keeps the viral load undetectable means HIV cannot be transmitted sexually.

Oliguric (low urine output, rising potassium and creatinine), diuretic (large volumes, risk of dehydration and low potassium), and recovery. Monitor fluids and electrolytes closely in each phase.

Stop the burning process, ensure the airway, and give fluid resuscitation guided by the Parkland formula (4 mL x kg x % total body surface area; half in the first 8 hours). Use the rule of nines, pain control, wound care, and tetanus prophylaxis.

Female sex, older age, low calcium and vitamin D, smoking, steroid use, and inactivity. Teach weight-bearing exercise, calcium and vitamin D, fall prevention, and bisphosphonate use upright with water.

Hyperglycemia, ketones, metabolic acidosis, fruity breath, Kussmaul respirations, dehydration, and abdominal pain. Give IV fluids first, then IV regular insulin, and replace potassium as levels fall. Monitor glucose, potassium, and acid-base status hourly.

New hypertension after 20 weeks with proteinuria or organ dysfunction, headache, visual changes, and hyperreflexia. Give magnesium sulfate to prevent seizures, antihypertensives, and monitor closely; delivery is the cure.

Sudden dyspnea, confusion, petechiae over the chest and axillae, and hypoxia within 24 to 72 hours. Give oxygen and supportive care and notify the provider immediately.

Crushing chest pain radiating to the arm, jaw, or back, with diaphoresis, nausea, and dyspnea (women and older adults may have atypical symptoms). Call 911, give oxygen only if hypoxic, aspirin, nitroglycerin as ordered, obtain a 12-lead ECG, and prepare for reperfusion.

Sudden pleuritic chest pain, dyspnea, decreased or absent breath sounds, and tracheal deviation in tension pneumothorax. Tension pneumothorax needs immediate needle decompression or a chest tube.

A pulsating abdominal mass, back or flank pain, and a bruit. Rupture presents as severe pain, hypotension, and shock; do not palpate deeply and prepare for emergency surgery.

Periumbilical pain moving to McBurney's point in the right lower quadrant, with fever, nausea, and rebound tenderness. Sudden relief of pain with fever and a rigid abdomen suggests rupture; do not give heat or enemas.

Beck triad: hypotension, muffled heart sounds, and jugular venous distention, with pulsus paradoxus. Prepare for pericardiocentesis and monitor hemodynamics closely.

Acyanotic defects (ventricular septal defect, patent ductus arteriosus) cause left-to-right shunting and heart failure signs. Cyanotic defects (tetralogy of Fallot, transposition) cause cyanosis; a child may squat to relieve hypoxic spells.

Weight loss, thirst, dry membranes, tachycardia, low blood pressure, weak pulse, flat neck veins, low urine output, and rising hematocrit and urine specific gravity. Replace fluids and treat the cause.

Weight gain, edema, crackles, distended neck veins, bounding pulse, hypertension, and dyspnea. Restrict sodium and fluids, give diuretics, and monitor daily weight and intake and output.

Weight loss, heat intolerance, tachycardia, tremor, diarrhea, and exophthalmos in Graves disease. Thyroid storm brings high fever, extreme tachycardia, and agitation. Treat with antithyroid drugs, beta blockers, and cooling.

Low magnesium: tremor, hyperreflexia, seizures, and dysrhythmias, often with hypokalemia. High magnesium: hypotension, absent reflexes, and respiratory depression. Treat high levels with calcium gluconate.

Fatigue, weight gain, cold intolerance, constipation, dry skin, bradycardia, and a puffy face. Myxedema coma is an emergency with hypothermia, hypoventilation, and decreased consciousness. Give IV levothyroxine and supportive care.

Early: headache, vomiting, and decreased level of consciousness. Late: Cushing triad (hypertension with wide pulse pressure, bradycardia, irregular breathing) and dilated pupils. Raise the head of the bed to 30 degrees and avoid neck flexion and straining.

Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxia, and anxiety. Raise the head of the bed, give oxygen, notify the provider at once, and anticipate anticoagulation or thrombolysis.

Severe colicky flank pain radiating to the groin, nausea, and hematuria. Give analgesia, encourage fluids, strain urine, and treat obstruction or infection promptly.

Fever, productive cough, crackles, pleuritic pain, and sometimes confusion in older adults. Give antibiotics, oxygen, fluids, and deep breathing, and obtain cultures before the first antibiotic dose.

