High-Yield NCLEX Review

    NCLEX Study Tips & Quick Reference Guide

    Essential nursing concepts, mnemonics, lab values, and clinical pearls for NCLEX-RN and NCLEX-PN exam preparation.

    Designed for nursing students who want to pass the NCLEX on their first try.

    Prioritization & Test-Taking

    • 1ABC (Airway, Breathing, Circulation) — always prioritize in this order.
    • 2Acute over Chronic: prioritize the acute problem if it poses immediate threat.
    • 3Unstable over Stable: sudden changes in vitals always take precedence.
    • 4Maslow's Hierarchy: physiological > safety > psychosocial. Physical needs trump educational needs on the NCLEX.
    • 5STAT words (Highest Priority, Immediate Action) → pick the answer where failure causes death or great harm.
    • 6Least Invasive First: verbal de-escalation before restraints, oral meds before IV.
    • 7Secondhand info (UAP, family, labs) → the right answer is usually to ASSESS.
    • 8Eliminate absolutes — answers with 'always', 'never', or 'must' are usually wrong.

    Delegation Rules

    • 1RN: Cannot delegate assessment, teaching, or nursing judgment.
    • 2LPN/LVN: Assign stable patients with expected outcomes.
    • 3UAP: Delegate only standard, unchanging procedures.
    • 4Five Rights: Right Task, Right Circumstances, Right Person, Right Communication, Right Supervision.
    • 5Stable patients go to: UAP, LPN, new nurse, graduate nurse, float nurse, travel nurse.

    Lab Values to Memorize

    • 1Na: 135–145 | K: 3.5–5.0 | Ca: 8.5–10.5 | Mg: 1.5–2.5
    • 2BUN: 8–20 | Creatinine/Lithium: 0.6–1.2 | GFR: maintain above 60
    • 3WBC: 4K–11K | RBC: 4–6 | Hgb: 12–18 | Hct: 36–52 | Plt: 150K–400K
    • 4Digoxin: 0.5–2.0 | Dilantin/Theophylline: 10–20
    • 5INR (Warfarin): 2.0–3.5 | PTT (Heparin): 25–35 seconds | Therapeutic PTT: 46–76
    • 6HbA1c: 4–6 normal, 7 ideal for diabetics (corresponds to blood sugar ~130).

    Antidotes

    • 1Heparin → Protamine Sulfate
    • 2Warfarin (Coumadin) → Vitamin K
    • 3Opioids → Narcan (Naloxone)
    • 4Digoxin → Digibind (Immune Fab)
    • 5Tylenol (Acetaminophen) → Mucomyst (Acetylcysteine) — given orally
    • 6Magnesium Sulfate → Calcium Gluconate
    • 7Benzodiazepines → Flumazenil
    • 8Iron overdose → Deferoxamine

    Cardiac Essentials

    • 1Blood tests for MI: Myoglobin, CK, and Troponin.
    • 2Auscultation order: APE To Man — Aortic, Pulmonic, Erb's, Tricuspid, Mitral.
    • 3EleVate Veins; dAngle Arteries for better perfusion.
    • 4Virchow's Triad (DVT risk): Vascular Trauma, Increased Coagulability, Reduced Blood Flow.
    • 5Fluid retention? Think heart problems first.
    • 6Post cardiac cath: VS, keep leg straight, bed rest 6–8 hrs, supine.
    • 7Digoxin: check apical pulse for 1 full minute — hold if <60 BPM.

    Diabetes Quick Guide

    • 1Hyperglycemia: Hot & Dry = Sugar High. Hypoglycemia: Cold & Clammy = Need Candy.
    • 2Drawing up insulin: Air into NPH → Air into Regular → Draw Regular → Draw NPH.
    • 3DKA and HHNS: Fluids are the MOST important intervention — get them going first.
    • 4DKA: Kussmaul breathing, serum ketones rise, watch for dropping K+ during treatment.
    • 5HHNS: No ketosis, no acidosis. Potassium is low due to diuresis.
    • 6Steroids (Prednisone) increase glucose — extra insulin may be needed.

    Endocrine Disorders

    • 1Addison's: hypoNa, hyperK, hypoglycemia, dark pigmentation, severe hypotension. Need to 'ADD' hormones.
    • 2Cushing's: hyperNa, hypoK, hyperglycemia, moon face, buffalo hump. Extra 'CUSHION' of hormones.
    • 3Diabetes Insipidus (↓ ADH): excessive urine, thirst → give Vasopressin.
    • 4SIADH (↑ ADH): ↓ LOC, tachycardia, N/V → give Declomycin + diuretics.
    • 5Thyroid Storm: HOT + ↑ HR + HTN. Post-thyroidectomy: semi-Fowler's, trach at bedside.

