NCLEX Rapid Review

Acid–Base Essentials

  • \uparrow pH = hyper-excitability; \downarrow pH = system shut-down (except K^+)

  • Respiratory: ask “lung problem?”
    • Over-ventilation → alkalosis • Under-ventilation → acidosis

  • Metabolic: anything not lung
    • Only metabolic alkalosis cause: prolonged vomiting/suction
    • Unsure? pick metabolic acidosis

  • Kussmaul respirations = metabolic acidosis

Ventilator Alarms

  • High-pressure = obstruction (kink, water, mucus → TCDB, last: suction)

  • Low-pressure = disconnection (main tubing / FiO2 sensor)

  • If ventilating over → resp. alkalosis; under → resp. acidosis

Substance-Use Principles

  • Denial: confront with facts; loss → support

  • Dependency vs codependency: set & enforce limits

  • Manipulation: easier than dependency (no self-esteem gain)

  • Wernicke–Korsakoff: prevent with Vit B_1 ; irreversible; redirect, not confront

  • Antabuse/naltrexone: 2 wk onset & offset; avoid hidden alcohol products

  • Uppers: caffeine, cocaine, PCP/LSD, meth, Adderall → \uparrow everything, seizure risk

  • Downers: heroin, marijuana, alcohol, benzos etc.
    • OD picture = drug effect; withdrawal = opposite

  • Newborn: assume intoxication at birth; withdrawal ≥24 h (shrill cry, seizures)

  • AWS (safe) vs Delirium Tremens (life-threat, 72 h, NPO, private, restraints, same meds + precautions)

Aminoglycosides (Mean Old ‘mycins’)

  • Not: azithro, clarithro, erythro (“thro” → throw off)

  • Toxicities: ototoxic & nephrotoxic → monitor hearing, 24\,h creatinine clearance

  • Route: IV/IM q8h; PO only to sterilize bowel (hepatic coma, pre-op bowel)

  • “Who can sterilize my bowel? Neo & Cana”

  • TAP: trough 30 min before; peaks—SL 5–10 min, IV 15–30 min, IM 30–60 min

Cardiac Calcium-Channel Blockers

  • Negative ino/chrono/dromo → treats: HTN, angina, atrial arrhythmias (incl. SVT)

  • End “-dipine”, plus verapamil, diltiazem; hold if systolic <100

Arrhythmia Rapid Guide

  • Lethal: asystole & V-fib (no pulse) • Potential: V-tach (+pulse)

  • PVCs: never high priority; concern if >6/min, grouped, or on T wave

  • Treatments:
    • Atrial/SVT → Adenosine (push <8 s), Beta-blocker, CCB, Dig
    • V-fib → Defibrillate
    • V-tach/PVCs → Amiodarone
    • Asystole → Epinephrine then atropine

Chest Tubes Quick View

  • Apical = air (pneumo); Basilar = blood (hemo); both for pneumo-hemo

  • Knocked-over device: set back up, deep breaths

  • Water-seal break: clamp→cut→submerge→unclamp

  • Tube out: cover (hand then Vaseline gauze)

  • Bubbling rules: Water-seal should be intermittent; suction chamber continuous

  • Clamp ≤15 s; double-rubber-tipped clamps

Congenital Heart “TRouBLe”

  • Trouble = Right→Left shunt, cyanotic, all start with “T”, need surgery; always murmur & echo

  • Tetralogy: VSD, Pulmonary stenosis, Overriding aorta, Right hypertrophy

Isolation Precautions Snapshot

  • Contact: C-diff, Hep A, staph, RSV → private, gloves, gown, dedicated items

  • Droplet: meningitis, H-flu → mask, gloves

  • Airborne: measles, mumps, rubella, varicella, TB → N95 for TB, negative airflow

  • PPE off: gloves→goggles→gown→mask; on: gown→mask→goggles→gloves

Mobility Aids

  • Crutch length: 2–3 finger-widths below axilla to point lateral/anterior to foot; elbows 30^{\circ}

  • Gaits: 2-pt (mild bilateral), 3-pt (one leg), 4-pt (severe bilateral), swing-through (non-weight-bearing)

  • Stairs: up with good, down with bad (crutches move with bad)

  • Cane on strong side; Walker: pick–place–walk, nothing tied front

Psych Basics

  • Non-psychotic: insight → therapeutic communication

  • Psychotic: delusions, hallucinations, illusions
    • Functional (schizo, major depression, mania): Acknowledge→Present reality→Set & enforce limit
    • Dementia: Acknowledge→Redirect (no reality-presenting)
    • Delirium: Acknowledge→Reassure & treat cause

