Free NCLEX-RN Exam Flashcards

Delegation lets a competent delegatee perform a specific nursing task beyond their routine role while the RN keeps accountability for the decision, directions, monitoring, and evaluation; routine care within someone's scope or routine functions is an assignment (NCSBN/ANA 2019). Apply the five rights—task, circumstance, person, direction/communication, and supervision/evaluation—and check the state nurse practice act and facility policy for LPN/VN and assistive-personnel scope.

Informed consent is an ongoing communication process, not merely a signed form. The clinician responsible for the procedure explains its purpose, material risks, benefits, and alternatives; the patient or authorized surrogate decides voluntarily. The nurse may witness, assess understanding, reinforce information within scope, and pause/escalate unanswered questions before the procedure.

HIPAA generally permits protected health information to be used or disclosed for treatment, payment, and health care operations without separate patient authorization, subject to safeguards. The minimum-necessary rule generally applies to payment/operations uses and requests, but not disclosures to or requests by providers for treatment. Access records only for a legitimate role-related purpose.

An advance directive records preferences for future decisions or designates a surrogate if the patient loses decision-making capacity. A capable patient’s informed current wishes govern even when they differ from an older directive or family preference. If capacity is lost, use applicable directive and surrogate rules.

An incident or variance report supports internal safety review after an unexpected event or near miss. Assess and treat the patient first; chart objective clinical facts, actions, and notifications in the health record. Complete the separate report per facility policy without speculating or blaming.

Standard Precautions apply to every patient. Perform hand hygiene and use gloves, gown, mask/eye protection when exposure to blood, body fluids, secretions, nonintact skin, or mucous membranes is anticipated; also use safe injection and respiratory hygiene practices. Add transmission-based precautions when indicated.

Airborne Precautions use an airborne-infection isolation room and appropriate respirator for infections such as measles or pulmonary tuberculosis. Varicella (chickenpox) requires both Airborne and Contact Precautions; do not teach an airborne-only mnemonic as complete protection.

Droplet Precautions call for a medical mask according to facility entry/close-contact policy, plus source control and placement measures. Examples include influenza, pertussis, and meningococcal disease. There is no universal six-foot rule for all pathogens, and “all sepsis” or “all meningitis” does not identify a single isolation category.

Contact Precautions usually add gown and gloves and dedicated/disinfected equipment for direct or indirect contact spread, such as C. difficile or scabies. For zoster, disseminated disease—or localized disease in an immunocompromised patient until dissemination is excluded—needs Airborne plus Contact; coverable localized zoster in an immunocompetent patient generally uses Standard Precautions.

RACE is a fire-response memory aid: Rescue people in immediate danger **if safe**, Activate the alarm, Contain by closing doors, then Extinguish only if trained and safe or Evacuate. Follow the facility fire plan; never enter an unsafe fire or delay alarm activation to attempt a rescue alone.

Check the correct patient, medication, dose, route, time, and documentation; also verify indication, allergies, required assessments, patient education/refusal, and response. “Rights” are a final safety check, not a substitute for reconciling the order and monitoring effects.

A therapeutic drug level is interpreted in the context of dose timing, renal function, response, and toxicity—not one universal “safe” number. For serious MRSA infection, current vancomycin guidance favors AUC/MIC 400–600 (assuming MIC 1 mg/L) rather than a stand-alone 10–20 mcg/mL trough target. Follow drug-specific protocols.

A peak approximates post-dose maximum concentration; a trough is sampled just before the next dose when the drug-specific protocol calls for it. Exact sampling times vary by drug, route, infusion length, and local method. Modern vancomycin monitoring for serious MRSA commonly uses AUC-based assessment, not a universal peak/trough timetable.

Protamine sulfate reverses unfractionated heparin; the dose depends on recent heparin exposure and is given slowly because hypotension and reactions can occur. It only **partially** reverses low-molecular-weight heparin such as enoxaparin. Confirm agent, timing, and protocol before administration.