Tumor lysis: rapid cell breakdown with hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia; give hydration and allopurinol or rasburicase. Superior vena cava syndrome: facial and neck swelling with dyspnea; it is an emergency.

Addison disease causes fatigue, weight loss, hypotension, hyponatremia, hyperkalemia, hypoglycemia, and skin darkening. Adrenal crisis presents with shock and requires IV hydrocortisone, fluids, and glucose.

Acute inflammatory lung injury with severe hypoxemia, bilateral infiltrates, and non-cardiogenic edema. Care includes lung-protective ventilation, high PEEP, prone positioning, and treating the underlying cause.

A medical emergency in spinal injury at T6 or above, triggered by a full bladder or bowel. Signs are severe hypertension, headache, flushing above the lesion, and bradycardia. Sit the client up, loosen clothing, find and remove the trigger, and give antihypertensives if needed.

Simultaneous clotting and bleeding from a triggering illness such as sepsis. Findings are bleeding, petechiae, prolonged clotting times, and low platelets and fibrinogen. Treat the cause and give blood products.

pH low with low HCO3 from diabetic ketoacidosis, renal failure, lactic acidosis, diarrhea, or starvation. Compensate with deep rapid breathing (Kussmaul). Treat the underlying cause.

pH high with high HCO3 from vomiting, nasogastric suction, diuretics, or excess antacids. Manifestations include tingling, dizziness, and hypokalemia. Replace fluids and potassium.

pH low with high PaCO2 from hypoventilation (COPD, opioids, neuromuscular disease). Improve ventilation with positioning, bronchodilators, reversing sedation, or assisted ventilation, and avoid high-flow oxygen in CO2 retainers.

pH high with low PaCO2 from hyperventilation due to anxiety, pain, fever, hypoxia, or mechanical ventilation. Treat the cause and coach slow breathing.

Massage a boggy fundus, empty the bladder, give uterotonics such as oxytocin, monitor vital signs and blood loss, and inspect for lacerations or retained tissue. Call for help and prepare blood products.

Teach about Helicobacter pylori treatment, avoiding NSAIDs, smoking, and alcohol, and taking proton pump inhibitors. Report melena, vomiting blood, and sudden severe abdominal pain, which suggests perforation.

Tremor, rigidity, bradykinesia, and postural instability. Promote safety and mobility with a wide-based gait and assistive devices, give medication on time, and monitor swallowing.

Sudden high fever, drooling, muffled voice, dysphagia, and a tripod position. Do not examine the throat or use a tongue depressor; keep the child calm and prepare for airway intervention.

For overload, reduce noise and stimulation. For deprivation, provide glasses, hearing aids, clocks, light, orientation, and meaningful contact to prevent confusion and delirium.

Allow the client to express feelings, encourage looking at and touching the area, involve the client in care, provide peer support, and give accurate information.

Ask open questions about beliefs, respect and facilitate practices (including Indigenous ceremonies such as smudging, as policy allows), involve spiritual care or an Elder, and never impose personal beliefs.

Stay with the client, use a calm, quiet voice, give short simple directions, reduce stimuli, and guide slow breathing. Avoid touching without permission.

Maintain a consistent routine, safe environment with wander precautions, simple tasks, cues and labels, and reassure with a calm approach. Do not argue or force orientation in later stages.

Use consistent boundaries and firm limits, ensure all staff communicate and respond consistently, avoid splitting, and teach coping skills such as dialectical behaviour therapy.

Reduce stimulation, set firm consistent limits, offer high-calorie finger foods, monitor sleep and hydration, protect from impulsive behavior, and monitor medication levels such as lithium.

Provide privacy and support, ask the person not to wash, collect evidence with consent and chain of custody (often by a specialized nurse examiner), offer STI prophylaxis and emergency contraception, and refer for counseling.

Decreased level of consciousness, slow shallow breathing, and pinpoint pupils. Give naloxone, support breathing, and call emergency services. In Canada, the Good Samaritan Drug Overdose Act protects people who call for help.

Ask directly about thoughts, plan, means, and intent; asking does not increase risk. A specific plan with lethal means and access is high risk, and the client needs continuous observation. In Canada, the 988 Suicide Crisis Helpline provides 24/7 support by call or text.

Screen privately without the partner present using direct, nonjudgmental questions, document findings objectively, develop a safety plan, and refer to shelters and services. Competent adults decide whether to report except where law requires.

Use a consistent routine, concrete language, limit overstimulation, prepare for changes, and support communication with visual aids.