  • Hallucination vs illusion: illusion has real referent

Key Toxic/ Therapeutic Levels

  • Lithium 0.6–1.2 (>2 toxic)

  • Digoxin 1–2 (≥2 toxic)

  • Aminophylline 10–20 (≥20 toxic)

  • Dilantin 10–20 (≥20 toxic)

  • Newborn bilirubin <9.9 (>20 toxic → kernicterus, opisthotonus – place on side)

Electrolyte Patterns

  • K^+: same direction as prefix (except HR, UO)

  • Ca^{2+} & Mg^{2+}: opposite of prefix

  • Na^+: \uparrow = dehydration, \downarrow = overload

  • Earliest sign any: paresthesia; universal: muscle weakness

  • High K^+ emergency: D5W + insulin (quick) then Kayexalate (permanent)

Thyroid & Adrenal

  • Graves: hyper-metabolism, heat intolerance, exophthalmos → radio-iodine, PTU, thyroidectomy
    • Thyroid storm: >105^{\circ}F, extreme vitals; treat O_2, cooling

  • Post-thyroidectomy: 0–12 h airway/bleed, 12–48 h total → hypocalcemia tetany; subtotal → storm

  • Addison: tan, cannot handle stress → steroids

  • Cushing: “cushy” ↑glucose, moon face, central obesity, striae, infection risk → adrenalectomy

Diabetes Fast Facts

  • Type 1: insulin most important (D-I-E)

  • Type 2: diet most important – calorie restriction + 6 small meals (D-O-A)

  • Insulin profiles:
    • Regular: onset 1 h, peak 2 h, dur 4 h – IV ok
    • NPH: 6-8-12 (o-p-d); cloudy; no IV
    • Lispro: 15-30-3 (give with food)
    • Glargine: no peak, give HS

  • Sick days: take insulin, check glucose, sip fluids

  • Hypoglycemia = “drunk+shock”: give rapid sugar + starch/protein; unconscious → glucagon IM or D50 IV

  • DKA (type 1): dehydration + ketones/Kussmaul/acetone breath → IV fluids + regular insulin

  • HHNK (type 2): dehydration → IV fluids

OB Milestones & Care

  • Naegele: LMP + 7 d − 3 mo

  • Weight gain: 1st tri ≈3 lb, then 1\,lb\,/\,wk; ideal = gestational wk − 9

  • FHR heard 8–12 wk; quickening 16–20 wk

  • Prenatal visits: q4wk →28 wk, q2wk →36 wk, then weekly

  • Labor Phases (latent 0-4 cm, active 5-7 cm, transition 8-10 cm) — active numbers testable: freq 3-5 min, dur 30-60 s, mod intensity

  • Contraction danger: >90 s OR <2 min apart

  • LION for late decels, low variability etc.; stop Pit first if running

  • Stage 4 (recovery): VS, fundus, lochia pads, roll → q15 min ×4

  • Tocolytics: terbutaline (maternal tachy), MgSO4 (↓RR, reflexes)

  • Oxytocics: Pitocin (watch hyper-stim), Methergine (↑BP)

  • Lung maturity: betamethasone IM to mom pre-birth; surfactant to neonate tracheal post-birth

Lab Priority Coding (Klimek)

  • A: abnormal, monitor B: be concerned C: critical, act D: deadly, act now & stay

  • Remember D’s: pH <7, K^+≥6, CO2≥60, PO2<60, platelets <40K

Prioritization Rules

  1. Acute > chronic 2. Fresh post-op <12 h > others 3. Unstable > stable

  • Always unstable: hemorrhage, hypoglycemia, high fever >105^{\circ}F, pulseless/breathless

  • Organ hierarchy: brain → lung → heart → liver → kidney → pancreas

Delegation Snapshot

  • LPN: stable patients, routine care, reinforce teaching, no IV pushes, no firsts, no assessments

  • UAP: ADLs, vitals & finger-sticks on stable pts, enemas; no meds (except barrier cream), no assessments, no teaching

Disaster Triage (Black Tag)

  • Pulseless, breathless, fixed-dilated pupils = expectant care

Quick Guessing Tips

  • Psych: “examine own feelings”, “establish trust”

  • Nutrition: choose chicken; no casseroles for kids

  • Pharm: same-system side effect; oral unknown → GI upset

  • OB: check fetal heart first

  • Kids dev: give more time, pick older age & easier task