NCLEX 2026

Contact Precautions PPE

Gloves and Gown

Contact Precautions Disease

• MRSA

• VRE

• CRE

• RSV

• Scabies

• HSV

• Pediculosis (lice)

• Wound infections

• C. difficile

• Rotavirus

• Norovirus

• Conjunctivitis

C.diff Handwashing

Wash hands with soap and water (alcohol sanitizer does not kill spores)

Droplet Precautions PPE

Surgical mask

Droplet Precautions Disease

• Sepsis (meningococcal)

• Scarlet fever

• Streptococcal pharyngitis

• Pertussis

• Influenza

• Diphtheria

• Epiglottitis

• Rubella

• Mumps

• Adenovirus

• Mycoplasma pneumonia

(SPIDERMAN)

• Diphtheria

• Roseola

• Meningitis (bacterial)

• Rhinovirus

• Parvovirus

Droplet & Airborne Precautions Transportation

Patient wears surgical mask when transported.

Airborne Precautions PPE

N95, goggles, gown and gloves

Airborne Precautions Room

Negative pressure & door closed

Negative pressure room

pulls air into room, used for airborne diseases

Airborne Precautions Disease

• Measles (Rubeola)

• Varicella

• Tuberculosis

MTV

• SARS

• Smallpox

Tuberculosis Latent

positive TB test, no symptoms, not contagious

Tuberculosis Active

symptoms present, contagious, airborne precautions required

Tuberculosis Teaching

• do not stop medication (INH/rifampin)

• give B6/Pyridoxine with INH

• may turn urine orange

• are hepatotoxic (measure LFTs)

Neutropenic Precautions

Used when ANC <500

(normal is 1,500-8,000)

Neutropenic Precautions Interventions

• Private room

• No sick visitors

• No fresh flowers

• No fresh fruits or vegetables

• No rectal temperatures

• Avoid raw foods

• Positive pressure room (pushes air out)

Neutropenic Precautions Priority

fever is sign of infection → sepsis

PPE Donning

Bottom Up: Gown, Mask, Goggles, Gloves

PPE Doffing

Alphabetical: Gloves, Goggles, Gown, Mask

Sterile Field Rules

• 1-inch border is contaminated.

• Wet field is contaminated.

• Never reach over sterile field.

• Never turn your back on sterile field.

• Sterile items stay above waist level.

• Open flap away first, then sides, then toward self.

Sterile Field Broken

Replace it

Fall Prevention

• Bed in lowest position

• Call light within reach

• Non-skid footwear

• Scheduled toileting

• Bed alarms if indicated

Restraints Usage

• Patient is danger to self or others

• Less restrictive measures failed

Restraints Rules

• Obtain provider order

• Assess circulation

• Remove periodically per policy

• Document frequently

Suicide Precautions

• Remove sharps, cords, belts and harmful objects

• 1-1 observation for high risk patients

• Ask directly about suicidal thoughts

Physical Restraints

• Mitts

• Wrist restraints

• Four side rails up

Mechanical Restraints

• Handcuffs

• Straps

• Enclosed beds

Chemical Restraints

• Sedatives

• Antipsychotics

Seclusion Restraint

• Used for violent behavior

• Last resort

Fire: RACE

• Rescue

• Alarm

• Contain

• Extinguish

Fire Extinguisher: PASS

• Pull

• Aim

• Squeeze

• Sweep

CAUTI Prevention

• Avoid unnecessary Foley catheters

• Maintain closed drainage system

• Keep bag below bladder

• Secure catheter

• Perform perineal care

• No routine irrigation

• Do not disconnect tubing unnecessarily

CLABSI Prevention

• Scrub hub 15-30 seconds

• Chlorhexidine dressing

• Sterile dressing changes

• Hand hygiene

• Assess necessity daily

• Cap ports when not in use

• Flush with sterile saline using aseptic technique

Air Embolism Positioning

Left lateral Trendelenburg (keeps air trapped in R side of heart)