Vitamin K restores synthesis of vitamin K–dependent clotting factors but does not provide immediate reversal. For life-threatening warfarin-associated bleeding, urgent management commonly combines **four-factor prothrombin complex concentrate (4F-PCC)** with IV vitamin K, using local protocol and specialist direction; plasma may be used when PCC is unavailable. Monitor INR and bleeding.

Digoxin toxicity may cause nausea, poor appetite, confusion, visual changes, bradycardia, or other arrhythmias; these do not follow a reliable early-to-late sequence. Check ECG, renal function, potassium, and serum level when indicated. Hold and notify per the ordered heart-rate/clinical parameters; do not use one blanket adult pulse cutoff for every patient.

ACE inhibitors (for example lisinopril) lower angiotensin II and are used for hypertension, heart failure, and selected kidney disease. Watch for cough, hyperkalemia, rising creatinine, and potentially life-threatening angioedema. They can injure a fetus and should not be used during pregnancy.

Beta blockers (for example metoprolol) slow heart rate and reduce sympathetic effects. Assess pulse/BP and clinical status; adverse effects can include bradycardia, hypotension, fatigue, and masking of adrenergic hypoglycemia warning signs. Avoid abrupt discontinuation without a prescriber plan because rebound ischemia or tachycardia can occur.

Maslow’s hierarchy is a planning heuristic: physiologic needs, safety, belonging, esteem, and self-actualization. In triage, prioritize the most immediate threat using current cues, time sensitivity, and patient preferences; the pyramid does not justify ignoring active hemorrhage, acute confusion, or imminent self-harm because a rote “ABC first” slogan says so.

Airway, breathing, and circulation are a rapid assessment framework, not an inflexible order. Treat the life-threatening problem found now: start CPR and attach a defibrillator for pulseless arrest; control catastrophic external bleeding when present; support airway/ventilation when compromised. Reassess and escalate as the patient changes.

Fowler’s positioning elevates the head of the bed; semi-Fowler’s is commonly about 30–45° and higher Fowler’s about 60–90°. It can improve comfort and lung expansion in an appropriate patient, but select position for the patient’s hemodynamics, precautions, and procedure rather than assuming it treats every respiratory or cardiac problem.

Trendelenburg tilts the supine patient head-down. It may be used for selected procedures or short-term positioning under a specific order, but is **not recommended as routine shock treatment** and may worsen breathing or raise intracranial pressure. Treat the cause of shock; use positioning only when appropriate to the patient.

The Glasgow Coma Scale scores eye opening (1–4), verbal response (1–5), and motor response (1–6), for a total of 3–15. A score of 8 or less signals severe impairment and need for urgent airway assessment, but intubation depends on actual airway protection, ventilation, trajectory, and clinical context—not the number alone.

Adult normal sinus rhythm has a regular 60–100/min rate, a sinus P wave before each QRS, a consistent PR interval (usually 0.12–0.20 s), and typically narrow QRS complexes. Interpret the tracing with symptoms and perfusion; a “normal” strip does not replace patient assessment.

Atrial fibrillation has an irregularly irregular ventricular rhythm without consistent discrete P waves. Assess rate, symptoms, hemodynamic stability, and stroke risk; treatment may include rate or rhythm control and anticoagulation when indicated after weighing thromboembolic and bleeding risks.

Ventricular fibrillation is disorganized ventricular electrical activity without effective cardiac output. In a pulseless patient, start high-quality CPR and deliver unsynchronized defibrillation promptly under the current resuscitation algorithm; resume CPR immediately after shock and give drugs at the indicated stages.

High-sensitivity cardiac troponin detects myocardial **injury**, not myocardial infarction by itself. An acute rise/fall above the assay’s 99th-percentile limit plus evidence of ischemia (symptoms, ECG, imaging, or thrombus) supports MI. Serial testing and the clinical picture distinguish ischemic MI from other injury causes; timing is assay-specific.