Stay calm, use a quiet low voice, acknowledge the feeling, allow expression, set clear limits on unacceptable behavior, and keep distance and an exit available.

Acknowledge the client's feelings, state that you do not experience the same thing, and orient to reality without arguing. Assess for command hallucinations and safety.

Do not argue with or support the belief. Focus on the underlying feeling, present reality, use simple clear statements, and encourage reality-based topics.

Allow the ritual initially without criticism, gradually set limits, schedule time for it, and teach alternative coping strategies. Stopping it suddenly increases anxiety.

Anticipatory grief occurs before an expected loss. Complicated grief is prolonged and intense, impairing function. Disenfranchised grief is a loss that society does not openly recognize, such as a pregnancy loss or ex-partner.

Displacement: a client angry at a supervisor yells at a nurse or kicks the dog. Projection: blaming one's own unacceptable feelings on another, such as saying 'You are angry at me.'

Approach from the front, use a calm voice, short simple sentences, one-step instructions, and redirect rather than argue. Use validation if the client cannot be reoriented.

False reassurance, giving advice, asking why, changing the subject, defending, judging, belittling feelings, and using clichés. They block communication and damage trust.

Agitation, paranoia, dilated pupils, tachycardia, hypertension, and hyperthermia, with a risk of myocardial infarction, stroke, and seizures. A crash with fatigue and depression follows.

A safe, structured environment with predictable routines, clear expectations, group activities, and respectful relationships. Seclusion and restraint are last resorts under strict policy.

Mild (alert, heightened perception), moderate (narrowed perception, selective inattention), severe (very narrow focus, physical symptoms), and panic (loss of control, disorganization). Learning is possible only in mild to moderate anxiety.

Denial, repression, suppression (conscious), projection, displacement, regression, rationalization, reaction formation, sublimation, intellectualization, undoing, identification, and compensation.

Anorexia: severe restriction, fear of weight gain, and distorted body image, with risk of refeeding syndrome. Bulimia: binge eating and purging with near-normal weight, dental erosion, and hypokalemia.

Depressed mood or loss of interest for at least 2 weeks with changes in sleep, appetite, energy, concentration, and feelings of worthlessness. Nursing care focuses on safety, routine, and encouraging self-care.

Active listening, open-ended questions, reflection, clarification, silence, summarizing, and offering self. They encourage clients to express thoughts and feelings.

Report suspected abuse immediately to child protective services, such as a Children's Aid Society. The duty overrides confidentiality, and only reasonable grounds are required, not proof.

A non-judgmental approach that reduces the harms of substance use without requiring abstinence, such as naloxone kits, sterile supplies, supervised consumption sites, and opioid agonist therapy.

Reduced intake, cool mottled extremities, Cheyne-Stokes breathing, and noisy secretions. Focus on comfort, mouth care, positioning, medication for symptoms, and family support; hearing may persist.

Unexplained bruises, malnutrition, poor hygiene, social isolation, and financial exploitation. Report to the supervisor and the appropriate agency; mandatory reporting laws differ by province.

Yawning, runny nose, tearing, dilated pupils, goosebumps, muscle aches, nausea, vomiting, and diarrhea. It is very uncomfortable but rarely life-threatening, and opioid agonist therapy relieves it.

Early symptoms (tremor, anxiety, sweating) appear 6 to 24 hours after the last drink, seizures may occur 12 to 48 hours, and delirium tremens 48 to 96 hours. Manage with CIWA-Ar monitoring, benzodiazepines, and thiamine.

Denial, anger, bargaining, depression, and acceptance. People may move back and forth between the stages and may not experience all of them.

Alarm (fight or flight), resistance (adaptation to the stressor), and exhaustion (resources depleted, leading to illness). Chronic stress can lead to exhaustion.

Maturational (developmental transitions), situational (job loss, illness), and adventitious (disaster, violence). The goal is safety and restoring pre-crisis functioning in a short-term, focused way.

Previous attempts, a detailed plan, access to means, hopelessness, giving away possessions, and sudden calm after depression. Risk may rise when energy returns early in treatment.

Delirium has acute onset, fluctuating attention, and is usually reversible when the cause (infection, medication, hypoxia) is treated. Dementia is gradual, progressive, and irreversible.

Tension building, acute battering, and a honeymoon phase with remorse and promises. The cycle repeats and often escalates, which keeps the victim in the relationship.

Positive symptoms add experiences: hallucinations, delusions, and disorganized speech. Negative symptoms take away: flat affect, alogia, avolition, and social withdrawal.

