Free NCLEX-PN Exam Flashcards

LPN/LVNs provide care under RN or provider supervision. CAN: Collect data, reinforce teaching, administer medications (varies by state), perform treatments. CANNOT: Initial assessment, develop care plans, delegate to other LPNs, give IV push meds in most states.

Right Task (appropriate to delegate), Right Circumstance (stable patient, proper setting), Right Person (competent and qualified), Right Direction (clear instructions), Right Supervision (follow-up and feedback). LPNs can delegate to UAPs within scope.

Organizational reporting structure: UAP → LPN → RN → Charge Nurse → Nurse Manager → Director of Nursing → Administration. Always report changes in patient condition UP the chain. Document communication.

Structured handoff tool: S-Situation (what's happening), B-Background (relevant history), A-Assessment (what you think is wrong), R-Recommendation (what you need). Use when reporting to RN or provider.

Legal documents expressing patient's healthcare wishes. Includes living will (treatment preferences) and healthcare proxy/POA (designated decision-maker). LPN role: Document existence, ensure forms are in chart, respect patient wishes.

Document completed after unusual occurrences (falls, medication errors, injuries). Purpose: Quality improvement, NOT punishment. Never document in patient chart that report was filed. Include only objective facts.

Used for ALL patients regardless of diagnosis. Includes: Hand hygiene, PPE when contact with blood/body fluids anticipated, safe sharps disposal, respiratory hygiene. Treats all blood and body fluids as potentially infectious.

Most important infection prevention measure. Alcohol-based rub: 15-20 seconds. Soap and water required for: Visibly soiled hands, C. diff, before eating, after restroom. WHO's 5 Moments: Before patient contact, before aseptic task, after body fluid exposure, after patient contact, after touching surroundings.

For infections spread by direct/indirect contact. Requires: Private room, gown and gloves for all contact. Diseases: C. diff, MRSA, VRE, scabies, herpes zoster. Dedicated equipment. Hand hygiene with soap and water for C. diff.

For pathogens spread via large respiratory droplets (<6 feet). Requires: Private room, surgical mask within 6 feet. Diseases: Influenza, pertussis, meningitis, mumps. Mnemonic: SPIDERMAN.

For pathogens that remain airborne over distance. Requires: Negative pressure room, N95 respirator (fit-tested). Diseases: TB, measles, varicella (chickenpox). Mnemonic: MTV needs AIR.

Risk factors: Age >65, medications (sedatives, diuretics), mobility issues, confusion, incontinence, previous falls. Interventions: Bed alarm, low bed, non-slip footwear, call light in reach, toileting schedule, adequate lighting.

R-Rescue anyone in immediate danger, A-Activate alarm, C-Contain fire (close doors/windows), E-Extinguish or Evacuate. For extinguisher use: PASS (Pull pin, Aim low, Squeeze handle, Sweep side to side).

Right Patient (2 identifiers), Right Drug, Right Dose, Right Route, Right Time, Right Documentation. Additional rights: Right to Refuse, Right Education, Right Reason, Right Response.

Medications with high risk for harm if given incorrectly. Includes: Insulin, opioids, anticoagulants, chemotherapy, potassium IV. Require independent double-check. Many facilities use special labeling.

Rapid-acting (lispro, aspart): Onset 15 min, peak 1-2 hr. Short-acting (Regular): Onset 30 min, peak 2-4 hr. Intermediate (NPH): Onset 2 hr, peak 4-12 hr. Long-acting (glargine): No peak, 24 hr duration. Never mix long-acting with other insulins.

Cardiac glycoside for heart failure and atrial fibrillation. Check apical pulse for 1 minute before giving—hold if <60 bpm in adults. Therapeutic level: 0.5-2.0 ng/mL. Toxicity signs: Nausea, vomiting, yellow-green halos, bradycardia.

Anticoagulant that inhibits vitamin K-dependent clotting factors. Monitor INR (therapeutic: 2-3 for most conditions). Antidote: Vitamin K. Interacts with many foods (leafy greens) and drugs. Teach consistent vitamin K intake.

Fast-acting anticoagulant. Monitor aPTT (therapeutic: 1.5-2.5x control). Given IV or SubQ (never IM). Antidote: Protamine sulfate. Risk: HIT (heparin-induced thrombocytopenia)—monitor platelet count.

Respiratory depression (<12/min), pinpoint pupils, decreased LOC, hypotension, constipation. Antidote: Naloxone (Narcan). Monitor after reversal—may need repeat doses as opioid outlasts naloxone. Pain may return.

Stage 1: Non-blanchable redness. Stage 2: Partial thickness (blister or shallow crater). Stage 3: Full thickness to subcutaneous. Stage 4: Full thickness with bone/tendon visible. Unstageable: Covered with slough/eschar.

Pressure injury risk assessment. Six subscales: Sensory perception, moisture, activity, mobility, nutrition, friction/shear. Score 6-23; lower score = higher risk. <18 = at risk, <12 = high risk.

Use behavioral cues: Facial grimacing, guarding, restlessness, moaning, changes in vital signs. Tools: FLACC scale (children), PAINAD (dementia). Document behaviors observed and interventions.

Gold standard: X-ray confirmation. Bedside methods: Aspirate gastric contents and test pH (<5 indicates gastric). Observe for respiratory distress. Never use auscultation of air injection alone—unreliable.

Keep drainage bag below bladder level. Secure tubing to prevent pulling. Cleanse perineum daily. Monitor output hourly in critical patients. Remove as soon as clinically indicated—infection risk increases with duration.