Left-sided heart failure often causes pulmonary congestion (dyspnea, orthopnea, crackles); right-sided failure often causes systemic congestion (edema, jugular venous distention, hepatomegaly). The two commonly coexist. Track weight, perfusion, breathing, and response to therapy rather than relying on one mnemonic.

Pulse oximetry estimates arterial oxygen saturation but is not a direct measure of ventilation or oxygen delivery. Poor perfusion, motion, nail products, carbon monoxide, and skin pigmentation can affect accuracy; darker skin may mask hypoxemia in some devices. Assess the patient and waveform, verify unexpected readings, and use the ordered condition-specific oxygen target.

Oxygen devices provide different ranges, but delivered FiO2 is **not fixed** by a flow-rate table: fit, inspiratory demand, breathing pattern, and device setup matter. Nasal cannula gives low-flow oxygen; a Venturi device provides a controlled set concentration; a nonrebreather needs sufficient flow to keep its reservoir inflated. Titrate to the prescribed SpO2 goal and reassess.

Respiratory acidosis results from inadequate alveolar ventilation with elevated PaCO2; acute cases usually lower pH below 7.35, while chronic compensation may partly normalize pH. Check the blood gas and patient, improve ventilation as appropriate, and treat the cause rather than treating the number alone.

Respiratory alkalosis reflects excessive ventilation relative to CO2 production, with low PaCO2 and often high pH. Causes include pain/anxiety, hypoxemia, pulmonary embolism, or sepsis. Assess and treat the cause; never use paper-bag rebreathing as a routine response because it can worsen unrecognized hypoxemia.

Keep a chest drainage unit below the patient’s chest and monitor respiratory status, water-seal behavior, tubing, and drainage trend/character. Continuous bubbling can signal an air leak; sudden bright-red output, abrupt change, or patient deterioration needs prompt escalation according to the indication and local protocol. There is no universal “>100 mL/hr” notification threshold for every chest tube.

Worsening consciousness, new headache/vomiting, or focal/pupillary changes can signal rising intracranial pressure. Bradycardia, widened pulse pressure, and irregular breathing are late Cushing findings. Escalate a new neurologic change immediately; do not wait for the full triad.

FAST means Face droop, Arm weakness, Speech difficulty, Time to activate emergency response. Sudden vision loss, imbalance, severe headache, or other focal deficits can also indicate stroke. Record last-known-well time and follow the acute stroke pathway.

During a seizure, protect the person from injury, time the event, ease to the side when safe, and maintain airway after it ends. Do not restrain limbs or put anything in the mouth. Escalate prolonged, repeated, or first-time seizures and assess postictal breathing, injury, and recovery.

Hypokalemia (often K+ <3.5 mEq/L) can follow GI loss, diuretics, or intracellular shifts. Weakness and ECG changes (flattened T waves, U waves, arrhythmias) may occur, especially when severe. Assess ECG, magnesium, renal function, and replacement route/rate under the order; never give IV potassium by IV push; it is given only diluted, as a controlled infusion under the order.

Hyperkalemia can impair conduction and cause peaked T waves, QRS widening, or arrhythmia, though ECG changes are not perfectly sensitive. With severe hyperkalemia or ECG changes, use the emergency pathway: IV calcium stabilizes myocardium, insulin with glucose shifts K+ into cells, and potassium must then be removed (for example diuretics, binders in selected cases, or dialysis). Sodium polystyrene sulfonate is too slow and unreliable as the sole immediate rescue.

Hyponatremia is generally serum sodium below 135 mEq/L. Urgency depends on neurologic symptoms, acuity, cause, and risk of overcorrection—not a single “severe” number. Seizures or severe encephalopathy require urgent clinician-directed hypertonic saline; chronic cases need carefully monitored correction to reduce osmotic demyelination risk.

