MEDICAL-SURGICAL
NURSING: CONCEPTS AND
PRACTICE (5TH EDITION)
Comprehensive Preparation Guide, Expert
Rationales & Visual Study Aids
2026-2027 Pro-Level Edition | Covers Chapters 1–49 | Optimized for
NCLEX-PN® & NCLEX-RN® Success
LEGAL DISCLAIMER
This document is a premium educational aid and study guide designed to accompany the text
Medical-Surgical Nursing: Concepts and Practice, 5th Edition by Holly K. Stromberg. It is
independently produced and is not affiliated with, endorsed by, or connected to Elsevier, the
National Council of State Boards of Nursing (NCSBN), or the authors of the primary text. The
scenarios, rationales, and field notes provided herein are for exam preparation and academic
reinforcement purposes only. While every effort has been made to ensure clinical accuracy
based on current evidence-based practice and research , medical protocols vary by institution.
Students should always defer to their specific program’s curriculum and local facility protocols
for definitive guidance.
,THE CANDIDATE'S TOOLKIT:
HIGH-YIELD FRONT MATTER
1. Introduction: The "Pro-Level" Mindset
Success in Medical-Surgical Nursing requires a transition from rote memorization to Clinical
Judgment. The 5th Edition of Stromberg's text emphasizes the Next Generation NCLEX (NGN)
standards, which demand that students not only recall facts but also recognize cues, analyze
hypotheses, and prioritize solutions.
This guide is structured to function as a personal tutor. We do not simply provide the "right
answer"; we provide the clinical logic—the "why" and "how" that defines expert practice. Each
module begins with a "Clinical Refresher" designed to synthesize the core pathophysiology and
nursing principles of the corresponding chapters, followed by high-stakes exam questions
derived from the most complex scenarios found in the field.
2. Topic Index & Module Breakdown
To maximize the efficacy of this study guide, the content has been reorganized from the
standard 49 chapters into 7 High-Yield Clinical Modules. This structure mirrors the cognitive
clustering used in licensure examinations.
● Module 1: Professional Foundations & Perioperative Care (Chapters 1–6)
○ Focus: The role of the LPN/LVN, legal/ethical frameworks, and the continuum of
surgical care (Pre-op, Intra-op, Post-op).
● Module 2: Fluid, Electrolyte, and Acid-Base Dynamics (Chapter 3)
○ Focus: Homeostasis, IV therapy, and the interpretation of Arterial Blood Gases
(ABGs).
● Module 3: Respiratory & Hematologic Systems (Units III, IV, V)
○ Focus: Gas exchange, airway management, anemia, and transfusion medicine.
● Module 4: Cardiovascular Health & Perfusion (Unit VI)
, ○ Focus: Hemodynamics, heart failure, vascular disorders, and shock states.
● Module 5: Gastrointestinal, Renal & Reproductive Systems
○ Focus: Elimination, nutrition, and inflammatory disorders of the gut and kidneys.
● Module 6: Endocrine & Metabolic Disorders
○ Focus: Hormonal regulation, diabetes management, and thyroid/adrenal crises.
● Module 7: Neurological, Musculoskeletal & Integumentary Systems
○ Focus: Intracranial dynamics, mobility, trauma, and burn care.
3. The "Must-Know" Formula Sheet
Memorize these before entering the testing center. These are the mathematical backbones of
safe nursing practice.
A. The Parkland Burn Formula (Fluid
Resuscitation)
This is the gold standard for managing burn shock. Major burns cause a massive capillary leak,
leading to third-spacing and hypovolemic shock. The Parkland formula calculates the volume of
Lactated Ringer’s (LR) required to maintain perfusion during the first 24 hours.
● Formula: 4 mL × Body Weight (kg) × % Total Body Surface Area (TBSA) burned
● The "Rule of Nines" for TBSA:
○ Head: 9%
○ Arms: 9% each
○ Legs: 18% each
○ Chest/Back: 18% Anterior / 18% Posterior
○ Perineum: 1%
● Administration Schedule:
○ 1st 8 Hours: Give 50% of the total calculated volume. Note: The clock starts at the
time of the BURN, not the time of admission.
○ Next 16 Hours: Give the remaining 50% of the volume.
● : Do not include superficial (1st-degree) burns in the TBSA calculation. Only 2nd (partial
thickness) and 3rd (full thickness) degrees count. The goal is to maintain urine output at
0.5–1 mL/kg/hr.
B. IV Flow Rate (gtt/min)
Used when an electronic infusion pump is unavailable, and gravity drip is required. This requires
knowledge of the tubing's "Drop Factor" (drops per mL).
