Free NCLEX-RN Exam Flashcards

The transfer of responsibility for performing a nursing task from a licensed nurse to an unlicensed assistive personnel (UAP) or LPN, while retaining accountability for the outcome. Remember the Five Rights: Right Task, Right Circumstance, Right Person, Right Direction, Right Supervision.

A legal document requiring the healthcare provider to explain the procedure, risks, benefits, and alternatives before a patient agrees to treatment. The nurse's role is to witness the signature and ensure the patient understands—NOT to explain the procedure.

Federal law protecting patient health information (PHI). Requires minimum necessary disclosure, patient access to records, and authorization for non-treatment uses. Violations can result in civil and criminal penalties.

Legal documents expressing a patient's wishes about future healthcare decisions. Includes living wills (treatment preferences) and durable power of attorney for healthcare (designates decision-maker). Must be honored regardless of family wishes.

Internal document completed after any unusual occurrence that could harm a patient. Purpose is quality improvement, NOT punishment. Never reference the report in the patient's chart—document only the facts of what happened.

Infection control practices used for ALL patients regardless of diagnosis. Includes hand hygiene, PPE when contact with blood/body fluids is anticipated, safe injection practices, and respiratory hygiene. Assumes all blood/body fluids are potentially infectious.

Used for pathogens that remain suspended in air and travel long distances. Requires negative-pressure room and N95 respirator. Diseases: Measles, Varicella (chickenpox), Tuberculosis. Mnemonic: MTV needs AIR.

Used for pathogens transmitted via respiratory droplets (travel <6 feet). Requires private room and surgical mask within 6 feet. Diseases include influenza, pertussis, meningitis, diphtheria. Mnemonic: SPIDERMAN - Sepsis, Pertussis, Influenza, Diphtheria, Epiglottitis, Rubella, Meningitis, Adenovirus, Mumps.

Used for pathogens transmitted by direct or indirect contact. Requires private room, gown, and gloves for all patient contact. Diseases: C. diff, MRSA, VRE, scabies, herpes zoster (shingles). Dedicated equipment required.

Fire emergency protocol: R-Rescue patients in immediate danger, A-Activate alarm (pull station, call code), C-Contain fire (close doors/windows), E-Extinguish or Evacuate. Rescue always comes first.

Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation. Additional rights include: Right to Refuse, Right Reason, Right Response, Right Education.

The concentration of a drug in the blood that produces the desired effect without toxicity. Drugs requiring monitoring: digoxin (0.5-2 ng/mL), lithium (0.6-1.2 mEq/L), phenytoin (10-20 mcg/mL), vancomycin (trough 10-20 mcg/mL).

Peak = highest drug concentration (drawn 30-60 min after IV infusion). Trough = lowest concentration (drawn just before next dose). Used to monitor aminoglycosides, vancomycin, and other drugs with narrow therapeutic ranges.

Protamine sulfate. Reverses heparin's anticoagulant effect. Given IV slowly. 1 mg neutralizes approximately 100 units of heparin. Watch for hypotension and bradycardia during administration.

Vitamin K (phytonadione). Reverses warfarin's anticoagulant effect by restoring clotting factors. Takes 24-48 hours for full effect. For urgent reversal, also give fresh frozen plasma (FFP) or prothrombin complex concentrate.

Early signs: anorexia, nausea, vomiting, visual disturbances (yellow-green halos, blurred vision). Late signs: bradycardia, heart block, dysrhythmias. Check potassium—hypokalemia increases toxicity risk. Hold if HR < 60 bpm in adults.

Antihypertensives that block angiotensin-converting enzyme. Examples: lisinopril, enalapril. Key side effect: persistent dry cough (switch to ARB if intolerable), hyperkalemia, angioedema. Contraindicated in pregnancy.

Block beta-adrenergic receptors, decreasing heart rate and blood pressure. Examples: metoprolol, atenolol, propranolol. Side effects: bradycardia, hypotension, fatigue, masks hypoglycemia symptoms. Never stop abruptly—taper dose.

Priority framework: 1) Physiological (airway, breathing, circulation), 2) Safety/Security, 3) Love/Belonging, 4) Self-Esteem, 5) Self-Actualization. Always address physiological needs first—ABC before psychosocial.

Airway, Breathing, Circulation—the foundation of nursing priority. A patent airway is always the first priority. Exception: In cardiac arrest, start CPR (Circulation) immediately while preparing airway management.

Semi-sitting position with head of bed elevated 45-60 degrees (High Fowler's is 60-90 degrees). Used for respiratory distress, cardiac conditions, eating, and post-operative care. Promotes lung expansion and reduces venous return.

Supine with feet higher than head (bed tilted). Previously used for shock—NOW CONTRAINDICATED as it increases intracranial pressure and impairs breathing. Modified Trendelenburg (legs elevated only) may be used.

Standardized neurological assessment measuring Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Scores range 3-15. Score ≤8 indicates severe brain injury/coma and likely need for intubation.

Heart rate 60-100 bpm, regular rhythm, P wave before every QRS, consistent PR interval (0.12-0.20 sec), narrow QRS (<0.12 sec). This is the baseline normal heart rhythm.

Irregularly irregular rhythm with no discernible P waves (fibrillatory waves instead). Major complication: stroke from blood clots forming in atria. Treatment: rate control, rhythm control, anticoagulation (Stroke risk: CHA₂DS₂-VASc score).

Chaotic, disorganized electrical activity with no effective cardiac output—a lethal rhythm requiring immediate defibrillation. No pulse = start CPR immediately. Treatment: Defibrillation, CPR, epinephrine, amiodarone.