Notify the provincial organ donation organization about potential donors, and let trained specialists approach the family. Provide dignified post-mortem care, respecting cultural and religious customs and coroner requirements.

Care based on safety, trustworthiness, choice, collaboration, and empowerment that avoids re-traumatizing clients. In Canada it is vital for survivors of residential schools, abuse, and violence.

A brain disorder from thiamine deficiency in alcohol use disorder. Wernicke: confusion, ataxia, and eye movement abnormalities. Korsakoff: memory loss with confabulation. Give thiamine before glucose.

Intoxication causes red eyes, tachycardia, increased appetite, and impaired judgment. Heavy use can cause psychosis risk and cannabis hyperemesis, and it should be avoided in pregnancy and breastfeeding.

Provincial mental health acts allow assessment when a person has a mental disorder and poses a danger to self or others, or cannot care for self, for example a 72-hour assessment in Ontario. Rights of review and appeal remain.

Check the pH first (acid or alkali), then see whether PaCO2 or HCO3 matches the pH. ROME: respiratory opposite (pH and CO2 move opposite), metabolic equal (pH and HCO3 move together). Then look for compensation.

Discard the first void at the start time, collect all urine for the next 24 hours on ice or refrigerated, and include the final void at the end time. If any specimen is missed, restart the collection.

On the right side, with a pillow or towel under the costal margin, for several hours to compress the puncture site. Monitor vital signs and for bleeding, and check coagulation values beforehand.

A portable ECG recorder worn for 24 to 48 hours. The client keeps a diary of activities and symptoms, avoids showers and magnets, and continues usual activities.

If glucose is below 4.0 mmol/L and the client can swallow, give 15 g of fast-acting carbohydrate such as juice or glucose tablets, recheck in 15 minutes, and repeat if needed. Give IV dextrose or glucagon if unable to swallow.

Obtain an early morning specimen after rinsing the mouth, ask the client to cough deeply from the lungs, and use a sterile container. Collect before antibiotics when possible.

Collect into the container with preservative as instructed, avoid contamination with urine or toilet water, and deliver promptly. Some tests require multiple samples on different days.

Check for the thrill and bruit every shift, avoid blood pressure, IV lines, and venipuncture in that arm, avoid tight clothing, and teach the client not to sleep on it or lift heavy loads. Absence of the thrill needs urgent reporting.

Sit upright, exhale, seal the lips, inhale slowly and deeply, hold for 3 to 5 seconds, and repeat about 10 times every hour while awake. Splint the incision with a pillow when coughing.

Early ambulation, leg exercises, sequential compression devices, adequate hydration, and prophylactic anticoagulants as ordered. Do not massage a leg with suspected DVT.

MAP equals systolic plus two times diastolic, divided by three. Normal is about 70 to 100 mmHg and a MAP of at least 65 is needed to perfuse vital organs.

Eye opening (1 to 4), verbal response (1 to 5), and motor response (1 to 6), for a total of 3 to 15. A score of 8 or less indicates severe impairment and a need for airway protection.

Pre-oxygenate, use sterile technique and a catheter no larger than half the tube's diameter, apply suction only while withdrawing, limit each pass to 10 to 15 seconds, and reassess breathing and saturation.

Place the client in low Fowler's with knees bent, cover exposed tissue with a sterile saline-soaked dressing, do not push contents back, stay with the client, and notify the surgeon.

Poor perfusion, cold extremities, nail polish, motion, and carbon monoxide poisoning (falsely normal). Reassess and use arterial blood gases if in doubt. A target of 88% to 92% is typical in chronic CO2 retainers.

Use a soft toothbrush and electric razor, avoid intramuscular injections, rectal temperatures, and enemas, apply firm pressure to puncture sites, and report petechiae, gum bleeding, or blood in stool or urine. Platelets below 20 x 10^9/L carry high risk.

Fasting plasma glucose of 4.0 to 7.0 mmol/L is a common target in diabetes, and the usual HbA1c target is 7.0% or less. Hypoglycemia is below 4.0 mmol/L.

Atelectasis and pneumonia, deep vein thrombosis, urinary retention, paralytic ileus, wound infection, and dehiscence. Early mobilization, deep breathing, and monitoring prevent most.

Hand hygiene, a private room, no fresh flowers or raw foods, avoid sick visitors, and no rectal temperatures or procedures. Report any fever of 38.0 degrees Celsius or more at once; it is an emergency.

