Overview
This crash course delivers a high-yield, concise review of essential nursing topics and strategies for conquering the NCLEX, focusing on core clinical content, prioritization, management, and test-taking skills.
Acid-Base and Electrolyte Imbalances
- Normal pH is 7.35-7.45; below is acidosis, above is alkalosis.
- Lungs control CO₂ (acid); kidneys control HCO₃⁻ (base).
- Use ABG: check pH, PaCO₂ (35-45), HCO₃⁻ (22-26), and apply "ROME" mnemonic (Respiratory Opposite, Metabolic Equal).
- Fully compensated: normal pH; uncompensated: one value normal; partially: all abnormal.
- Respiratory acidosis: COPD, hypoventilation; respiratory alkalosis: hyperventilation.
- Metabolic acidosis: DKA, diarrhea; alkalosis: vomiting, antacids.
- Electrolyte imbalances:
- Potassium (3.5-5): hyper/hypoK affect heart, monitor ECG.
- Calcium (8.5-10.5), Magnesium (1.5-2.5): opposite of prefix.
- Sodium (135-145): follows fluid balance.
- Early sign of imbalance: paresthesia.
- Management: Fix underlying cause, ensure safety first (monitor heart).
Test-Taking Strategies
- Always apply ABCs (airway, breathing, circulation) to prioritize.
- Use Maslow’s Hierarchy: physical > safety > psychosocial needs.
- ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation—assess first unless immediate emergency.
- SATA: Read stem carefully, treat each option as true/false.
- NGN: Prioritize acute/unstable over chronic/stable; track patient trends.
Prioritization & Delegation
- ABCs and acute/new/unstable patients take priority.
- RN: unstable patients, assessments, IV meds, teaching.
- LPN: stable patients, routine meds, reinforce teaching.
- UAP: basic care, vitals, feeding stable patients.
- Delegate appropriately and intervene immediately for unsafe/illegal actions.
Pharmacology Basics
- Insulin:
- Rapid (Lispro): onset 15min, peak 1-2h, with meals.
- Short (Regular): IV for DKA, onset 30min.
- NPH (intermediate): cloudy, roll before use.
- Long (Glargine): no peak, do not mix.
- Heparin: monitor PTT (60-80), reversal with protamine sulfate.
- Warfarin: monitor INR (2-3), reversal with Vitamin K.
- IV fluids: hypotonic (hydrate cells), isotonic (volume expanders), hypertonic (shrink cells).
- Blood transfusion: double-check IDs, monitor for reactions, stop for fever/chills/rash.
Cardiac Emergencies
- Left-sided HF: pulmonary symptoms (crackles, SOB).
- Right-sided HF: peripheral edema, JVD.
- MI vs angina: MI is unrelieved by rest; treat with MONA.
- Cardiac tamponade: Beck’s triad—muffled heart sounds, JVD, hypotension (needs pericardiocentesis).
- Tetralogy of Fallot: four defects, causes cyanosis.
Respiratory Emergencies
- Asthma: wheezing, treat with albuterol.
- COPD: low O₂, never high-flow O₂.
- Pneumonia: fever, crackles, antibiotics.
- PE: sudden SOB, treat with heparin.
- Vent alarms: high = blockage/suction; low = disconnect/leak.
- Chest tubes: bubbling = air leak; never clamp.
Neurological Disorders
- GCS <8: intubate.
- Stroke: FAST, CT to rule out hemorrhage before TPA.
- Increased ICP: elevate HOB, avoid straining.
- Seizure safety: side-lying, never restrain.
- Meningitis: fever, neck stiffness; bacterial = droplet precautions.
Endocrine Disorders
- Diabetes:
- Dx fasting glucose ≥126, A1C ≥6.5%.
- DKA (Type 1): metabolic acidosis, ketones, treat fluids/insulin/potassium.
- HHS (Type 2): hyperosmolar, no ketones, aggressive fluids.
- Addison’s: needs steroids; Cushing’s: too much cortisol.
- SIADH: fluid overload, hyponatremia, restrict fluids.
- DI: excessive urination, hypernatremia, give desmopressin.
Renal & GI Disorders
- AKI: sudden, reversible; CKD: irreversible, needs dialysis.
- Hyperkalemia in CKD: EKG changes, no K if no pee.
- Dialysis: protect fistula, check weight/BP/K before.
- Upper GI bleed: melena, hematemesis; lower GI: bright red stool.
- Bowel obstruction: NPO, NG tube, no laxatives.
Maternal & Pediatric Care
- Pregnancy: trimesters, fetal movement at 16-20w, preeclampsia: HTN + proteinuria.
- FHR: 110-160, late decels = placental insufficiency.
- Postpartum hemorrhage: fundal massage first.
- Pediatric milestones: walk by 1, talk by 2, play cooperatively by 4.
- Dehydration: severe needs IV fluids.
- Kawasaki: fever >5d + CRASH, treat with IVIG + aspirin.
- Vaccines: Hep B at birth, MMR/varicella at 12mo; no live vax if immunocompromised.
Mental Health
- Alcohol withdrawal: DTs 48-72h, seizure precautions.
- Suicide risk: assess plan/means, 1:1 supervision if high risk.
- Depression: sudden mood lift = assess for suicide.
- Anorexia: refeeding syndrome risk, monitor labs.
- Delirium (acute, reversible) vs dementia (chronic, progressive).
Critical Care & Emergencies
- ECG:
- P wave = atria; QRS = ventricles.
- Bradycardia: symptomatic = atropine, then pacing.
- VT/VF: defibrillate, start CPR.
- ABCDE survey for trauma.
- CPR: 30:2 compressions/breaths, 2 in adult, 1.5 in infant.
- Shock: fluids for hypovolemic/septic; pressors for cardiogenic/distributive.
Infection Control, Safety & Procedures
- Airborne (N95): TB, measles; droplet: flu; contact: C. diff.
- Hand hygiene: soap for C. diff.
- Fall prevention: bed alarms, non-skid socks.
- Restraints: MD order, check q15min, release q2h.
- Positioning: Fowlers for lungs, flat for LP headache.
Key Terms & Definitions
- ABG — Arterial blood gas, assesses oxygenation and acid-base status.
- ADPIE — Assessment, Diagnosis, Planning, Implementation, Evaluation.
- DKA — Diabetic ketoacidosis, a life-threatening type 1 DM complication.
- MONA — Morphine, Oxygen, Nitroglycerin, Aspirin (MI management).
- SATA — Select all that apply questions.
- SIADH — Syndrome of inappropriate antidiuretic hormone secretion.
- GCS — Glasgow Coma Scale, assesses consciousness.
Action Items / Next Steps
- Review normal lab values for CBC, BMP, coagulation.
- Complete assigned readings on prioritization and delegation.
- Practice NCLEX-style questions daily.
- Use full study guide on the referenced nursing platform for comprehensive review.