Durant’s maneuver

Pulmonary Embolism Signs

• Restlessness**

• Sudden SOB

• chest pain

• tachycardia

• hypoxia

• dullness to percussion

• anxiety

Pulmonary Embolism Position

High Fowler's (oxygenation)

Liver Biopsy Positioning

Right lateral (pressure to biopsy site)

Prolapsed Umbilical Cord

• Knee-chest, elevate hips, Trendelenburg

• cervical exam

• apply manual pressure, elevate fetus off cord

• administer O2

• wrap cord in sterile moist towel

• Emergency C-section

Tracheostomy Care Position

Semi-Fowler’s or Fowler’s

Adult Vital Signs

• HR: 60-100

• RR: 12-20

• BP: ~120/80

• O2: ≥95%

• Temp: 36.5-37.5°C

• Cap refill: <2 sec

Infant Vital Signs

• HR: 100-160

• RR: 30-60

Young Child Vital Signs

• HR: 90-140

• RR: 24-40

Older Child Vital Signs

• HR: 70-120

• RR: 18-30

Pain Assessment

• P = Provokes

• Q = Quality

• R = Region/Radiation

• S = Severity

• T = Timing

PQRST

Nonverbal Pain Signs

• Grimacing

• Guarding

• Restlessness

• Increased HR

• Increased BP

NG Tube & ETT Initial Placement

x-ray verified

NG Tube Verification Placement

aspirate contents & test pH (<5.5)

NG Tube Unsure Placement

stop feeding

Positive pressure room

pushes air out, for burn patients and neutropenic patients

Hypoxia early signs

• Restlessness

• Anxiety

• Tachycardia

• Tachypnea

Hypoxia Late Signs

• Cyanosis

• Bradycardia

• Decreased LOC

Hypoxia Earliest Sign

Restlessness

O2 Delivery Methods

Nasal cannula: 1-6 L/min

Simple face mask: 5-8 L/min

Nonrebreather: up to 15L/min

Venturi mask: 100% FiO2, often in COPD

Pulmonary Embolism Priority

Oxygen, Heparin IV, high fowler’s, notify HCP

Pneumothorax Signs

• Sudden chest pain

• Absent breath sounds

• Crepitus

• Tracheal deviation (tension pneumothorax)

• Dyspnea

Pneumothorax Priority

Prepare for chest tube.

Internal bleeding signs

• Tachycardia

• Hypotension

• Restlessness

• Cool clammy skin

• Decreased UO

Normal wound healing

• Pink granulation tissue

• Minimal drainage

• Approximated edges

• Mild redness limited to incision line

• Temp is slightly increased (99.1)

Infection Signs

• Redness

• Warmth

• Swelling

• Pain

• Purulent drainage

• Fever

• Elevated WBCs

• Chills

Wound Dehiscence

Separation of wound edges.

Wound dehiscence Intervention

• Reduce strain.

• Notify provider.

• Cover with sterile saline dressing.

Evisceration

Organs protrude through incision.

Evisceration Intervention

1. Cover with moist sterile saline/water dressings

2. Keep patient warm, quiet, no coughing

3. Low fowler’s & Knees bent.

4. Notify surgeon immediately.

5. NPO.

JP Drain Purpose

Remove fluid and prevent accumulation.

JP Drain Care

• Maintain suction

• Empty regularly

• Measure output

Ileostomy Output

small intestine opening, Liquid & continous

Colostomy Output

opening in large intestine, more formed stool

Dehydration risk

Ileostomy** & colostomy patients

Incentive Spirometer Purpose

Prevent atelectasis

Incentive Spirometer Teaching

• Sit upright

• Slow deep inhalation

• Hold 3-5 seconds

• Repeat 10 times/hour while awake

Compartment Syndrome/ Arterial problems

6 Ps:

• Pain

• Pallor

• Pulselessness

• Paresthesia

• Paralysis

• Poikilothermia

Compartment Syndrome Earliest Sign

Pain with passive movement

Compartment Syndrome Emergency

Can lead to tissue necrosis. Prepare for fasciotomy.

