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NCLEX High-Yield Review

Aug 8, 2025

Overview

This lecture provides a last-minute crash review of high-yield NCLEX topics, focusing on critical thinking, patient safety, prioritization, delegation, infection control, pharmacology, calculations, and key medical and mental health concepts.

NCLEX Test-Taking Strategies

  • Eliminate extreme answers with words like "never," "always," or "only."
  • For Select All That Apply (SATA), treat each response as true/false individually.
  • Trust your first instinct and avoid overanalyzing.
  • Prioritize safety, use critical thinking, and do not cram facts.

Prioritization & Delegation

  • Use ABCs: Airway, Breathing, Circulation; airway always comes first.
  • Address unstable patients (new symptoms, acute conditions, abnormal vitals) before stable ones.
  • RNs must EAT: Evaluate, Assess, Teach; LPNs care for stable patients; UAPs assist with ADLs for stable patients.
  • Discharge stable chronic patients, not those with new symptoms or recent surgery.
  • Always choose less restrictive interventions first when possible.

Safety & Infection Control

  • PPE donning order: gown, mask, goggles, gloves; removal: gloves, goggles, gown, mask.
  • Airborne precautions: N95 mask, negative pressure room (e.g., TB, measles, varicella).
  • Droplet: surgical mask (e.g., influenza, meningitis); Contact: gown and gloves (e.g., MRSA, C. diff).
  • For C. diff, wash hands with soap and water, not sanitizer.

Pharmacology & Calculations

  • Toxic drug levels: Digoxin >2.0, Lithium >1.5, Phenytoin/Theophylline >20, Acetaminophen >150–200 mcg/mL.
  • Antidotes: Naloxone (opioids), N-acetylcysteine (acetaminophen), Calcium gluconate (magnesium/Ca channel blocker), Protamine (heparin), Vitamin K (warfarin), Digibind (digoxin).
  • Black box warnings: Beta blockers (asthma, bradycardia), ACE inhibitors (angioedema), SSRIs/SNRIs (suicide risk), QT prolonging drugs (arrhythmias).
  • Dosage formula: D/H × Q = X; IV rate: total volume/time; Drip rate: volume × drop factor/time (min); Weight-based: kg × mg/kg = dose.

Restraints & Crutches

  • Use restraints only as a last resort with a provider order; try alternatives first (reorient, bed alarms, move closer).
  • Tie restraints to bed frame, check every 15–30 min.
  • Crutch fit: 2-3 finger gap under axilla, elbows 30°; weight on hands, not axilla.
  • Gait: 2-point (partial wt bearing), 3-point (non-wt bearing), 4-point (max stability).
  • Stairs: "Up with the good, down with the bad."

Lab Values & ABGs

  • Sodium 135–145 (brain), Potassium 3.5–5 (heart), Calcium 8.5–10.5, Magnesium 1.5–2.5, Phosphorus 2.5–4.5.
  • CBC: WBC 4,000–11,000, Platelets 150,000–400,000.
  • Coag: PT 11–14s, INR 2–3 (warfarin), aPTT 30–40s, 60–80 (heparin).
  • ABG: pH 7.35–7.45, CO2 35–45, HCO3 22–26. "ROME": Respiratory Opposite, Metabolic Equal.

Maternity & Newborn Care

  • Variable decels = cord compression (reposition mom), Early decels = head compression (normal), Late decels = placental insufficiency (emergency).
  • Labor stages: Latent (0–3cm), Active (4–7cm), Transition (8–10cm), Stage 2 (pushing), Stage 3 (placenta), Stage 4 (recovery).
  • Fundal assessment: fundus at umbilicus after delivery, down 1 cm/day.

High-Yield Medical-Surgical Conditions

  • Heart failure: Left = lungs (SOB, crackles), Right = body (edema, JVD).
  • Stroke: Use FAST (Face, Arm, Speech, Time); tPA for ischemic only after CT.
  • Diabetes emergencies: DKA (type 1, acidosis, ketones), HHS (type 2, severe dehydration, high sugar).

Mental Health Nursing

  • Therapeutic communication: encourage expression, use open-ended questions, avoid "why" and false reassurance.
  • Schizophrenia: Positive (hallucinations, delusions), Negative (flat affect).
  • Hallucination: acknowledge, reorient, assess safety, never argue or validate.
  • Delusion: acknowledge feelings, do not confront, encourage reality focus.

Key Terms & Definitions

  • EAT — Evaluate, Assess, Teach; tasks only RNs can do.
  • SATA — Select all that apply; treat each option as true/false.
  • PPE — Personal Protective Equipment.
  • ABG — Arterial Blood Gas, measures pH, CO2, HCO3.
  • TPA — Tissue Plasminogen Activator, clot-busting drug for ischemic stroke.
  • Fundus — Top portion of the uterus, assessed postpartum for bleeding risk.

Action Items / Next Steps

  • Practice NCLEX-style prioritization and calculation questions.
  • Review downloadable study guides at the provided website.
  • Use adaptive question banks for further practice.
  • Focus on therapeutic communication techniques.

Full transcript