Coordinated Care
18-24%of exam
Safety + Infection
10-16%of exam
Health Promotion
6-12%of exam
PreventionDevelopmentPregnancyAgingScreening
Psychosocial Integrity
9-15%of exam
CommunicationCopingGriefCrisisCulture
Basic Care
7-13%of exam
NutritionMobilityEliminationPainADLs
Pharmacological Therapies
10-16%of exam
Risk Reduction
9-15%of exam
Physiological Adaptation
7-13%of exam
FluidsCardiacRespiratoryNeuroEndocrine
Quick Facts
- Exam
- NCLEX-PN
- Credential
- LPN/LVN license
- Format
- CAT + NGN
- Items
- 85-150
- Time
- 5 hours
- Case studies
- 3 sets
- Pretest
- 15 unscored
- Fee
- $200
- Result
- Pass/fail
NCJMM Loop
Recognize, Analyze, Prioritize, Generate, Act, Evaluate
Recognize cuesAnalyze cuesPrioritize hypothesesGenerate solutionsTake actionEvaluate outcomes
LPN vs RN
LPN/VN
- Collects data
- Implements plan
- Reports changes
RN
- Comprehensive assessment
- Creates care plan
- Evaluates outcomes
Assist vs lead
Priority Picker
- Airway problem→Assess first(ABC)
- Breathing impaired→Oxygen, notify(ABC)
- Circulation unstable→Supine, legs up
- Acute change→See before chronic
- Unstable client→RN/provider now
- Pain only→After ABCs
CAT + NGN
- CAT
- Adaptive item selection
- Minimum
- 85 items
- Maximum
- 150 items
- Time
- 5 hours total
- Case study
- 6 linked items
- Pretest
- 15 unscored items
- Length
- Not pass/fail clue
- Results
- NRB releases
Delegation Rights
Task, circumstance, person, direction, supervision
Right taskRight circumstanceRight personRight directionRight supervision
UAP vs LPN
UAP
- Stable routine tasks
- ADLs
- Vital signs
LPN
- Medications
- Focused data
- Sterile skills
Routine vs licensed
Clinical Judgment
- Recognize cues
- Find relevant data
- Analyze cues
- Connect findings
- Prioritize hypotheses
- Rank likely problems
- Generate solutions
- Choose interventions
- Take action
- Implement priority care
- Evaluate outcomes
- Compare expected results
LPN Scope
- Collect data
- Focused findings
- Contribute plan
- Under RN direction
- Implement care
- Assigned interventions
- Reinforce teaching
- Established plan
- Report changes
- RN/provider promptly
- Know limits
- State practice act
Delegation
- Right task
- Routine predictable
- Right circumstance
- Stable client
- Right person
- Competent delegatee
- Right direction
- Clear instructions
- Right supervision
- Monitor results
- Accountability
- Nurse retains
Rights + Legal
- Autonomy
- Right to choose
- Refusal
- Document, notify
- Consent
- Provider explains
- HIPAA
- Minimum necessary
- Abuse
- Report suspected
- Incident report
- Not charted
PPE Order
On: gown, mask, goggles, gloves
Off: gloves firstMask lastHand hygieneAvoid self-contamination
Standard vs Transmission
Standard
- All clients
- Hand hygiene
- Body fluids
Transmission
- Known risk
- Extra PPE
- Isolation room
Baseline vs added
Isolation Picker
- Blood/body fluids→Standard(Always)
- Draining wound→Contact(Gown/gloves)
- C. diff stool→Contact(Soap/water)
- Influenza cough→Droplet(Mask)
- TB suspected→Airborne(N95)
- Measles/varicella→Airborne(Negative pressure)
Precautions
- Standard
- Every client
- Contact
- Gown + gloves
- Droplet
- Surgical mask
- Airborne
- N95 + negative pressure
- C. diff
- Soap and water
- TB
- Airborne isolation
- Influenza
- Droplet isolation
- MRSA wound
- Contact isolation
Fire Response
RACE then PASS
RescueAlarmContainExtinguishPull/aim/squeeze/sweep
Contact vs Droplet
Contact
- Touch spread
- Gown/gloves
- MRSA, C. diff
Droplet
- Large droplets
- Surgical mask
- Influenza, pertussis
Touch vs splash
Safety Basics
- Two identifiers
- Before care
- Falls
- Bed low
- Call light
- Within reach
- Restraints
- Last resort
- Seizure
- Protect, time
- Fire RACE
- Rescue alarm contain extinguish
- PASS
- Pull aim squeeze sweep
Primary vs Secondary
Primary
- Before disease
- Immunizations
- Safety teaching
Secondary
- Early detection
- Screenings
- Prompt treatment
Prevent vs detect
Prevention + Development
- Primary
- Prevent disease
- Secondary
- Detect early
- Tertiary
- Prevent complications
- Infant
- Trust vs mistrust
- Toddler
- Autonomy vs shame
- School-age
- Industry vs inferiority
- Older adult
- Integrity vs despair
- Pregnancy danger
- Bleeding, headache, edema
Therapeutic vs Nontherapeutic
Therapeutic
- Open questions
- Reflection