Chest Tube Expected Findings

Tidaling in water seal chamber & continuous bubbling in suction control chamber

Chest Tube Unexpected Findings

Continuous bubbling = air leak

Cessation of bubbling in water seal = occlusion/lung re-expansion

Subcutaneous crepitus around insertion sight

Tracheal deviation to the unaffected side

Chest Tube Don’ts

Clamp routinely or strip tubing

Chest Tube Disconnection

Place end in sterile water.

Chest Tube Pulled Out

Apply occlusive dressing on 3 sides, stay with patient and notify provider.

UAP Delegation

• ADLs (dressing, washing, bathing, ambulating, feeding, brushing teeth patient)

• Transport stable patients

• Routine vitals, weight, I/O

CANNOT evaluate, assess or monitor

LPN Delegation

• Stable patients

• Reinforce teaching

• Routine procedures

• Routine vitals

• Routine labs

• Administer non-IV meds

• Ambulation

• Dressing changes

• Foley Cath insertion

• Focus assessments

NO IV or blood transfusion

RN Delegation

• Initial assessments

• Teaching

• Care plans

• Evaluation

• Unstable patients (unstable 12hrs after surgery)

Prioritization

ABCs

Airway, Breathing, Circulation

Maslow’s Hierarchy

1. Physiological

2. Safety

3. Love/Belonging

4. Esteem

5. Self-Actualization

NCLEX Prioritization

1. Airway

2. Breathing

3. Circulation

4. Safety

5. Acute before chronic

6. Unstable before stable

7. Actual problem before potential problem

Beta Blockers Suffix

-olol (Metoprolol, Atenolol, Propranolol)

Beta Blockers Indication

• HTN

• Angina (stable)

• HF

• MI

• Tachydysrhythmias

Beta Blockers MOA

Blocks beta receptors and decreases sympathetic stimulation. Slow HR.

Beta Blockers Side Effects

• Bradycardia

• rebound cardiac excitation

• AV block

• Bronchospasm

• Nasal stuffiness

• Hypotension

• Depression

• Can mask hypoglycemia

Beta Blockers Contraindications

• AV block

• Asthma (selective like metoprolol okay tho)

• Severe bradycardia

• Severe allergies (caution)

Beta Blockers Nursing Considerations

• Check BP and HR before administration.

• Hold for HR <60 unless otherwise ordered.

• Check blood sugars

• Discontinue slowly

ACE inhibitors suffix

-pril (Lisinopril, Enalapril)

ACE inhibitors indications

• HTN

• HF

• MI

• Diabetic nephropathy

ACE inhibitors MOA

Prevents Angiotensin I → Angiotensin II

ACE inhibitors Side Effects

• Dry cough

• Angioedema

• Arthralgies (joint pain)

• Agranulocytosis

• Hyperkalemia (don’t give spironolactone)

• Hypotension

• Don’t give to Black or pregnant patients

Beta blockers priority

Angioedema is life-threatening.

Calcium Channel Blockers Suffix

-dipine, -zem, -mil

Calcium Channel Blockers Indications

• HTN

• Angina (unstable)

• A-fib, a flutter

Calcium Channel Blockers MOA

Decreases calcium entry into cells.

Calcium Channel Blockers Side Effects

• Peripheral edema

• Constipation

• Reflex tachycardia

• Hypotension

• Gum swelling/changes

• Facial flushing

• CONTRA in AV Block, HF

• Enhances suppression of digoxin and beta blockers

Statins Indications

• Hyperlipidemia

• Prevent MI

Statins Side Effects

• Myopathy (muscle weakness, cramps, stiffness)

• Hepatotoxicity

• Rhabdomyolysis (weakness, muscle pain, dark urine)

• Muscle aches/pain