Sodium 135 to 145 mmol/L and potassium 3.5 to 5.0 mmol/L. Hyperkalemia shows peaked T waves and a wide QRS; hypokalemia shows flat T waves, U waves, and weakness.

White blood cells 4 to 11 x 10^9/L and platelets 150 to 400 x 10^9/L. Neutropenia is an absolute neutrophil count under 1.5 x 10^9/L and needs infection precautions.

Primary: edges approximated and closed (surgical incision). Secondary: edges left open and healing by granulation. Tertiary: delayed closure after the wound is cleaned or infection resolved.

Newborn: heart rate 120 to 160, respiratory rate 30 to 60. Toddler: 90 to 150 and 24 to 40. School age: 70 to 120 and 18 to 30. Values fall with age.

Secretions, coughing, biting the tube, kinked tubing, bronchospasm, pneumothorax, and the client fighting the ventilator. Assess the client first, suction if needed, and use manual ventilation if the problem cannot be fixed quickly.

Nasal cannula 1 to 6 L/min (24% to 44%), simple mask 6 to 10 L/min, non-rebreather 10 to 15 L/min with the reservoir bag inflated (up to about 90%), and Venturi mask for precise low concentrations in COPD.

Regular rhythm with rate 60 to 100, a P wave before every QRS, PR interval 0.12 to 0.20 seconds, and QRS under 0.12 seconds.

Keep the system below chest level and upright, watch for fluctuation in the water-seal chamber, and note drainage. Constant bubbling in the water seal suggests an air leak. Do not clamp routinely. If the tube pulls out, cover the site with an occlusive dressing and call for help.

Confirm identity, allergies, and surgical site marking, ensure informed consent is signed, follow fasting instructions, remove jewellery and dentures, record baseline vitals, and give teaching on coughing, deep breathing, and pain control.

Transparent films for superficial wounds, hydrocolloids for light drainage, foams and alginates for heavier drainage, hydrogels for dry wounds, and gauze for packing. Keep wounds moist and clean, not necessarily dry.

Heart rate 60 to 100 per minute, respiratory rate 12 to 20, blood pressure below 120/80 mmHg, temperature about 36.5 to 37.5 degrees Celsius, and oxygen saturation 95% to 100% on room air.

pH 7.35 to 7.45, PaCO2 35 to 45 mmHg (4.7 to 6.0 kPa), HCO3 22 to 26 mmol/L, and PaO2 80 to 100 mmHg (10.6 to 13.3 kPa).

INR about 0.8 to 1.2 in clients not on warfarin, aPTT about 25 to 35 seconds, and PT about 11 to 13.5 seconds. Heparin is monitored by aPTT, warfarin by INR.

Hemoglobin: females 120 to 160 g/L, males 140 to 180 g/L. Hematocrit: females about 0.37 to 0.47, males about 0.42 to 0.52. Reference ranges vary by laboratory.

Total calcium about 2.1 to 2.6 mmol/L, magnesium about 0.7 to 1.0 mmol/L, and phosphate about 0.8 to 1.5 mmol/L. Calcium and phosphate move in opposite directions.

Urea about 2.5 to 7.1 mmol/L and creatinine about 45 to 110 micromol/L (lower in females). A falling eGFR indicates reduced kidney function, and values below 60 for three months indicate chronic kidney disease.

Keep weights hanging freely, maintain alignment, check pin sites for infection, perform neurovascular checks, and prevent skin breakdown and complications of immobility. Never remove weights unless ordered.

Obtain consent, confirm fasting, monitor level of consciousness, oxygen saturation, heart rate, blood pressure, and capnography, and keep airway equipment and reversal agents available. Recovery continues until criteria are met.

Airway, breathing, circulation, then level of consciousness, vital signs, pain, nausea, temperature, surgical site, and urine output. Report airway obstruction, hypoxia, or hemorrhage immediately.

Call 'clear' and ensure no one touches the client or bed. Remove oxygen sources and nitroglycerin patches from the chest, place pads away from pacemakers, and for cardioversion synchronize the device and give sedation.

Keep the bed low with padded rails and suction available. During a seizure, protect the head, loosen clothing, turn to the side, and time it. Never restrain or place anything in the mouth. Call emergency services for seizures over 5 minutes or repeated seizures.

Cloudy effluent, abdominal pain, fever, and rebound tenderness. Use strict asepsis when connecting, send effluent for culture, and notify the provider promptly.

