The complete NCLEX study guide

Endocrine & Metabolic

Kussmaul breathing, fruity breath, pH ↓ · HCO₃⁻ ↓

Vomiting and diuretics, tingling fingers, pH ↑ · HCO₃⁻ ↑

Respiratory

COPD, CO₂ narcosis, pH ↓ · PaCO₂ ↑

Endocrine & Metabolic

Hyperventilation, numb lips, pH ↑ · PaCO₂ ↓

Peaked T waves, muscle cramps, hold the bananas

Flat T waves, U waves, silent belly, never IV push

Thirsty, dry, agitated — Na⁺ > 150, correct it slowly

Too much water, Na⁺ < 135, headache to seizure

Twitchy face, tingling lips, watch the airway

Stones, bones, groans and psychiatric overtones

Low Mg = torsades; high Mg = reflexes gone

Cardiovascular

Warm flushed skin early, then BP bottoms out

Pump fails: cold, clammy, crackles, high filling pressures

Tank is empty: tachycardia first, hypotension late

Pharmacology

Airway closing — epinephrine IM, thigh, now

Respiratory

Sudden dyspnea — High-Fowler's + oxygen first

Refractory hypoxemia, stiff lungs, white-out on x-ray

A silent chest is worse than a loud one

Crackles, rusty sputum, confusion in the elderly

Night sweats, weight loss, airborne isolation, RIPE

High-pressure alarm = obstruction; low = disconnection

Endocrine & Metabolic

Type 1, glucose > 250, ketones, acidosis — fluids first

Type 2, glucose > 600, no ketones, profound dehydration

Pharmacology

Cold and clammy, need some candy — 15 and 15

Endocrine & Metabolic

Everything accelerates: fever, tachycardia, delirium

Everything slows: hypothermia, bradycardia, hypoventilation

Bronze skin, low Na⁺, high K⁺, hypotension — steroids now

Moon face, buffalo hump, high Na⁺, low K⁺, high glucose

Liters of pale urine, Na⁺ ↑, specific gravity < 1.005

Neurological

Cushing's triad is late — act on the early changes

Time is brain — last known well decides everything

Protect, don't restrain — time the seizure

Cardiovascular

Left = lungs, right = rest of the body; weigh daily

Crushing pain unrelieved by rest — MONA, then reperfusion

Irregularly irregular — rate, rhythm, and clot prevention

Warfarin → INR → vitamin K; heparin → aPTT → protamine

Gastrointestinal & Renal

Jaundice, ascites, asterixis — lactulose until 2–3 stools a day

Urine < 30 mL/hr, K⁺ ↑, creatinine ↑ — find the cause first

Pharmacology

Nausea, yellow-green halos, HR < 60 — check K⁺ and the level

Maternal & Newborn

BP ≥ 140/90 after 20 weeks + proteinuria — headache means danger

Gastrointestinal & Renal

Boring epigastric pain to the back, lipase ↑, Ca²⁺ ↓ — NPO and rest the gland

Mental Health

Tremors at hour 6, seizures at 24, DTs at 72 — CIWA drives the dose

Pressured speech, no sleep for days — then lithium 1.8, coarse tremor, vomiting

Auditory hallucinations, then a rigid jaw, then a 104°F fever — stop the drug, call the doctor

A sudden calm after weeks of despair is not recovery — it may mean a plan

Fireworks trigger a flashback; racing heart and doom feel like a heart attack — it isn't

Pinpoint pupils, RR 6, unresponsive — naloxone now, then watch for it to wear off first

BMI 14, bradycardic and 'fine' — feed her slowly, watch the phosphorus crash

Two serotonergic drugs, then agitation, clonus and a 102°F fever — stop both now

Pediatrics

Seal-bark cough, inspiratory stridor at rest — cool mist, keep him calm

Infant, wheezing, nasal flaring — suction, humidified O2, no routine antibiotics

Severe bone pain, dactylitis, priapism risk — hydrate, oxygenate, treat pain around the clock

Salty skin, greasy foul stools, thick mucus — airway clearance and pancreatic enzymes with every meal

Fever ≥5 days, strawberry tongue, peeling hands — IVIG + aspirin, watch the coronaries

Currant jelly stool, sausage-shaped mass, sudden inconsolable crying — think emergency, not colic

Sunken fontanel, no tears, < 4 wet diapers/day — weigh-based oral or IV rehydration now

Pica, old paint chips, blood lead ≥3.5 mcg/dL — remove the source, chelate if high

Maternal & Newborn

Boggy fundus, soaked pad in 15 min — fundal massage first, always

Painless bright red bleeding — NEVER do a vaginal exam

Sudden pain + dark bleeding + rigid uterus — fetal distress races the clock

Fasting glucose ↑, macrosomic baby risk — diet and monitoring come first

VEAL CHOP: Variable=Cord, Early=Head, Accel=Okay, Late=Placenta

Jaundice head-to-toe by day 2-3 — eyes covered, skin bare under lights

Cord visible or felt pulsating — knee-chest, lift the presenting part off it NOW

Fever ≥100.4°F after day 1, foul lochia, or a hot red breast wedge

Safety & Infection Control

ANC < 500, temp ≥ 100.4°F — a single fever is an emergency

Critical Care

K⁺ ↑, uric acid ↑, phosphate ↑, Ca²⁺ ↓ — cells burst 24–72 hrs post-chemo

Safety & Infection Control

Fever, flank pain, hives within minutes — STOP the transfusion first

Critical Care

Bleeding AND clotting at once — oozing IV sites plus low platelets and fibrinogen

