NCLEX-RN flashcards

Abandonment occurs when a nurse who has accepted responsibility for client care leaves the assignment without properly notifying a supervisor or transferring care to another qualified provider.

• Once an assignment is accepted, a duty of care exists
• Even personal emergencies require proper notification/handoff
• Abandonment can result in disciplinary action against the nurse's license

Memory trick: Never walk out without a handoff — that's abandonment.

A competent client has the legal right to refuse treatment and leave the facility even if it is medically unwise, as long as they understand the risks.

• Client must be alert, oriented, and informed of risks
• AMA form documents informed refusal, not consent
• Nurse cannot restrain or coerce a competent adult
• Document teaching, risks explained, and client's response

Memory trick: Can't cage a competent client—document, don't detain.

Discharge planning must address a client's physical, cognitive, and social limitations by coordinating appropriate referrals (e.g., home health, social services) to ensure safe transition from hospital to home.

• Identify barriers to self-care before discharge
• Formal referrals provide more reliable support than informal arrangements
• Continuity of care spans across settings and providers

Memory trick: Bridge the gap — refer, don't just instruct.

UAPs may perform tasks that are routine, standardized, have predictable outcomes, and do not require nursing judgment (e.g., ADLs, vital signs, ambulation).

• The 5 Rights of Delegation: right task, circumstance, person, direction, supervision
• Assessment, teaching, and evaluation are never delegable
• The nurse retains accountability for delegated tasks

Memory trick: UAP does ADLs, RN does the thinking

Frequent sleep interruptions prevent completion of REM sleep cycles; prolonged REM deprivation causes irritability, disorientation, and vivid/intense dreaming when REM sleep is finally achieved (REM rebound).

• REM sleep is essential for cognitive restoration
• ICU patients are at high risk due to frequent monitoring
• Nurses should cluster care to protect sleep cycles

Memory trick: "Interrupt REM, and the mind gets grim."

When prioritizing care among multiple clients, always address airway and breathing problems before other concerns such as pain, minor lab abnormalities, or teaching needs.

• Airway and breathing take priority over circulation and other needs
• New or worsening respiratory distress signals urgent assessment
• Stable chronic issues can be addressed after acute threats are resolved

Memory trick: Airway first, always — breathe before everything else.

Pericardial fluid accumulation compresses the heart, causing hypotension, JVD, and muffled heart sounds.

• Beck's triad: hypotension, JVD, muffled heart sounds
• Pulsus paradoxus (>10 mmHg drop in SBP on inspiration) supports diagnosis
• Emergency treatment is pericardiocentesis
• Common after trauma, cardiac surgery, or pericarditis

Memory trick: Beck's Triad: BP down, veins up, sounds muffled

A rare, life-threatening hypermetabolic reaction to certain anesthetic agents (e.g., succinylcholine, volatile anesthetics) causing rapid rise in temperature, muscle rigidity, and hypercapnia.

• Genetic predisposition affecting calcium channels in skeletal muscle
• Treatment: stop triggering agent, give dantrolene sodium, cool the client
• Untreated can cause rhabdomyolysis, cardiac arrest, and death

Memory trick: Dan the man saves the day with Dantrolene

Collapse of alveoli commonly occurring 24–48 hours after abdominal or thoracic surgery due to shallow breathing from pain, presenting with low-grade fever and crackles.

• Common cause of early postoperative fever
• Prevented and treated with incentive spirometry, coughing/deep breathing, and ambulation
• Adequate analgesia improves the client's ability to breathe deeply

Memory trick: Cough, breathe, walk—don't let lungs balk

When receiving a verbal or telephone order, the nurse must read the order back to the prescriber to confirm accuracy before transcribing or administering it, per National Patient Safety Goals.

• Read-back is required for verbal and telephone orders
• Reduces risk of transcription/miscommunication errors
• Order must later be authenticated (signed) by the prescriber per policy

Memory trick: Hear it, repeat it, confirm it — before you give it.

Compensation is classified as none, partial, or full based on whether pH has returned to normal range despite abnormal PaCO2/HCO3-.

• Normal pH range: 7.35-7.45
• Partial compensation: pH abnormal, but opposite system shifted toward normal
• Full compensation: pH normalized, both PaCO2 and HCO3- abnormal
• Uncompensated: only one value abnormal, pH markedly abnormal

Memory trick: ROME: Respiratory Opposite, Metabolic Equal

When a nurse witnesses a client's signature on a consent form, the nurse confirms voluntariness and apparent competence, not that teaching or disclosure occurred.

• Disclosure of risks/benefits is the physician's duty
• Witnessing verifies signature is voluntary
• Nurse should notify provider if client seems confused or uninformed
• Nurses commonly serve as witnesses, not only physicians

Memory trick: Witnessing is watching the pen, not repeating the pitch.

The physician performing the procedure is responsible for obtaining informed consent by explaining risks, benefits, and alternatives; the nurse witnesses the signature and verifies client understanding.