Hypocalcemia means low biologically active ionized calcium; a low total calcium can reflect low albumin, and acid–base changes also affect interpretation. Symptoms may include paresthesias, tetany, laryngospasm, seizures, and QT prolongation. Symptomatic or severe cases may need monitored IV calcium; mild/asymptomatic cases usually need cause-directed oral treatment. Check ionized calcium when total calcium is unreliable.

Apgar scores appearance, pulse, grimace, activity, and respiration (0–2 each) at 1 and 5 minutes after birth. **Begin resuscitation when clinically indicated before the 1-minute score**; Apgar does not decide whether to start. If the 5-minute score is under 7, repeat every five minutes through 20 minutes while documenting care.

Preeclampsia can arise after 20 weeks or postpartum: new, confirmed hypertension (systolic ≥140 **or** diastolic ≥90 mm Hg) with proteinuria or qualifying organ dysfunction. Persistent severe-range BP is systolic ≥160 **or** diastolic ≥110 and needs urgent escalation/treatment, including postpartum. Watch for headache, visual symptoms, epigastric/RUQ pain, pulmonary edema, or lab changes; magnesium prevents/treats seizures when indicated.

Magnesium sulfate is used for seizure prevention/treatment in preeclampsia/eclampsia. Monitor respirations, deep-tendon reflexes, urine output, and clinical status; toxicity can cause diminished reflexes, respiratory depression, and cardiac effects, but no sign is guaranteed to occur first. Stop the infusion and escalate suspected toxicity; IV calcium gluconate is the reversal agent under protocol.

Early decelerations often mirror contractions and reflect head compression; abrupt variable decelerations suggest cord compression; recurrent late decelerations have a nadir after the contraction peak and warrant assessment for impaired uteroplacental perfusion. Reposition, address hypotension/tachysystole and oxytocin as indicated, notify the team, and consider delivery if unresolved. **Do not give routine maternal oxygen when saturation is normal**; treat maternal hypoxia when present.

Ask directly about suicidal thoughts, intent, plan, access to means, prior attempts, and current protective factors without judgment. Imminent risk requires immediate safety measures and urgent mental-health evaluation under policy; do not leave an acutely unsafe patient without appropriate observation. Demographics alone cannot classify individual risk.

Therapeutic communication uses open invitations, reflection, clarification, silence, and validation to understand the patient’s experience. Avoid false reassurance, arguing with delusions, premature advice, or abruptly changing the subject. Ask respectful, nonjudgmental questions and adapt to patient preference and culture.

Serotonin syndrome is a potentially life-threatening serotonergic drug reaction. Look for acute mental-status change, autonomic instability, and neuromuscular findings—especially clonus/hyperreflexia—after a new drug, dose, or interaction. Stop serotonergic agents and obtain urgent supportive care; specific medication such as cyproheptadine is clinician-directed.

Neutropenia increases infection risk, especially when ANC is <500/µL or expected to fall there. Prioritize hand hygiene, prompt evaluation of fever, and food safety; a fever may be the only clue to serious infection. Protective rooms, flower restrictions, and food limits depend on treatment and institutional policy (especially stem-cell transplant), not one universal rule for every patient with ANC <1500.

Tumor lysis syndrome releases intracellular potassium, phosphate, and nucleic acids, causing hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and kidney injury. Prevention and treatment are risk-adapted: hydration and monitoring, allopurinol for selected prophylaxis, and rasburicase for selected high-risk/hyperuricemic cases. **Rasburicase is contraindicated in G6PD deficiency** because of hemolysis risk.

Suspect an acute transfusion reaction with fever/chills, back pain, dyspnea, hypotension, or dark urine. **Stop the transfusion immediately**, assess/support the patient, keep IV access with normal saline through **new tubing** per protocol, recheck patient/unit identification, and notify the provider and blood bank. Preserve the unit and samples for the prescribed investigation; do not restart it without authorization.