Cardiac biomarker released when heart muscle is damaged. Most specific indicator of myocardial infarction (MI). Rises 4-6 hours after injury, peaks at 12-24 hours, remains elevated 7-10 days. Serial levels needed.

Left-sided: Pulmonary symptoms—dyspnea, orthopnea, crackles, pink frothy sputum, S3 gallop. Right-sided: Systemic congestion—peripheral edema, JVD, hepatomegaly, weight gain. Remember: Left=Lungs, Right=Rest of body.

Non-invasive measurement of oxygen saturation. Normal: 95-100%. Below 90% indicates hypoxemia requiring intervention. Factors affecting accuracy: poor perfusion, dark nail polish, carbon monoxide poisoning (falsely high).

Nasal cannula: 1-6 L/min (24-44% O2). Simple mask: 5-8 L/min (40-60%). Non-rebreather: 10-15 L/min (80-95%). Venturi mask: precise FiO2 delivery. High-flow nasal cannula: up to 60 L/min with heated humidity.

pH <7.35, PaCO2 >45 mmHg. Caused by hypoventilation (COPD, sedation, neuromuscular disease). CO2 is an acid—retaining it lowers pH. Treatment: Improve ventilation, treat underlying cause. May need mechanical ventilation.

pH >7.45, PaCO2 <35 mmHg. Caused by hyperventilation (anxiety, pain, fever, early sepsis). Blowing off too much CO2. Treatment: Calm patient, slow breathing, treat underlying cause. Paper bag breathing is outdated.

Maintains negative pressure in pleural space. Keep drainage system below chest level. Monitor for air leaks (bubbling in water seal), drainage amount/color. Never clamp unless ordered or changing system. Notify provider if >100 mL/hr drainage.

Early: Headache, vomiting (often without nausea), altered LOC, pupil changes. Late (Cushing's Triad): Widening pulse pressure, bradycardia, irregular respirations. Posturing (decerebrate/decorticate) indicates severe injury.

F-Face drooping, A-Arm weakness, S-Speech difficulty, T-Time to call 911. Additional signs: sudden confusion, vision changes, severe headache, difficulty walking. Time is critical—'Time is Brain.'

Pad side rails, bed in lowest position, suction at bedside, oxygen available, IV access. During seizure: Protect from injury (don't restrain), turn to side, nothing in mouth, time the seizure. Post-ictal: Maintain airway, reorient.

Causes: Diuretics, vomiting, diarrhea, alkalosis. Signs: Muscle weakness, leg cramps, constipation, shallow respirations, cardiac dysrhythmias (flattened T waves, U waves). Life-threatening—can cause cardiac arrest.

Causes: Renal failure, ACE inhibitors, K+-sparing diuretics, crush injuries. Signs: Muscle weakness, paresthesias, bradycardia, peaked T waves, wide QRS. Emergency treatment: Calcium gluconate (cardioprotective), insulin + glucose, kayexalate.

Causes: SIADH, water intoxication, diuretics, heart failure. Signs: Confusion, headache, nausea, seizures, muscle cramps. Severe cases (<120): Cerebral edema, coma. Correct slowly to prevent osmotic demyelination syndrome.

Causes: Hypoparathyroidism, vitamin D deficiency, renal failure, pancreatitis. Signs: Tetany, Trousseau's sign (carpal spasm with BP cuff), Chvostek's sign (facial twitch), laryngospasm, prolonged QT interval. Administer calcium IV slowly.

Assessment at 1 and 5 minutes after birth. Evaluates: Appearance (color), Pulse, Grimace (reflex), Activity (tone), Respirations. Score 0-2 for each = total 0-10. Score <7 at 5 minutes requires intervention.

Pregnancy-induced hypertension (BP ≥140/90) after 20 weeks with proteinuria or end-organ dysfunction. Signs: Edema (face/hands), headache, visual changes, epigastric pain. Severe: BP ≥160/110. Treatment: Magnesium sulfate (prevent seizures), delivery.

Given for preeclampsia/eclampsia seizure prevention. Therapeutic level: 4-7 mEq/L. Toxicity signs: Loss of deep tendon reflexes (first sign), respiratory depression (<12/min), cardiac arrest. Antidote: Calcium gluconate.

Early: Mirror contractions, head compression—normal. Variable: Abrupt drops, cord compression—reposition mother. Late: After contraction peak, uteroplacental insufficiency—emergency, position change, oxygen, notify provider, prepare for delivery.

Ask directly: 'Are you thinking of killing yourself?' Assess plan (specific method), means (access to method), intent (timeline). Higher risk: Male, older, substance abuse, previous attempts, hopelessness. Never leave high-risk patient alone.

Techniques: Open-ended questions, reflection, clarification, silence, empathy, summarizing. Avoid: Giving advice, false reassurance, 'why' questions, changing subject, approval/disapproval, agreeing with delusions.

Life-threatening reaction from excess serotonin, often from drug interactions (SSRIs + MAOIs). Signs: Hyperthermia, agitation, tremor, hyperreflexia, diarrhea, muscle rigidity. Treatment: Stop offending drugs, supportive care, cyproheptadine.

For patients with ANC <1500 (severe: <500). Private room, strict hand hygiene, no fresh flowers/plants, no raw foods, avoid crowds, daily assessment for infection. Fever may be only sign of infection—report immediately.

Oncologic emergency when tumor cells die rapidly (after chemo). Release of intracellular contents causes: Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia. Can cause acute kidney injury, cardiac arrest. Prevention: Hydration, allopurinol.

Signs of acute hemolytic reaction: Fever, chills, back/flank pain, hypotension, hemoglobinuria (dark urine). Action: STOP transfusion immediately, keep IV open with NS, notify provider and blood bank, send blood bag and patient samples.