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NCLEX-RN Cram Sheet
ABCs & Prioritization
- Priority order: Airway → Breathing → Circulation → Safety (ABC + S)
- Maslow's: Physiological → Safety → Love/Belonging → Esteem → Self-Actualization
- Actual problem > potential problem; acute > chronic; life-threatening > non-life-threatening
- Unstable patient always takes priority over stable; assess before delegating
- SBAR: Situation, Background, Assessment, Recommendation — standard communication tool
- First action for any emergency: assess/call for help; never leave unstable patient
Critical Lab Values
- Na+ 136-145 | K+ 3.5-5.0 | Ca2+ 8.5-10.5 | Mg2+ 1.5-2.5 | Phos 3.0-4.5
- BUN 10-20 | Creatinine 0.6-1.3 | Glucose 70-100 (fasting)
- Hgb: M 14-18, F 12-16 | Hct: M 42-52%, F 37-47%
- WBC 4,500-10,000 | Platelets 150,000-400,000
- INR normal 0.8-1.1 | Therapeutic (anticoagulation) 2.0-3.0
- aPTT normal 25-35s | Therapeutic (heparin) 60-100s (1.5-2.5× normal)
- ABG: pH 7.35-7.45 | PaCO2 35-45 | HCO3 22-26 | PaO2 80-100
ABG Interpretation (ROME)
- ROME: Respiratory Opposite, Metabolic Equal
- Respiratory acidosis: pH↓ PaCO2↑ (hypoventilation — COPD, sedation)
- Respiratory alkalosis: pH↑ PaCO2↓ (hyperventilation — anxiety, pain)
- Metabolic acidosis: pH↓ HCO3↓ (DKA, renal failure, diarrhea)
- Metabolic alkalosis: pH↑ HCO3↑ (vomiting, NG suction, antacid overuse)
- Compensated: pH normal but CO2 or HCO3 still abnormal
- Uncompensated: pH abnormal, only one system affected
High-Alert Medications & Antidotes
- Heparin → antidote: Protamine sulfate | monitor: aPTT
- Warfarin → antidote: Vitamin K (slow) or FFP (fast) | monitor: INR
- Opioids → antidote: Naloxone (Narcan) | monitor: RR ≥12
- Acetaminophen OD → antidote: N-acetylcysteine (Mucomyst)
- Benzodiazepines → antidote: Flumazenil (Romazicon)
- Digoxin → antidote: Digibind | hold if HR <60 | toxic: yellow-green halos, N/V
- Magnesium toxicity → antidote: Calcium gluconate | toxic: RR<12, no DTRs
- Insulin: always double-check; hypoglycemia: treat with 15g fast-acting carbs
Infection Control & Precautions
- Standard precautions: ALL patients, ALL body fluids
- Contact: MRSA, VRE, C. diff, scabies — gloves + gown
- Droplet: influenza, RSV, pertussis, meningitis — surgical mask, private room
- Airborne: TB, measles, varicella — N95, negative pressure room, door closed
- C. diff: soap + water ONLY (alcohol kills most bugs but NOT C. diff spores)
- PPE don: gown → mask → goggles → gloves
- PPE doff: gloves → goggles → gown → mask (remove most contaminated first)
Delegation Rules
- RN cannot delegate: assessment, teaching, care planning, evaluation, unstable patients
- LPN/LVN can: wound care, urinary catheter, NG tube care, routine meds (stable patients)
- UAP/CNA can: vital signs (stable), ADLs, ambulation, I&O, positioning
- Delegate stable, routine, predictable tasks — never new/complex/critical
- RN always retains accountability even when delegating
- Five rights of delegation: right task, right circumstance, right person, right directions, right supervision
Cardiac & Respiratory Emergencies
- V-fib: defibrillate IMMEDIATELY — no pulse, no organized rhythm
- MI (MONA): Morphine, Oxygen, Nitroglycerin, Aspirin — in order
- Left HF: pulmonary edema, crackles, dyspnea, frothy sputum | Position: High Fowler's
- Right HF: peripheral edema, JVD, ascites, weight gain
- PE: sudden dyspnea, tachycardia, hypoxia, pleuritic chest pain — O2 and notify MD
- Pneumothorax: absent breath sounds, tracheal deviation AWAY from affected side
- COPD: O2 at 2-3 L/min max — high flow removes hypoxic drive → apnea
Neuro & Mental Health
- Increased ICP (Cushing's Triad): HTN + Bradycardia + Irregular respirations
- Stroke (FAST): Face, Arm, Speech, Time — tPA within 3-4.5h of onset if no contraindications
- Seizure: side-lying, clear area, time seizure, do NOT restrain or put in mouth
- Alcohol withdrawal: seizures peak 24-48h; DTs peak 72h — give benzodiazepines
- Schizophrenia: positive = added (hallucinations, delusions); negative = absent (flat affect)
- Depression: always assess for suicide risk — direct questions do NOT increase risk
- Therapeutic communication: open-ended, reflection, silence. NOT: false reassurance, advice, 'why'
OB & Pediatric Essentials
- Normal FHR: 110-160 bpm — late decelerations are ALWAYS ominous (uteroplacental insufficiency)
- GTPAL: Gravida, Term, Preterm, Abortions, Living
- Pre-eclampsia: HTN + proteinuria + edema after 20 weeks — seizure precautions
- Eclampsia: seizures — priority is MgSO4, antidote: calcium gluconate
- Apgar: Appearance, Pulse, Grimace, Activity, Respiration — scored 0-2 each at 1 and 5 min
- Denver Developmental: know major milestones — rolling 4mo, sitting 6mo, walking 12mo
- Erikson adolescent: Identity vs Role Confusion — provide privacy, involve in care decisions
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