Health Assessment

Fatigue, pallor, spoon nails, pica — low hemoglobin, low ferritin

Safety & Infection Control

Watery diarrhea after antibiotics — soap and water, not hand sanitizer

CD4 < 200 = AIDS-defining risk — white oral patches, cough, weight loss

Health Assessment

Butterfly rash, joint pain, photosensitivity — protect skin, watch the kidneys

Pain out of proportion, unrelieved by opioids — pallor and pulselessness are late

Neurological

Pounding headache, BP 220/120, bradycardia — sit him up and find the trigger

Ptosis and diplopia worsen with use — watch for crisis when swallowing and breathing fail

Ascending weakness after a GI infection — watch vital capacity, not just strength

Resting tremor, rigidity, bradykinesia — time levodopa exactly, never abruptly stop it

Respiratory

Barrel chest, pursed-lip breathing, low-flow O₂ — his drive to breathe is low oxygen

Gastrointestinal & Renal

Black tarry stools, coffee-ground emesis, dropping BP — airway first, then fluids

No stool, no flatus, high-pitched bowel sounds above the block — vomiting relieves, then it's silence

Cardiovascular

BP 220/130 with a pounding headache and blurred vision — end-organ damage is the emergency, not the number alone

Pulsatile abdominal mass, sudden tearing back pain, and a dropping BP — never palpate deeply once rupture is suspected

Cold, pale legs that hurt with walking and improve with dangling — arterial disease is the opposite of venous

New murmur, fever, and tiny splinter hemorrhages under the nails — bacteria are colonizing his heart valves

Sharp chest pain that eases leaning forward, then muffled heart sounds and a falling BP — the pericardial sac is filling

A childhood strep throat left scarred valves — now a harsh murmur and signs of failure decades later

Hiccups after pacemaker placement can mean the lead is stimulating the diaphragm — check the pocket and the rhythm strip

Unilateral calf swelling, warmth, and a positive Homans-like tenderness — never massage the leg, a clot may already be loose

Gastrointestinal & Renal

Pain migrates to McBurney's point, then suddenly stops — that relief can mean rupture, not recovery

RUQ pain after a fatty meal, radiating to the right shoulder — a positive Murphy's sign clinches it

Skip lesions and fistulas mean Crohn's; continuous rectal bleeding means ulcerative colitis

LLQ pain, fever and a change in bowel habits — perforation turns this into peritonitis fast

Jaundice, dark urine, clay stools and RUQ tenderness — know your route of transmission to know your teaching

Never take a BP or draw blood from the fistula arm — a thrill and bruit confirm it's still patent

Burning and frequency stay in the bladder — flank pain, fever and chills mean it's climbed to the kidney

Bright red urine with clots post-TURP is expected briefly — watch for bladder spasms and clot retention

Critical Care

Deep partial-thickness burns over 40% TBSA — the Parkland formula tells you how much fluid, but urine output tells you if it's working

Health Assessment

Non-blanchable redness over the sacrum is Stage 1 — waiting for an open wound means waiting too long

Mental Health

Sudden confusion that fluctuates hour to hour is delirium until proven otherwise — and it usually has a treatable cause

Safety & Infection Control

The five rights of delegation exist because the RN keeps accountability even after handing off the task

Pharmacology

Know the peak, know the risk — hypoglycemia strikes hardest when the insulin is working hardest

Red man syndrome isn't an allergy — it's histamine release from infusing vancomycin too fast

Safety & Infection Control

In a mass casualty event, the sickest client doesn't always go first — resources go where they can save the most lives

The provider obtains informed consent — the nurse verifies it was given freely and understood

Pharmacology

Lisinopril lowers her blood pressure beautifully — until the dry cough starts and her lips begin to swell

Metoprolol keeps her heart calm — but check the apical pulse first, and never let her stop it cold turkey

Furosemide drains the fluid from his failing heart — and flushes his potassium out with it

Lithium steadies her moods — but it rides on sodium, and one sweaty week or skipped salt can push her into toxicity

Phenelzine finally lifts her depression — until aged cheese and tap beer send her blood pressure through the roof

One tablet under the tongue melts her angina in minutes — one tablet with the wrong pill can drop her pressure to the floor

The heparin drip keeps her clot from growing — but the aPTT tells the nurse how fast it runs, and protamine turns it off

Phenytoin stops his seizures at 10-20 — but nystagmus says the level is climbing, and his gums grow over his teeth

Health Assessment

He pushed through the workout, then collapsed — and his urine came out the color of iced tea