Influenza: Annually. Tdap: Once, then Td every 10 years. Pneumococcal: Age 65+ or high-risk. Shingrix: Age 50+, two doses. COVID-19: Per current guidelines. HPV: Up to age 26 (or 45 with shared decision-making).

Breast: Mammogram starting age 40-50, every 1-2 years. Cervical: Pap smear starting age 21. Colorectal: Starting age 45, colonoscopy every 10 years or stool test annually. Prostate: Discuss with provider age 50+.

Ask about tobacco use, Advise to quit, Assess readiness to quit, Assist with quit plan, Arrange follow-up. Nicotine replacement, bupropion, and varenicline are pharmacologic options.

Effective: Open-ended questions, reflection, restating, silence, clarification, summarizing, empathy. Avoid: False reassurance, giving advice, changing subject, 'why' questions, approval/disapproval, agreeing with delusions.

Delirium: Acute onset, fluctuating course, reversible, caused by medical condition. Dementia: Gradual onset, progressive, irreversible, alert consciousness. Delirium in elderly often mistaken for dementia—always investigate cause.

Ask directly: 'Are you thinking of hurting yourself?' Assess: Plan specificity, means access, intent, previous attempts, hopelessness. Higher risk: Male, elderly, substance abuse, recent loss. Never leave high-risk patient alone.

Maintain calm voice and demeanor. Give space—don't corner. Listen actively, acknowledge feelings. Offer choices when possible. Set clear limits. Know when to get help. Document behaviors and interventions.

DABDA: Denial, Anger, Bargaining, Depression, Acceptance. Not linear—patients may move between stages or experience multiple simultaneously. All responses are normal. Provide support and therapeutic presence.

Temperature: 97.8-99.1°F (36.5-37.3°C). Pulse: 60-100 bpm. Respirations: 12-20/min. Blood pressure: <120/80 mmHg. SpO2: 95-100%. Report significant deviations to RN.

Drop in BP when changing position (≥20 mmHg systolic or ≥10 mmHg diastolic). Symptoms: Dizziness, lightheadedness, syncope. Prevention: Rise slowly, dangle legs before standing, adequate hydration.

Normal fasting: 70-100 mg/dL. Pre-meal target for diabetics: 80-130 mg/dL. Hypoglycemia (<70): Give 15g fast-acting carbs, recheck in 15 minutes. Hyperglycemia: Report to RN for insulin coverage.

Hemoglobin: M 14-18, F 12-16 g/dL. Hematocrit: M 42-52%, F 37-47%. WBC: 5,000-10,000/mm³. Platelets: 150,000-400,000/mm³. Report critical values immediately.

Sodium: 136-145 mEq/L. Potassium: 3.5-5.0 mEq/L. Glucose: 70-100 mg/dL (fasting). BUN: 10-20 mg/dL. Creatinine: 0.7-1.3 mg/dL. CO2: 23-30 mEq/L.

P-Provokes (what makes it worse/better), Q-Quality (sharp, dull, crushing), R-Radiates (jaw, arm, back), S-Severity (0-10 scale), T-Timing (when started, constant vs intermittent). Report immediately and obtain vital signs.

Signs: Shakiness, sweating, hunger, confusion, irritability, tachycardia, pallor. Treatment: Conscious—15g fast carbs (4 oz juice, glucose tablets). Unconscious—glucagon IM or dextrose IV. Recheck in 15 min.

Signs: Polyuria, polydipsia, polyphagia, fruity breath (DKA), Kussmaul respirations (DKA), dehydration, altered mental status. Emergency—report immediately. Treatment: Fluids, insulin, electrolyte replacement.

Early: Tachycardia, anxiety, restlessness, cool/pale skin, delayed capillary refill. Late: Hypotension, weak pulse, altered LOC, decreased urine output. Report immediately—medical emergency.

Left-sided: Dyspnea, orthopnea, crackles, cough, fatigue. Right-sided: Peripheral edema, JVD, hepatomegaly, weight gain. Daily weights important—report gain >2 lbs overnight or >5 lbs/week.

F-Face drooping, A-Arm weakness, S-Speech difficulty, T-Time to call 911. Also: Sudden confusion, vision changes, severe headache, difficulty walking. Note time symptoms started—critical for treatment decisions.

Signs: Dyspnea, tachypnea, accessory muscle use, nasal flaring, retractions, cyanosis, decreased SpO2, tripod positioning, inability to speak full sentences. Report immediately, elevate HOB, prepare oxygen.

Precautions: Padded side rails, bed low, suction ready, oxygen available. During: Stay with patient, protect from injury (don't restrain), turn to side if possible, time seizure, don't put anything in mouth. After: Maintain airway, reorient, document.

First 24 hrs: Hemorrhage, respiratory depression, airway obstruction. Days 1-3: Atelectasis, paralytic ileus. Days 3-5: Infection signs appear, pneumonia. Days 5-7: Wound dehiscence. Days 7-10: DVT, PE.

Signs: Increased pain, redness, warmth, swelling (rubor, calor, tumor), purulent drainage, fever, elevated WBC. Report to RN. Culture may be ordered. Clean wounds before contaminated in care sequence.

Prevention: Early ambulation, SCDs, anticoagulants, hydration, avoid leg crossing. Signs: Unilateral leg pain, warmth, redness, swelling, positive Homan's sign (unreliable). Do not massage affected leg. Report immediately—risk of PE.

Sudden onset: Dyspnea, chest pain (pleuritic), tachycardia, tachypnea, anxiety, hemoptysis, hypotension. Medical emergency—call for help immediately. Position: HOB elevated. Prepare for oxygen, IV access, anticoagulation.