Pain (out of proportion), pallor, pulselessness, paresthesia, paralysis, and poikilothermia. Pain with passive stretch signals compartment syndrome, an emergency requiring prompt provider notification.

Troponin rises after myocardial injury and is the key marker of myocardial infarction. BNP rises with heart failure, with a value below 100 ng/L making heart failure unlikely.

ALT and AST rise with hepatocyte injury, bilirubin rises in jaundice, and ammonia rises in hepatic encephalopathy. Clients with liver disease need caution with sedatives and acetaminophen.

Cloudy urine with positive leukocyte esterase and nitrites, bacteria, white blood cells, and sometimes blood. Specific gravity of 1.005 to 1.030 reflects hydration, and a midstream clean-catch sample reduces contamination.

A life-threatening reaction to certain anesthetic agents with hyperthermia, rigidity, tachycardia, and rising carbon dioxide. Stop the trigger, call for help, give dantrolene, cool the client, and give 100% oxygen.

Keep the limb elevated, let a plaster cast dry fully (24 to 72 hours) by handling with palms, assess for the 6 Ps, and never insert objects inside. Report increasing pain, odour, drainage, or swelling.

Position flat or as ordered, encourage fluids, assess the puncture site and neurological status, and monitor for headache, leg numbness, and infection signs. Report severe headache or fever.

Keep the access limb straight and the head of bed low as ordered, check the site and distal pulses frequently, monitor for bleeding and hematoma, and encourage fluids to flush contrast. Radial access allows earlier mobilization.

Monitor vital signs, breath sounds, saturation, and the puncture site. After thoracentesis report dyspnea or chest pain (possible pneumothorax); after paracentesis watch for hypotension and fluid leakage.

Keep NPO until the gag reflex returns, monitor for sedation effects, and watch for perforation (chest or abdominal pain, fever, bleeding). A sore throat is expected.

Teach the client about chalky barium and give fluids and a laxative afterwards to prevent impaction. Stools turn white for a few days.

Explain the procedure and obtain baseline vitals. For a stress test, advise comfortable clothing, avoid caffeine and heavy meals, and monitor ECG, blood pressure, and symptoms. An echocardiogram is noninvasive and needs no special preparation.

Scores such as NEWS and PEWS combine vital signs to detect deterioration early. A rising score triggers escalation and a rapid response team call before arrest.

A full bladder is usually needed for transabdominal imaging: drink water and do not void before the test. Abdominal ultrasound may need fasting for gallbladder studies.

Explain the breathing manoeuvres, hold bronchodilators if ordered, avoid smoking, large meals, and tight clothing before the test, and rest between efforts. Results measure airflow and lung volumes.

Check for previous reactions and kidney function, hydrate, and hold nephrotoxic drugs or metformin as ordered. Shellfish allergy is not a reliable predictor of contrast reaction. Monitor for allergic reactions afterwards.

Check the pulse daily, carry the device card, avoid strong magnetic fields and keep cell phones away from the generator, avoid heavy arm lifting on the implant side initially, and report dizziness, syncope, or slow pulse.

Before starting antibiotics, from two separate sites with sterile technique, and ideally with each set drawn into aerobic and anaerobic bottles. This detects bacteremia and guides therapy.

Trough is drawn just before the next dose, and peak is drawn after the infusion ends or per the drug protocol. They guide dose adjustment for drugs such as gentamicin and vancomycin.

Through the facility's incident process and to Health Canada's Canada Vigilance Program. Under Vanessa's Law, hospitals must report serious adverse drug reactions and medical device incidents.

In a private room with limited visitors and nurse time, excluding pregnant staff, visitors, and children. If an implant is dislodged, pick it up with long tongs and place it in a lead container.

Avoid whole nuts, popcorn, hard candy, whole grapes, hot dogs in rounds, and raw hard vegetables. Cut food into small pieces, and have children sit and be supervised while eating.

In an airborne isolation room with staff using fit-tested N95 respirators, three sputum samples for acid-fast bacilli, and a surgical mask on the client during transport. Cases are reported to public health.

Segregate waste at the point of care according to provincial regulations: sharps in puncture-resistant containers and infectious waste in labelled, leak-proof bags or containers.

Notify public health at once and use the right precautions: airborne plus contact for smallpox, droplet for plague, and standard precautions for anthrax. Decontaminate the exposed and follow the facility disaster plan.

Avoid catheters unless needed, remove them as soon as possible, use aseptic insertion, keep a closed drainage system with the bag below the bladder, and provide routine perineal hygiene.

