NCLEX-PN Cheat Sheet

1. Safe and Effective Care Environment

A. Coordinated Care

• Legal and Ethical Principles
  • Scope of Practice: Understand which duties LPNs can assign and which must be handled by RNs or doctors.
  • Advance Directives: Documents like living wills, healthcare proxies, and DNRs guide care preferences.
  • Informed Consent: The healthcare provider explains the procedure’s risks and benefits; the nurse ensures the patient understands and witnesses the signing.
  • HIPAA: Protect patient privacy by only accessing information relevant to care.
  • Mandatory Reporting: Required for suspected abuse (child or elder) and certain infectious diseases.
• Delegation and Prioritization
  • Five Rights of Delegation: Right task, circumstances, person, instructions, and supervision are essential to safe delegation.
  • Prioritization Frameworks: Use ABC (Airway, Breathing, Circulation), Maslow’s hierarchy (address basic needs first), and always assess before acting unless immediate danger exists.
• Resource Management and Teamwork
  • Referrals: Include physical therapy, occupational therapy, nutrition, and social services as needed.
  • Care Coordination: Ensure effective communication among providers, including structured handoffs using SBAR (Situation, Background, Assessment, Recommendation).

B. Safety and Infection Control

• Standard Precautions: Consistently practice hand hygiene and wear gloves when exposure to bodily fluids is possible.
• Transmission Precautions:
  • Contact: Use gown and gloves for infections like MRSA or C. difficile.
  • Droplet: Use surgical mask (and gloves/gown if needed) for illnesses such as influenza and pertussis.
  • Airborne: Use N95 respirator and negative-pressure rooms for diseases like tuberculosis, measles, and varicella.
• Medication Safety: Double-check medications with high risk of harm such as insulin, heparin, opioids, and warfarin.
• Ergonomics and Fall Prevention: Use safe body mechanics when moving patients, employ bed alarms, and keep environments clutter-free.
• Emergency Procedures:
  • Fire Safety: Follow RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep) protocols.
  • Disaster Response: Implement triage for mass casualty situations, follow chain of command, and adhere to facility emergency plans.

2. Health Promotion and Maintenance

A. Growth and Development

• Erikson’s Psychosocial Development:
  • Infants: Trust vs. Mistrust
  • Toddlers: Autonomy vs. Shame/Doubt
  • Preschoolers: Initiative vs. Guilt
  • School-age: Industry vs. Inferiority
  • Adolescents: Identity vs. Role Confusion
• Piaget’s Stages of Cognitive Development: Sensorimotor, Preoperational, Concrete Operational, Formal Operational.
• Typical Developmental Milestones:
  • Infants: Begin rolling, sitting up, crawling, and develop the pincer grasp.
  • Toddlers: Start walking, form simple sentences, engage in parallel play.
  • Preschoolers: Dress themselves, participate in cooperative play, improve fine motor skills.

B. Reproductive Health and Pregnancy

• Normal Pregnancy:
  • Divided into three trimesters: 1st trimester (organ development), 2nd trimester (fetal movements begin), 3rd trimester (weight gain).
  • Routine prenatal visits include monitoring blood pressure, fetal heartbeat, and measuring fundal height.
• Prenatal Screening Tests: Complete blood count, blood type and Rh factor, gestational diabetes screening, Group B strep test between weeks 35–37.
• Common Pregnancy Discomforts: Nausea, backache, and heartburn; advise supportive care such as small, frequent meals and proper posture.
• Labor and Delivery: Recognize labor stages—cervical dilation, birth of baby, placenta delivery, and recovery phase.
• Newborn Care: Assess APGAR score, observe reflexes like Moro and rooting, maintain body temperature, and support feeding choices (breastfeeding or formula).

C. Health Screenings and Prevention

• Immunization Guidelines: Follow CDC-recommended vaccines for children and adults, including DTaP, MMR, influenza, and pneumococcal vaccines.
• Cancer Screening Tests: Include mammograms, Pap smears, colonoscopies, and prostate-specific antigen (PSA) tests.
• Lifestyle Recommendations: Encourage quitting smoking, regular exercise, healthy eating, and stress reduction techniques.