- Silence
Nontherapeutic
- Why questions
- False reassurance
- Personal advice
Explore vs block
Psych Communication
- Open-ended
- Encourage sharing
- Silence
- Allow processing
- Reflection
- Mirror feelings
- False reassurance
- Avoid
- Suicide talk
- Assess safety
- Crisis
- Ensure safety first
- Interpreter
- Professional preferred
- Grief
- Nonlinear process
Basic Comfort
- Tube feeds
- HOB 30-45
- Aspiration
- Side-lying risk clients
- Pressure injury
- Turn q2h
- Braden
- Skin risk scale
- Catheter bag
- Below bladder
- Stoma
- Pink, moist
- Enema
- Left Sims
- PQRST
- Pain assessment
Infiltration vs Phlebitis
Infiltration
- Cool swelling
- Pale site
- Fluid in tissue
Phlebitis
- Warm redness
- Tender vein
- Possible cord
Leak vs inflammation
Med Action Picker
- Wrong dose ordered→Clarify first
- Med error occurs→Assess client
- Digoxin pulse low→Hold, notify
- Opioid RR low→Hold, notify
- Warfarin INR high→Bleeding precautions
- Blood reaction→Stop transfusion
Med Safety
- Three checks
- Before administration
- Right patient
- Two identifiers
- Medication error
- Assess first
- Digoxin
- Apical pulse first
- Opioids
- Assess respirations
- KCl IV
- Never push
- Warfarin
- Monitor INR
- Heparin
- Monitor aPTT
- Insulin
- Clear before cloudy
- TPN
- Central line
Calculations
- Dose
- Desired/have x quantity
- kg
- lb divided by 2.2
- mL/hr
- Volume divided hours
- gtt/min
- Volume x drop/time
- Safe range
- Verify dose
- Units
- Carry through
Priority Frame
ABC, acute, unstable, actual
Airway firstBreathing nextCirculation nextAcute beats chronic
Diagnostic Picker
- Iodinated contrast→Check allergy/kidneys
- Post cath→Check pulses
- Post liver biopsy→Right side
- After endoscopy→Check gag
- MRI ordered→Remove metal
- Colonoscopy tomorrow→Bowel prep
Labs + Vitals
- SpO2
- <90 critical
- Urine output
- 30 mL/hr minimum
- K+
- 3.5-5.0 mEq/L
- Na+
- 135-145 mEq/L
- WBC
- 5,000-10,000/mm3
- Platelets
- 150,000-400,000/mm3
- INR
- 2-3 warfarin
- BNP
- Heart failure marker
- Troponin
- Myocardial injury
Procedure Prep
- Contrast
- Check allergy, kidneys
- Metformin
- Hold around contrast
- Cardiac cath
- Check distal pulses
- Liver biopsy
- Right side after
- Throat sedation
- NPO until gag
- MRI
- Screen metal
Hypo vs Hyperglycemia
Hypoglycemia
- Fast onset
- Sweaty, shaky
- Give glucose
Hyperglycemia
- Slow onset
- Thirst, polyuria
- Check ketones
Low now kills
Adaptation Emergencies
- Hypoglycemia
- 15 g glucose
- DKA
- Kussmaul, fruity breath
- Stroke
- Time onset
- Anaphylaxis
- Epinephrine first-line
- Shock
- Tachycardia early
- ICP
- HOB 30, midline
- COPD O2
- Use ordered flow
- Transfusion reaction
- Stop blood
DI vs SIADH
DI
- Too little ADH
- High urine
- High sodium
SIADH
- Too much ADH
- Low urine
- Low sodium
Dry vs diluted
Body Systems
- Left HF
- Pulmonary symptoms
- Right HF
- Systemic edema
- Arterial disease
- Pale, weak pulses
- Venous disease
- Edema, present pulses
- Chest tube leak
- Continuous bubbling
- Meningitis
- Droplet first 24h
- Hyperthyroid
- Heat, tachycardia
- Hypothyroid
- Cold, bradycardia
Arterial vs Venous
Arterial
- Weak pulses
- Pale, cool
- Elevate worsens
Venous
- Present pulses
- Brown edema
- Dependent worsens
Supply vs return
Common Traps
Old item maximum
205 was old ≠ 150 is 2026
Exam length myth
85 can fail ≠ 150 can pass
Scope confusion
LPN collects data ≠ RN assesses comprehensively
Teaching confusion
RN initiates teaching ≠ LPN reinforces teaching
Consent confusion
Provider obtains consent ≠ Nurse witnesses signature
C. diff trap
Alcohol gel insufficient ≠ Soap/water required
Warfarin antidote
Vitamin K reverses ≠ Protamine reverses heparin
Transfusion reaction
Stop blood first ≠ Keep saline line
Stroke timing
Note onset time ≠ Keep NPO
IV potassium
Never IV push ≠ Monitor cardiac rhythm
Last Minute
- 1.Coordinated care is largest
- 2.Exam length: 85-150 items
- 3.Three NGN case studies
- 4.Clinical judgment has six steps
- 5.LPN collects; RN assesses
- 6.Delegate stable routine tasks
- 7.ABC before pain
- 8.Airborne = N95
- 9.C. diff = soap/water
- 10.Digoxin: apical pulse first
- 11.Opioids: assess respirations
- 12.KCl: never IV push
- 13.Hypoglycemia: 15 g glucose
- 14.Transfusion reaction: stop blood
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