● Formula: (Total Volume in mL × Drop Factor) ÷ Time in Minutes = gtt/min
● Step-by-Step Breakdown:
1. Identify the Volume (e.g., 1000 mL).
2. Identify the Drop Factor (e.g., 15 gtt/mL).
3. Convert Hours to Minutes (e.g., 8 hours x 60 = 480 mins).
4. Multiply Volume by Drop Factor.
5. Divide by Minutes.
NURSING: CONCEPTS AND
PRACTICE (5TH EDITION)
Comprehensive Preparation Guide, Expert
Rationales & Visual Study Aids
2026-2027 Pro-Level Edition | Covers Chapters 1–49 | Optimized for
NCLEX-PN® & NCLEX-RN® Success
LEGAL DISCLAIMER
This document is a premium educational aid and study guide designed to accompany the text
Medical-Surgical Nursing: Concepts and Practice, 5th Edition by Holly K. Stromberg. It is
independently produced and is not affiliated with, endorsed by, or connected to Elsevier, the
National Council of State Boards of Nursing (NCSBN), or the authors of the primary text. The
scenarios, rationales, and field notes provided herein are for exam preparation and academic
reinforcement purposes only. While every effort has been made to ensure clinical accuracy
based on current evidence-based practice and research , medical protocols vary by institution.
Students should always defer to their specific program’s curriculum and local facility protocols
for definitive guidance.
,THE CANDIDATE'S TOOLKIT:
HIGH-YIELD FRONT MATTER
1. Introduction: The "Pro-Level" Mindset
Success in Medical-Surgical Nursing requires a transition from rote memorization to Clinical
Judgment. The 5th Edition of Stromberg's text emphasizes the Next Generation NCLEX (NGN)
standards, which demand that students not only recall facts but also recognize cues, analyze
hypotheses, and prioritize solutions.
This guide is structured to function as a personal tutor. We do not simply provide the "right
answer"; we provide the clinical logic—the "why" and "how" that defines expert practice. Each
module begins with a "Clinical Refresher" designed to synthesize the core pathophysiology and
nursing principles of the corresponding chapters, followed by high-stakes exam questions
derived from the most complex scenarios found in the field.
2. Topic Index & Module Breakdown
To maximize the efficacy of this study guide, the content has been reorganized from the
standard 49 chapters into 7 High-Yield Clinical Modules. This structure mirrors the cognitive
clustering used in licensure examinations.
● Module 1: Professional Foundations & Perioperative Care (Chapters 1–6)
○ Focus: The role of the LPN/LVN, legal/ethical frameworks, and the continuum of
surgical care (Pre-op, Intra-op, Post-op).
● Module 2: Fluid, Electrolyte, and Acid-Base Dynamics (Chapter 3)
○ Focus: Homeostasis, IV therapy, and the interpretation of Arterial Blood Gases
(ABGs).
● Module 3: Respiratory & Hematologic Systems (Units III, IV, V)
○ Focus: Gas exchange, airway management, anemia, and transfusion medicine.
● Module 4: Cardiovascular Health & Perfusion (Unit VI)
, ○ Focus: Hemodynamics, heart failure, vascular disorders, and shock states.
● Module 5: Gastrointestinal, Renal & Reproductive Systems
○ Focus: Elimination, nutrition, and inflammatory disorders of the gut and kidneys.
● Module 6: Endocrine & Metabolic Disorders
○ Focus: Hormonal regulation, diabetes management, and thyroid/adrenal crises.
● Module 7: Neurological, Musculoskeletal & Integumentary Systems
○ Focus: Intracranial dynamics, mobility, trauma, and burn care.
3. The "Must-Know" Formula Sheet
Memorize these before entering the testing center. These are the mathematical backbones of
safe nursing practice.
A. The Parkland Burn Formula (Fluid
Resuscitation)
This is the gold standard for managing burn shock. Major burns cause a massive capillary leak,
leading to third-spacing and hypovolemic shock. The Parkland formula calculates the volume of
Lactated Ringer’s (LR) required to maintain perfusion during the first 24 hours.
● Formula: 4 mL × Body Weight (kg) × % Total Body Surface Area (TBSA) burned
● The "Rule of Nines" for TBSA:
○ Head: 9%
○ Arms: 9% each
○ Legs: 18% each
○ Chest/Back: 18% Anterior / 18% Posterior
○ Perineum: 1%
● Administration Schedule:
○ 1st 8 Hours: Give 50% of the total calculated volume. Note: The clock starts at the
time of the BURN, not the time of admission.
○ Next 16 Hours: Give the remaining 50% of the volume.
● : Do not include superficial (1st-degree) burns in the TBSA calculation. Only 2nd (partial
thickness) and 3rd (full thickness) degrees count. The goal is to maintain urine output at
0.5–1 mL/kg/hr.
B. IV Flow Rate (gtt/min)
Used when an electronic infusion pump is unavailable, and gravity drip is required. This requires
knowledge of the tubing's "Drop Factor" (drops per mL).
● Formula: (Total Volume in mL × Drop Factor) ÷ Time in Minutes = gtt/min
● Step-by-Step Breakdown:
1. Identify the Volume (e.g., 1000 mL).
2. Identify the Drop Factor (e.g., 15 gtt/mL).
3. Convert Hours to Minutes (e.g., 8 hours x 60 = 480 mins).
4. Multiply Volume by Drop Factor.
5. Divide by Minutes.