3. Psychosocial Integrity

A. Therapeutic Communication

• Active Listening: Use eye contact, nod affirmatively, summarize statements, and ask clarifying questions.
• Open-Ended Questions: Promote detailed responses (e.g., “Can you tell me more about…” ).
• Avoid: Offering false comfort, abruptly changing topics, or sharing personal viewpoints.

B. Mental Health Conditions

• Depression: Characterized by persistent sadness, loss of interest, and changes in appetite or sleep patterns.
• Bipolar Disorder: Alternates between manic episodes (increased activity, decreased need for sleep) and depressive phases.
• Schizophrenia: Includes symptoms such as hallucinations, delusions, and disorganized speech or behavior.
• Anxiety Disorders: Generalized Anxiety Disorder and Panic Disorder involve excessive worry, rapid heartbeat, and sweating.
• Substance Withdrawal: Alcohol withdrawal shows tremors and rapid heart rate; opioid withdrawal may present with agitation and gastrointestinal upset.

C. Crisis Management and Coping Strategies

• Grieving Process: Based on Kubler-Ross’s stages: Denial, Anger, Bargaining, Depression, and Acceptance.
• Suicide Prevention: Remove access to harmful items and ensure one-on-one monitoring for high-risk individuals.
• Abuse and Neglect: Watch for bruises in different healing stages, fearful behavior, or inconsistent explanations; reporting is mandatory.
• Behavioral Techniques: Use de-escalation methods, enforce clear boundaries, and maintain consistent routines for agitated or confused patients.

4. Physiological Integrity

A. Basic Care and Comfort

1. Mobility and Immobility
   • Perform range-of-motion exercises, reposition patients every two hours to avoid pressure injuries, and use mobility aids like walkers or canes.
   • Prevent deep vein thrombosis with compression stockings, sequential compression devices, and encouraging early movement.
2. Nutrition and Hydration
   • Diets include clear liquids, full liquids, soft foods, low-sodium, and carbohydrate-controlled (for diabetes).
   • For enteral feedings via PEG or NG tubes, verify tube placement, check gastric residuals, and flush tubes regularly to keep them clear.
   • Total Parenteral Nutrition (TPN) is administered through a central line; watch for high blood sugar and infection risks.
3. Elimination
   • Use scheduled toileting and pelvic floor exercises for bladder training.
   • Maintain catheter hygiene with a closed system, keep the perineal area clean, and remove catheters promptly to prevent infections.
   • Assess ostomy sites for healthy color and moisture, and ensure appliances fit correctly.
4. Sleep and Rest Disorders
   • Evaluate insomnia causes like stress or health problems; sedative-hypnotics may be used short-term.
   • Manage sleep apnea with CPAP machines and encourage weight loss.
   • Treat narcolepsy with stimulant medications and planned naps.
5. Pain Management
   • Assess pain using OLDCART: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment.
   • Pharmacological options include opioids (monitor breathing), NSAIDs (watch for stomach bleeding), and acetaminophen (monitor liver function).
   • Non-drug approaches involve heat or cold therapy, relaxation techniques, distraction, and TENS units.

B. Pharmacological Therapies

1. Pharmacokinetics and Pharmacodynamics
   • Understand how drugs are absorbed, distributed, metabolized, and eliminated.
   • Know drug-receptor interactions, therapeutic ranges, and half-lives.
2. Medication Administration
   • Follow the six rights: right patient, medication, dose, route, time, and documentation.
   • Calculate dosages with the formula: (Desired ÷ Available) × Quantity.
   • Determine IV flow rates in drops per minute or milliliters per hour.
3. High-Risk Medications
   • Insulin: Verify with another nurse, and understand onset, peak, and duration of types (rapid, short, intermediate, long-acting).
   • Heparin: Monitor aPTT; antidote is protamine sulfate.
   • Warfarin: Monitor PT/INR (therapeutic range 2–3); antidote is vitamin K.
   • Digoxin: Check apical pulse for one full minute; therapeutic levels 0.5–2.0 ng/mL; watch for toxicity signs like visual disturbances.
4. Drug Classes
   • Antibiotics: Penicillins, cephalosporins, macrolides, fluoroquinolones; monitor for allergic reactions and secondary infections.
   • Cardiac Medications: Beta-blockers reduce heart rate and blood pressure; ACE inhibitors may cause cough and increase potassium; diuretics require electrolyte monitoring.
   • Endocrine Drugs: Oral hypoglycemics like metformin and sulfonylureas, thyroid hormone replacement, corticosteroids.
   • Psychotropic Drugs: SSRIs, benzodiazepines, antipsychotics (monitor for extrapyramidal symptoms and neuroleptic malignant syndrome), mood stabilizers.
   • Emergency Medications: Epinephrine for anaphylaxis, naloxone for opioid overdose, atropine for slow heart rate.

