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NCLEX Review Highlights

Jun 8, 2025

Overview

This lecture is a comprehensive crash course review for the NCLEX exam, focusing on high-yield nursing topics, test-taking strategies, and critical clinical knowledge to ensure success.

Acid-Base Balance & Interpretation

  • Normal blood pH: 7.35–7.45; below is acidosis, above is alkalosis.
  • Lungs control CO₂ (acid); kidneys control HCO₃⁻ (base).
  • Interpreting ABGs: look at pH, PaCO₂ (35–45 mmHg), HCO₃⁻ (22–26 mEq/L).
  • ROMe mnemonic: Respiratory Opposite, Metabolic Equal (direction of pH and PaCO₂/HCO₃⁻).
  • Compensation: fully if pH normal, partial if all values abnormal, uncompensated if one is normal.
  • Respiratory acidosis: slow breathing (COPD, opioids); alkalosis: hyperventilation, panic.
  • Metabolic acidosis: DKA, diarrhea; alkalosis: vomiting, antacids.
  • Treat root cause; acidosis depresses, alkalosis excites (except K⁺: acidosis = hyperkalemia, alkalosis = hypokalemia).

Electrolyte Imbalances

  • Potassium (3.5-5): Follows prefix except heart/urine; hyper = cramps, bradycardia, low urine; hypo = weakness, tachycardia.
  • Calcium (8.5-10.5): Opposite of prefix; hypo = twitching, spasms; hyper = lethargy.
  • Magnesium (1.5-2.5): Opposite of prefix; hypo = tremors, seizures; hyper = drowsy, slow reflex.
  • Sodium (135-145): Controls fluids; hypo = overload, confusion; hyper = dehydration.
  • Prioritize fixing hyperkalemia; treat cardiac monitoring first in emergencies.

Test-Taking Strategies

  • ABCs: Airway, Breathing, Circulation—always prioritize.
  • Maslow: Physiological needs > Safety > Love/Belonging > Esteem > Self-actualization.
  • Nursing process: Assess, Diagnose, Plan, Implement, Evaluate (ADPIE).
  • SATA: Read question carefully, evaluate each option as true/false.
  • Next Gen questions: Acute beats chronic, unstable first, track trends.

Prioritization & Delegation

  • ABCs, acute/fresh/unexpected issues prioritized.
  • RNs: Assess, unstable, IV meds, education.
  • LPNs: Stable, routine meds, reinforce teaching.
  • UAPs: Basic care—feeding, vitals on stable.
  • Never delegate assessment/education to UAPs.

Pharmacology Essentials

  • Insulin: Rapid (15/1–2/3–5), Regular (30/2–4/5–8), NPH (1–2/4–12/12–18), Long (2–4/no peak/24+).
  • Heparin: Fast, IV, monitor PTT, antidote: protamine.
  • Warfarin: Oral, slow, monitor INR, antidote: vitamin K.
  • IV fluids: Hypotonic (cell swelling), isotonic (fluid stays), hypertonic (cell shrinks).

Cardiac & Respiratory Emergencies

  • Left heart failure: Crackles, SOB, pink sputum; right: edema, JVD, ascites.
  • MI: Unrelieved chest pain, diaphoresis, MONA (morphine, O₂, nitro, aspirin).
  • Asthma: Wheeze, albuterol, O₂ if sats <90%.
  • COPD: Low O₂ goal (88–92%), avoid high flow.
  • Pneumonia: Crackles, fever, antibiotics.

Neurology

  • Stroke: FAST mnemonic; ischemic (tPA), hemorrhagic (no tPA).
  • Increased ICP: Early restless, late Cushing’s triad.
  • Seizure safety: Side position, no restraints.
  • Meningitis: Fever, stiff neck; bacterial = antibiotics, droplet.

Endocrine & Metabolic

  • DKA: Type 1, ketones, acidosis, rapid acting insulin, fluids, K⁺.
  • HHS: Type 2, no ketones/acidosis, severe dehydration, fluids, then insulin.
  • Addison’s: Steroid deficiency, bronze skin, hypotension.
  • Cushing’s: Excess cortisol, moon face, striae, HTN.

Renal & GI

  • AKI: Oliguria, high BUN/Cr; CKD: Progressive, fluids and K⁺ buildup.
  • Dialysis: Protect fistula; peritonitis risk with peritoneal.
  • Upper GI bleed: Vomiting blood; lower: bloody stool.
  • Bowel obstruction: Vomiting, distension, no laxatives.

Maternal, Newborn, & Peds

  • Pregnancy: 3 trimesters; folic acid, watch for preeclampsia.
  • Fetal monitoring: VEAL CHOP mnemonic.
  • Postpartum hemorrhage: Fundal massage first.
  • Growth milestones: Walk by 1, 2-word phrases by 2.
  • Vaccines: HepB at birth, MMR/varicella at 12 months.
  • Pediatrics: Weight-based dosing, dehydration → IV fluids if severe.

Mental Health

  • Alcohol withdrawal: Seizure, DTs; priority = safety, low stimuli.
  • Depression: Sudden mood lift can mean suicide risk, monitor closely.
  • Anorexia: Start nutrition slowly, watch for refeeding syndrome.
  • Therapeutic communication: Open-ended, no "why," validate feelings.
  • Delirium: Acute, reversible; dementia: chronic, progressive.

Critical Care & Emergencies

  • ECG basics: P wave (atria), PR (0.12–0.20s), QRS (<0.12s), QT.
  • Shock: Hypovolemic (fluids), cardiogenic (inotropes), distributive (fluids, pressors).
  • CPR: 100–120/min, 2" adults, 1.5" infants.
  • Primary survey: ABCDE (airway, breathing, circulation, disability, exposure).

Infection Control, Safety, & Positioning

  • Airborne: N95, negative pressure; droplet: mask; contact: gown/gloves, soap for C diff.
  • Restraints: MD order, check q15min, release q2hr.
  • Positions: Fowler for lungs, flat for lumbar puncture, Sims for enemas.
  • Post-op: Assess ABCs, incentive spirometry, watch for DVT, infection timeline.

Key Terms & Definitions

  • ABG (Arterial Blood Gas) — test for blood pH, PaCO₂, and HCO₃⁻ to assess acid-base status.
  • DKA — diabetic ketoacidosis, emergency in type 1 diabetes.
  • SATA — Select All That Apply, a type of NCLEX question.
  • GCS — Glasgow Coma Scale, assesses consciousness.
  • MONA — Morphine, Oxygen, Nitroglycerin, Aspirin (immediate MI care).

Action Items / Next Steps

  • Review normal lab values and vital sign ranges.
  • Memorize ABG interpretation steps and ROMe mnemonic.
  • Study insulin types and emergency drugs.
  • Practice prioritization/delegation scenarios.
  • Complete practice NCLEX questions to reinforce concepts.

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