Recognize early warning signs, stay calm, keep an exit path, avoid turning your back, de-escalate with a quiet voice, call for help (such as a Code White), and report all incidents.

With a quick-release knot tied to the bed frame (never to the side rail), allowing two fingers beneath, with circulation and skin checks and release at regular intervals.

Label at the bedside with two identifiers, place in a sealed biohazard bag, avoid contaminating the outside of the container, wear gloves, and transport promptly to the lab.

Do not recap used needles, use safety-engineered devices, and discard sharps immediately at the point of use in a puncture-resistant container, never filled beyond about three-quarters.

Clients who can walk are directed out first, then those who need assistance (wheelchairs, walkers), and bedridden or dependent clients last, using horizontal evacuation to a safe zone on the same floor first.

Standard alerts for emergencies, such as Code Blue for medical emergency and Code Red for fire. Code colours vary by province and facility, so every nurse must know the local codes.

A private room, strict hand hygiene, restricting visitors with infections, avoiding fresh flowers and raw or unwashed foods, and (for stem cell transplant clients) positive pressure with HEPA filtration.

Infections that must be reported to public health authorities according to provincial and territorial lists, such as tuberculosis, measles, hepatitis A, and meningococcal disease. This allows tracking and control.

Routine Practices are the Canadian baseline infection prevention measures for all clients at all times, based on a point-of-care risk assessment. Additional Precautions (contact, droplet, airborne) are added for certain infections.

Place the baby on the back to sleep, on a firm, flat surface in a crib or bassinet, with no pillows, bumpers, loose blankets, or toys. Share a room but not a bed.

Keep the bed low with padded rails, have suction and oxygen available, and do not restrain or place objects in the mouth. During a seizure, protect the head, turn the client to the side, loosen clothing, and time the seizure.

Use a seat that meets Canadian safety standards, rear-facing for as long as possible up to the seat's limits, in the back seat, installed tightly and used for every trip. Replace it after a crash.

At least two client-specific identifiers, such as full name and date of birth or health card number, asked of the client when possible. Never use the room number or diagnosis.

Before initial contact with the client or their environment, before an aseptic procedure, after risk of body fluid exposure, and after contact with the client or their environment.

Constant touch supervision near water, four-sided fencing around pools, life jackets, and emptying wading pools and buckets after use.

Gates on stairs, outlet covers, locked cabinets for medications and cleaners, window guards, constant supervision, and a water heater set to no more than 49 degrees Celsius.

Assess fall risk, keep the bed low and call bell in reach, use non-slip footwear, provide toileting rounds, remove clutter, and use alarms or supervision as needed.

The magnet is always on. Remove all ferromagnetic items (jewelry, oxygen tanks, pumps), screen for pacemakers, aneurysm clips, cochlear implants, and other metal implants, and use MRI-safe equipment.

It must be fit-tested for the individual, a user seal check is done each time, and facial hair that breaks the seal is not allowed. It is worn for airborne precautions and aerosol-generating procedures.

Use grounded three-prong plugs, inspect cords for damage, avoid overloading outlets, pull the plug rather than the cord, and keep electrical equipment away from water. If a person is shocked, turn off the power first.

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Infection control works by breaking any link in the chain.

Hand hygiene, maximal sterile barrier precautions at insertion, chlorhexidine skin antisepsis, careful site selection, aseptic dressing and hub care, and daily review of the need for the line.

Reactions range from contact dermatitis to anaphylaxis. Risk groups include health workers and clients with spina bifida or many surgeries. Use latex-free products and watch for cross-reactions with banana, avocado, kiwi, and chestnut.

Elevate the head of the bed 30 to 45 degrees, provide regular oral care, assess readiness to extubate daily, minimize sedation, and keep circuits clean.

Use the least restrictive alternative as a last resort, with a provider's order, regular monitoring and release, and documentation. Chemical and physical restraints require the same justification.

Use mechanical lifts and slide sheets instead of manual lifting, use good body mechanics (wide base, bent knees, load close to the body), get help when needed, and assess the client before moving.

A negative-pressure airborne infection isolation room with the door closed and a fit-tested N95 respirator for staff. Used for tuberculosis, measles, and varicella. The client wears a surgical mask during transport.

A private room (or cohort), gown and gloves for contact with the client or environment, dedicated equipment, and hand hygiene. Used for MRSA, VRE, CRE, C. difficile, scabies, and wound infections.