She lost two inches of height and never felt a thing — until a hug fractured a vertebra

She lost her side vision so slowly she never noticed — then one night her eye turned to stone

Neurological

A college dorm, a fever, and a neck too stiff to touch her chin to her chest

Her symptoms come, go, and come back somewhere else — and a hot bath makes every one of them worse

Health Assessment

He woke at 2 a.m. with a big toe so hot and swollen the bedsheet felt like a blade

The room spins without warning, one ear roars, and she has to grab the wall to stay upright

Both hands, the same joints, every morning for over an hour — this is not wear and tear

Mental Health

She is freezing in a warm room, her heart beats in the 40s — and the danger begins the moment she starts eating again

He has washed his hands until they bleed — because stopping makes the anxiety unbearable

Maternal & Newborn

This is not morning sickness — she has lost 12 pounds and her urine is full of ketones

A hot red wedge on one breast and a 102 fever — and the treatment is to keep breastfeeding, not stop

Pediatrics

Five days of fever nothing touches, cracked red lips, a strawberry tongue — and arteries quietly at risk

His eyelids are swollen shut in the morning and his urine foams — protein is leaking straight out of him

Endocrine & Metabolic

His phosphorus climbs, his calcium falls, and he itches everywhere — the binder only works if he takes it with food

The IV ran wide open, and now she is coughing pink froth with veins standing out in her neck

Respiratory

He was stabbed in the chest, now he cannot catch his breath — and his windpipe is sliding away from the wound

Neurological

His tingling toes became weak legs, then a weak chest — the paralysis is climbing, and the only question that matters is his breathing

Mental Health

Every evening the sun goes down and Sid goes looking for a job he retired from twenty years ago

Safety & Infection Control

She has coughed for three weeks, lost ten pounds, and sweats through the night — now she lives behind a negative-pressure door

Pediatrics

Her cough sounds like a seal barking at midnight — but if she starts drooling and leaning forward, the rules change completely

Health Assessment

Her leg is shorter and turned outward after the fall — and two days later her confusion is not from the pain medicine

His heel is red and it does not fade when pressed — the clock on his skin started two hours ago

Safety & Infection Control

A stripe of blisters wraps one side of her chest like a belt that stops at the midline — and the pain arrived days before the rash

Pharmacology

Her nosebleed will not stop, her INR is 6.5, and the only thing that changed was a week of kale smoothies — then a week without them

Endocrine & Metabolic

The order says potassium — and the single most dangerous thing a nurse can do with it is give it fast

Safety & Infection Control

His tubing came apart for only a few seconds — and suddenly he is gasping, dizzy and dropping his pressure

Her IV arm is puffy, pale and cool to the touch — the fluid is going into the tissue, not the vein

Respiratory

His secretions are thick, his saturation is dropping, and the safest suction is the shortest one

Safety & Infection Control

One flat-lying tube feeding is all it takes to turn nutrition into pneumonia

Pharmacology

He felt better, so he stopped his prednisone on Friday — by Sunday his pressure was bottoming out

Endocrine & Metabolic

She takes her thyroid pill with breakfast and a calcium chew — and wonders why she still feels exhausted

Pharmacology

His face and neck turned red twenty minutes into the infusion — the drug is not the problem, the speed is

Respiratory

The right oxygen device is not the biggest one — it is the one that matches the liters, the diagnosis and the risk

Safety & Infection Control

Day one her lungs, day three her bowel, day five her wound — every post-op day has its own emergency

Pharmacology

His daughter pressed the button while he slept, because she loves him — and that is exactly how an overdose happens

Safety & Infection Control

Everything else is tried before anything is tied — and once it is, the clock and the checks begin

A low fever is not a reason to skip a shot — but pregnancy and a suppressed immune system change everything

The bag is nutrition and a sugar load at the same time — stopping it abruptly drops the blood sugar off a cliff

Mental Health

The right answer is almost never advice, reassurance or a question starting with 'why'

Pediatrics

Every age has one milestone the NCLEX loves — and one hazard that comes with it

Maternal & Newborn

Four stages, one APGAR at 1 and 5 minutes, and one number that says push

Health Assessment

The finding that gets reported is the one that changed, and the one that does not hurt

Pharmacology

Every blood pressure pill shares one teaching point — stand up slowly, and never stop it because you feel fine

Maternal & Newborn

Missed period, one-sided pain, spotting — then shoulder pain means it has burst

Pediatrics

Four defects, one blue spell — and the child squats to fix her own circulation

Projectile vomiting in a 3-to-6-week-old who is starving right after — feel for the olive

Critical Care

Phantom pain is real nerve pain — treat it, never dismiss it

Gastrointestinal & Renal

A sore throat two weeks ago, now smoky urine, puffy eyes and a climbing blood pressure

Health Assessment

Big cells, smooth red tongue, tingling feet — iron anemia never touches the nerves

Neurological

A curtain falling over the vision, flashes and floaters — painless, but the clock is ticking

Gastrointestinal & Renal

A healthy stoma is rose-red and moist — pale, purple or black means trouble