C. Reducing Risk Potential

1. Diagnostic Tests
   • CBC (white/red blood cells, hemoglobin, hematocrit, platelets), BMP (electrolytes, kidney function, glucose), LFTs (liver enzymes and bilirubin).
   • ABGs: Normal ranges pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3 22–26 mEq/L.
   • ECG: Assess heart rate, rhythm, and ST segment changes.
   • Imaging: X-rays, CT scans, MRIs; be aware of contraindications like allergies to contrast dye or presence of metal implants.
2. Perioperative Care
   • Preoperative: Confirm informed consent, ensure patient is NPO, record baseline vital signs, and remove jewelry.
   • Postoperative: Monitor airway, breathing, circulation, manage pain, inspect wounds, and prevent complications such as DVT and pneumonia.
3. Potential Complications
   • Shock types (hypovolemic, cardiogenic, septic, neurogenic): Monitor vital signs and tissue perfusion; act quickly.
   • Deep vein thrombosis/pulmonary embolism: Look for swelling and warmth in one limb; note that Homan’s sign isn’t always reliable; sudden shortness of breath could signal embolism.
   • Infections: Observe for increased white count, wound drainage, fever; use sterile technique.
   • Wound dehiscence or evisceration: Cover with sterile saline-soaked dressings, position in low Fowler’s, notify provider immediately.
4. Signs of Deterioration
   • Changes in level of consciousness: confusion, drowsiness, agitation.
   • Abnormal vital signs: fast heart rate, low blood pressure, rapid breathing.
   • Bleeding: falling blood pressure, rising heart rate, restlessness, check surgical sites or drains.
5. Laboratory Abnormalities
   • Hyperkalemia (>5.0 mEq/L): Can cause dangerous heart rhythms with peaked T waves.
   • Hypoglycemia (<70 mg/dL): Symptoms include sweating, shaking, confusion.
   • Anemia (low hemoglobin/hematocrit): Presents with tiredness, pale skin, rapid heartbeat.
6. Therapeutic Procedures
   • Chest Tubes: Keep below chest level, check for air leaks, monitor fluid drainage.
   • IV Therapy: Watch for infiltration and vein inflammation; maintain correct fluid flow rates.
   • Blood Transfusions: Verify blood type match twice, start slowly, watch closely for reactions like fever, chills, or back pain.

D. Physiological Adaptation

1. Respiratory Disorders

• COPD: Includes chronic bronchitis and emphysema; monitor for CO₂ buildup and teach pursed-lip breathing techniques.
• Asthma: Characterized by airway constriction and wheezing; treated with bronchodilators like albuterol and corticosteroid inhalers.
• Pneumonia: Infection and inflammation of the lung’s air sacs; symptoms include fever and crackling breath sounds; treated with antibiotics.
• ARDS: Acute respiratory distress causing severe oxygen deficiency; often requires mechanical ventilation with high positive end-expiratory pressure (PEEP); common causes include trauma and sepsis.

