Management of Care
18%of exam
Safety + Infection
13%of exam
Health Promotion
9%of exam
GrowthPregnancyNewbornScreeningImmunization
Psychosocial Integrity
9%of exam
CommunicationCrisisCopingMental HealthGrief
Basic Care
9%of exam
MobilityNutritionEliminationRestPain
Pharmacology
16%of exam
RightsHigh AlertIV TherapyAdverse EffectsCalculations
Risk Reduction
12%of exam
LabsDiagnosticsVitalsComplicationsProcedures
Physiological Adaptation
14%of exam
EmergenciesABGsFluidsCardiacRespiratory
Quick Facts
- Exam
- NCLEX-RN
- Format
- CAT
- Items
- 85-150
- Time
- 5 hours
- Result
- Pass/fail
- NGN
- Case studies
- Plan
- 2026-2029
Priority
ABCs before pain
AirwayBreathingCirculationSafety
RN vs LPN
RN
- Assess
- Teach
- Evaluate
LPN
- Stable clients
- Focused care
- Known outcomes
Judgment vs implementation
Priority Picker
- Airway problem→Assess first
- Breathing problem→Oxygen/position
- Circulation shock→Rapid response
- Unstable finding→See first
- Expected symptom→Monitor
- New confusion→Assess now
Priority Rules
- ABCs
- Airway first
- Unstable
- Assess first
- Acute
- Before chronic
- Unexpected
- Before expected
- Safety
- Immediate hazard
- Maslow
- Physiology first
- Nursing process
- Assess before action
NCJMM Steps
Cues -> meaning -> action -> evaluate
RecognizeAnalyzePrioritizeAct
LPN vs UAP
LPN
- Licensed nurse
- Medications
- Sterile tasks
UAP
- Unlicensed helper
- Vitals
- ADLs
Nursing task vs routine
Delegation Picker
- Initial assessment→RN
- Discharge teaching→RN
- Stable dressing→LPN
- Routine vitals→UAP
- Ambulate stable client→UAP
- Evaluate care→RN
Delegation
- RN
- Assessment/teaching
- LPN
- Stable procedures
- UAP
- Routine tasks
- Right task
- Appropriate work
- Right person
- Competent delegate
- Right direction
- Clear instructions
- Supervision
- RN retains accountability
NGN Picker
- Data presented→Recognize cues
- Meaning asked→Analyze cues
- Most likely→Prioritize hypotheses
- Orders considered→Generate solutions
- Intervention asked→Take action
- Response asked→Evaluate outcomes
Clinical Judgment
- Recognize cues
- Find data
- Analyze cues
- Link meaning
- Prioritize hypotheses
- Rank problems
- Generate solutions
- Plan actions
- Take action
- Intervene
- Evaluate outcomes
- Check response
Fire Safety
RACE first; PASS extinguisher
RescueAlarmContainExtinguish
Droplet vs Airborne
Droplet
- Surgical mask
- Large particles
- Influenza
Airborne
- N95
- Negative pressure
- TB
Mask vs respirator
Precautions Picker
- MRSA wound→Contact
- C difficile→Contact
- Influenza→Droplet
- Pertussis→Droplet
- TB→Airborne
- Measles→Airborne
Precautions
- Standard
- All clients
- Contact
- Gown/gloves
- Droplet
- Surgical mask
- Airborne
- N95 room
- Neutropenic
- Protect client
- PPE off
- Gloves first
- Hand hygiene
- Before/after care
Maternal Newborn
- Fundus
- Firm midline
- Lochia
- Bleeding trend
- FHR
- Fetal status
- Late decels
- Placental issue
- Postpartum hemorrhage
- Boggy uterus
- Preeclampsia
- Seizure risk
Psych Communication
- Open-ended
- Encourage sharing
- Reflection
- Mirror feelings
- Silence
- Allow processing
- Validation
- Acknowledge feeling
- Why questions
- Usually avoid
- False reassurance
- Avoid minimization
Basic Comfort
- Turn schedule
- Pressure prevention
- High Fowler
- Breathing support
- Cane
- Strong side
- Walker
- Move then step
- Dysphagia
- Thickened liquids
- Ostomy
- Stoma assessment
Medication Rights
Client drug dose route time
ClientDrugDoseRouteTime
Pharm Safety
- Right client
- Two identifiers
- Right drug
- Match order
- Right dose
- Calculate safely
- Right route
- Verify access
- Right time
- Schedule window
- Insulin
- Double check
- Heparin
- Bleeding labs
- Digoxin
- Check pulse
Expected vs Unexpected
Expected
- Known effect
- Monitor
- Teach
Unexpected
- New danger
- Assess first
- Escalate
Known vs priority
Lab Flags
- K+
- Cardiac priority
- Na+
- Neuro changes
- Glucose low
- Treat fast
- INR high
- Bleeding risk
- WBC low
- Infection risk
- Platelets low
- Bleeding precautions
- Creatinine high
- Renal impairment
Hypoglycemia vs DKA
Hypoglycemia
- Low glucose
- Sweaty/shaky
- Fast sugar
DKA
- High glucose
- Ketones
- Kussmaul
Low fast vs high acid
Fluids + ABGs
- Hypovolemia
- Low volume
- Hypervolemia
- Fluid overload
- Hypokalemia
- Weak muscles
- Hyperkalemia
- Peaked T waves
- Acidosis
- pH low
- Alkalosis
- pH high
- Respiratory
- CO2 problem
- Metabolic
- HCO3 problem
Respiratory vs Metabolic
Respiratory
- CO2 drives
- Lungs
- Ventilation
Metabolic
- HCO3 drives
- Kidneys
- Bicarbonate
CO2 vs HCO3
Common Traps
Assess before action
Need data first ≠ Unless emergency exists
Do not delegate
RN assessment ≠ RN teaching
Precaution confusion
Droplet uses mask ≠ Airborne uses N95
NGN wording
Cues are data ≠ Outcomes are response
Pain priority
Pain matters ≠ Airway outranks pain
Stable vs unstable
Stable can wait ≠ Unstable seen first
Last Minute
- 1.Plan: 2026 through 2029
- 2.Items: 85-150; time: 5h
- 3.Minimum includes 3 case studies
- 4.ABCs beat comfort
- 5.Assess before implementing
- 6.RN keeps accountability
- 7.UAP gets routine tasks
- 8.Airborne = N95
- 9.Cues = data; outcomes = response
- 10.Unexpected changes first
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