A private room (or cohort), a surgical mask when within about 2 metres of the client, and eye protection as indicated. Used for influenza, pertussis, mumps, rubella, and meningococcal disease.

Only sterile items touch the field, a 2.5 cm (1 inch) border is considered contaminated, keep the field above the waist, never turn your back, and treat wet or questionable items as contaminated.

No smoking, open flame, or flammable substances near oxygen. Post signs, secure cylinders upright, and avoid petroleum-based products, because oxygen supports combustion.

Side rails can act as restraints and may cause entrapment or falls from climbing over them. Use them only according to policy and assessment, and consider low beds and floor mats as alternatives.

Critical items enter sterile tissue and must be sterilized, semi-critical items contact mucous membranes and need high-level disinfection, and non-critical items touch intact skin and need low-level disinfection.

Contact precautions, soap and water for hand hygiene (alcohol does not kill spores), dedicated equipment, and cleaning with a sporicidal disinfectant such as a bleach solution.

Time (minimize exposure time), distance (stay as far away as possible), and shielding (use lead aprons or barriers). Staff wear dosimeters, and pregnant staff should avoid exposure.

Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep from side to side.

Rescue clients in danger, sound the Alarm, Contain the fire by closing doors, and Extinguish the fire if small or Evacuate if needed.

Remove throw rugs, add grab bars, non-slip surfaces, and good lighting, wear supportive footwear, and have working smoke and carbon monoxide alarms.

Contact precautions with a private room or cohort, gown and gloves, dedicated equipment such as a stethoscope or thermometer, and thorough environmental cleaning.

Resistance occurs when microbes survive antimicrobials, which makes infections hard to treat. Nurses help through hand hygiene, appropriate antibiotic use and completion of courses, and supporting antimicrobial stewardship programs.

Hand hygiene, gown, mask or respirator, eye protection, then gloves. Gloves go over the cuffs of the gown.

Gloves, gown, hand hygiene, eye protection, mask or respirator, then hand hygiene again. Remove the most contaminated items first and avoid touching the front of masks and goggles.

Medical asepsis (clean technique) reduces the number and spread of microorganisms. Surgical asepsis (sterile technique) removes all microorganisms, including spores, and is used for invasive procedures.

Wear a fit-tested N95 respirator, eye protection, gown, and gloves, and perform the procedure in an appropriate room. Examples include intubation, bronchoscopy, and open suctioning.

The Workplace Hazardous Materials Information System, Canada's system for communicating chemical hazards using standardized labels with pictograms, safety data sheets (SDS), and worker education.

Droplet precautions until 24 hours of effective antibiotic therapy, and antibiotic prophylaxis for close contacts as advised by public health.

ID bracelets, door alarms, increased supervision and structured activity, a recent photo on file, and following the facility's missing person code (such as Code Yellow) if the person is missing.

Pre-operative antiseptic skin preparation, clipping (not shaving) hair, timely prophylactic antibiotics (usually within 60 minutes before incision), maintaining normothermia and glucose control, and aseptic dressing care.

Wear a gown and double chemotherapy-rated gloves, eye or face protection as needed, use closed-system devices, dispose of waste in designated containers, and use a spill kit. Pregnant staff should avoid handling them.

Contact precautions, soap-and-water hand hygiene, a private room with a dedicated toilet, and thorough cleaning with a bleach-based disinfectant.

Droplet precautions, a private room, and a surgical mask on the client when leaving the room, continued until five days of effective antibiotics have been completed.

Remove the person from danger, call the Poison Centre at 1-844-POISON-X (1-844-764-7669) or emergency services, bring the container, and do not induce vomiting unless instructed.

Shut off oxygen and other medical gases to the fire area, then remove clients from danger. Oxygen supports combustion and can intensify a fire.

Wash the site with soap and water (or flush mucous membranes), report immediately, seek testing and assessment, and start time-sensitive post-exposure prophylaxis for HIV (ideally within 2 hours) and hepatitis B as indicated.

When hands are visibly soiled, and after contact with clients with C. difficile or norovirus. Otherwise, alcohol-based hand rub is preferred.

Clients infected with the same organism may be cohorted, based on infection prevention and control advice. An infected client should never share a room with an immunocompromised or high-risk client.

Hepatitis B, annual influenza, measles-mumps-rubella, varicella, Tdap, and COVID-19 as recommended by the workplace and public health.

Only staff with documented immunity, using airborne precautions (plus contact precautions for varicella). Non-immune staff and pregnant workers should not enter the room.