    Pharmacology Pearls

    • 1Give NSAIDs, Corticosteroids, Cephalosporins with FOOD.
    • 2Steroids in AM, Diuretics in AM, Aricept (Donepezil) in AM.
    • 3Aminoglycosides: Nephrotoxic + Ototoxic (bean-shaped organs).
    • 4Rifampin turns body fluids red-orange. TB drugs are hepatotoxic.
    • 5Lithium level: 0.5–1.5 therapeutic, 2–3 toxic. Hydrate 2–3L/day, maintain Na intake.
    • 6Anticholinergic side effects: can't Spit, Piss, Shit, or See.
    • 7Dilantin toxicity: poor gait, slurred speech, nausea, diplopia.

    Respiratory & Infection Control

    • 1COPD: 2L nasal cannula or less — hypoxic drive, not hypercapnic.
    • 2First sign of ARDS: increased respirations. Cardinal sign: hypoxemia.
    • 3Asthma: if wheezing stops, patient may be WORSENING. Best exercise: swimming.
    • 4Airborne precautions (My Chicken Hez TB): Measles, Varicella, Herpes Zoster, TB — N95 mask.
    • 5Droplet (SPIDERMAN): Sepsis, Scarlet fever, Strep, Parvovirus, Pneumonia, Pertussis, Influenza, Diphtheria, Epiglottitis, Rubella, Mumps, Meningitis.
    • 6Contact (MRS. WEE): MRSA, Varicella Zoster, C. diff, Scabies, Impetigo, Conjunctivitis.

    Neurological & Musculoskeletal

    • 1ICP vs Shock — opposite vitals. ICP: ↑BP, ↓Pulse, ↓Resp. Shock: ↓BP, ↑Pulse, ↑Resp.
    • 2Glasgow Coma Scale: Eyes (4), Verbal (5), Motor (6) = max 15. Comatose ≤8.
    • 3Decorticate: arms toward CORE. Decerebrate: arms out (worse).
    • 4Autonomic Dysreflexia: HTN, bradycardia, pounding headache → elevate HOB to 90°, check bladder/bowel.
    • 5Compartment Syndrome: paresthesia + unrelieved pain = EMERGENCY. Irreversible in 4–6 hrs.
    • 6Cane walking (COAL): Cane, Opposite, Affected, Leg. 'Up with good, down with bad.'

    Maternal & Pediatric

    • 1Prolapsed cord → knee-chest or Trendelenburg position.
    • 2Un-reassuring FHR → left side, O₂, stop Pitocin, increase IV fluids.
    • 3Pre-eclampsia: proteinuria, edema, HTN. Mg sulfate for seizure prevention — antidote is Calcium Gluconate.
    • 4IM injection sites by age: Vastus lateralis (<6 mo), Ventrogluteal (>18 mo), Deltoid (children).
    • 5SIDS prevention: infant sleeps on BACK in a bare crib.
    • 6No aspirin in children — Reye's Syndrome risk. Give Tylenol instead.
    • 7TEF in newborn (3 C's): Choking, Coughing, Cyanosis.

    Hallmark Signs

    • 1Pneumonia: rusty/pink frothy sputum. Asthma: expiratory wheezing. Emphysema: barrel chest.
    • 2Kawasaki: strawberry tongue. Pernicious anemia: red beefy tongue. Cushing's: moon face.
    • 3Appendicitis: rebound tenderness. Pancreatitis: Cullen's sign + Grey Turner's spots.
    • 4Meningitis: Kernig's + Brudzinski signs + photophobia.
    • 5Increased ICP (Cushing's Triad): HTN + bradypnea + bradycardia.
    • 6DVT: Homan's sign. PE: sudden chest pain + dyspnea + tachypnea.
    • 7Parkinson's: pill-rolling tremors. Multiple Sclerosis: Charcot's Triad (nystagmus, intention tremor, scanning speech).

    Patient Positioning

    • 1Air/Pulmonary Embolism → left side, lower HOB.
    • 2Post-lumbar puncture → flat supine 2–12 hrs to prevent CSF leak.
    • 3Head injury → elevate HOB 30° to decrease ICP.
    • 4Post-thyroidectomy → semi-Fowler's, support head/neck/shoulders.
    • 5Post-total hip replacement → don't flex hip >45–60°, maintain abduction with wedge pillow.
    • 6Spina bifida infant → prone (protect sac). Cleft lip → supine or infant seat.
    • 7Pancreatitis → fetal position. GERD → left side, HOB elevated 30°.

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