2. Cardiovascular Disorders

• Hypertension: Managed primarily through lifestyle modifications and antihypertensive medications.
• Congestive Heart Failure (CHF): Left-sided failure leads to fluid buildup in lungs (pulmonary edema), right-sided causes swelling in extremities; treatment includes diuretics and monitoring daily weight.
• Myocardial Infarction (MI): Presents with chest pain, ECG changes (ST elevation), and elevated cardiac enzymes; standard care includes Morphine, Oxygen, Nitrates, Aspirin, and Beta-blockers (MONA-B).
• Dysrhythmias: Common arrhythmias include atrial fibrillation, ventricular tachycardia, and ventricular fibrillation; treatment options may include medications, electrical cardioversion, or defibrillation.

3. Neurological Disorders

• Stroke (CVA): Two main types—ischemic (blockage) and hemorrhagic (bleeding); use FAST (Face drooping, Arm weakness, Speech difficulties, Time) for rapid assessment.
• Seizures: Focus on protecting the patient from injury, avoid physical restraint, and place the person in a recovery position after the event.
• Parkinson’s Disease: Features include tremors, stiffness, and slowed movement; managed with levodopa-carbidopa therapy.
• Multiple Sclerosis (MS): Demyelinating disease with episodes of relapse and remission; immunomodulating drugs help reduce flare-ups.

4. Endocrine Disorders

• Diabetes Mellitus: Type 1 involves autoimmune destruction of insulin-producing cells, requiring insulin therapy; Type 2 results from insulin resistance and may progress to diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).
• Thyroid Disorders: Hypothyroidism presents with low thyroid hormone levels and high TSH, whereas hyperthyroidism shows elevated thyroid hormones and suppressed TSH.
• Addison’s Disease: Adrenal gland failure causing fatigue, darkened skin, and elevated potassium levels.
• Cushing’s Syndrome: Excess cortisol production leading to characteristic moon face, buffalo hump, and elevated blood sugar.

5. Renal Disorders

• Chronic Kidney Disease (CKD): Gradual loss of kidney function that may require dialysis or transplantation at end-stage.
• Urinary Tract Infection (UTI): Symptoms include painful urination and frequent urge; antibiotics are the primary treatment.
• Acute Kidney Injury (AKI): Classified as prerenal (reduced blood flow), intrarenal (kidney tissue damage), or postrenal (urinary obstruction).

6. Gastrointestinal Disorders

• Gastroesophageal Reflux Disease (GERD): Acid reflux causing heartburn; managed with lifestyle changes, antacids, and proton pump inhibitors (PPIs).
• Peptic Ulcers: Often related to H. pylori infection or NSAID use; watch for complications like bleeding or perforation.
• Cholecystitis: Inflammation of the gallbladder, usually caused by gallstones; may require surgical removal.
• Hepatitis: Types A (spread fecal-orally), B and C (bloodborne); monitor liver function and watch for signs such as jaundice.

7. Musculoskeletal Disorders

• Fractures: Immobilize the affected area and assess neurovascular status; monitor for compartment syndrome.
• Osteoporosis: Characterized by decreased bone density; treated with bisphosphonates and supplementation with calcium and vitamin D.
• Rheumatoid Arthritis: Autoimmune condition causing symmetrical joint inflammation; managed with disease-modifying antirheumatic drugs (DMARDs).
• Gout: Caused by accumulation of uric acid crystals; acute attacks treated with colchicine or NSAIDs, while allopurinol is used long-term.

8. Immune Disorders

• HIV/AIDS: Results in low CD4+ T-cell counts and susceptibility to opportunistic infections; antiretroviral therapy (ART) is essential.
• Systemic Lupus Erythematosus (SLE): A multi-organ autoimmune disease with features such as a butterfly-shaped rash across the cheeks.
• Anaphylaxis: A life-threatening allergic reaction requiring intramuscular epinephrine and airway support.

9. Shock States

• Hypovolemic Shock: Due to significant fluid or blood loss (hemorrhage, dehydration); treated with fluid resuscitation and blood products.
• Cardiogenic Shock: Heart’s pumping ability fails (often post-MI); managed with inotropic drugs and controlling fluid overload.
• Neurogenic Shock: Caused by spinal cord injury resulting in widespread vasodilation and slow heart rate; focus on maintaining adequate perfusion.
• Septic Shock: Severe infection leading to systemic vasodilation and hypotension; treatment includes fluids, antibiotics, and vasopressor medications.