• Nurse witnesses signature, confirms voluntariness and understanding
• If client doesn't understand, notify the physician before proceeding
• Consent must be informed, voluntary, and given by a competent person

Memory trick: Doctor explains, nurse verifies and reports gaps

Protected health information cannot be disclosed to family members without the client's consent unless the client is incapacitated and disclosure serves their immediate best interest.

• Confidentiality applies even to close relatives
• Client authorization is required for disclosure
• Nurses can offer to relay messages without breaching privacy
• Exceptions exist for incapacitated clients needing emergency decisions

Memory trick: Family isn't a free pass to the file.

The gastrocolic reflex increases colonic peristalsis shortly after food enters the stomach, making post-meal timing ideal for scheduled bowel training programs.

• Reflex occurs 15-45 minutes after eating
• Breakfast is a commonly used trigger meal
• Consistency in timing improves training success

Memory trick: "Eat, then greet the toilet seat."

Potassium chloride is a high-alert drug that must always be diluted and administered via infusion pump; IV push administration can cause fatal arrhythmias.

• Never administer KCl as IV push or bolus
• Maximum peripheral infusion rate typically 10 mEq/hour
• Always use an infusion pump and cardiac monitoring for higher concentrations

Memory trick: 'K+ pushed fast can stop the heart'

Sudden blockage of a pulmonary artery by a clot, often from DVT, presenting with dyspnea, chest pain, tachycardia, and hypoxia.

• High risk after orthopedic surgery (hip/knee replacement)
• Classic triad: dyspnea, pleuritic chest pain, tachycardia
• Priority: oxygen, notify provider, prepare for CT angiogram/anticoagulation

Memory trick: 'Sudden SOB + hip surgery = think clot to lung.'

Accessing a client's health information without a legitimate care-related reason violates HIPAA and must be reported to appropriate supervisory or compliance personnel.

• HIPAA protects all client health information, including celebrities
• 'Need to know' basis applies to chart access
• Unauthorized access must be reported, not ignored or handled informally

Memory trick: See it, report it — don't sit on a privacy breach.

After bronchoscopy with topical throat anesthesia, the client must remain NPO until the gag reflex returns to prevent aspiration.

• Topical anesthetic numbs the pharynx
• Aspiration risk exists until gag reflex returns
• Also monitor for hemoptysis, laryngospasm, and pneumothorax

Memory trick: No gag, no grub

Malpractice (professional negligence) requires proof of four elements: duty of care, breach of that duty, causation linking the breach to harm, and actual damages suffered by the client.

• Duty: nurse's professional obligation to the client
• Breach: failure to meet the standard of care
• Causation: breach directly caused the injury
• Damages: actual harm resulted

Memory trick: Duty, Breach, Cause, Damage — the 4 D's of malpractice.

A durable power of attorney for healthcare legally designates a specific decision-maker for an incapacitated client, and this designation takes precedence over default next-of-kin, including a spouse.

• POA document names decision-maker in advance
• Overrides typical next-of-kin hierarchy
• Nurse advocates for the client's legal designation
• Family disagreement does not change legal authority

Memory trick: The document names the voice—follow the paper, not the pressure.

A serious reaction caused by ABO blood incompatibility, presenting with fever, chills, back pain, and hemoglobinuria shortly after transfusion begins.

• Stopping the transfusion is the first priority action
• Maintain IV access with normal saline via new tubing
• Notify provider and blood bank; send blood bag/tubing for analysis

Memory trick: STOP first, ask questions later

A hidden hemorrhage into the retroperitoneal space following femoral artery access, presenting with flank/back pain and signs of hypovolemic shock despite a normal groin site.

• Femoral artery access is the main risk factor
• Groin site may appear normal despite significant blood loss
• Requires immediate provider notification, possible CT scan, and transfusion

Memory trick: Back pain + BP drop = bleed you can't see

Proper measurement technique for cutting a skin barrier opening to fit a stoma without constricting it or exposing excess peristomal skin.

• Cut opening about 1/8 inch (0.3 cm) larger than the stoma
• Re-measure stoma regularly, especially in the first weeks postoperatively due to swelling changes
• Opening too tight causes ischemia; too large causes skin breakdown from stool exposure

Memory trick: An eighth of an inch bigger keeps the stoma from getting stiffer.

The volume of urine remaining in the bladder after voiding, used to assess urinary retention.

• Normal PVR is less than 50-100 mL
• PVR greater than 200 mL generally requires catheterization
• Retention increases risk for UTI and bladder/kidney damage

Memory trick: Two hundred is the line — cross it and it's cath time.

Application of temperature-based non-pharmacologic pain relief; cold is used for acute injury/inflammation, heat is used for chronic pain/muscle relaxation.

• Cold therapy: use within first 24-48 hours of acute injury, vasoconstriction reduces swelling
• Heat therapy: use for chronic pain or muscle stiffness, promotes vasodilation and relaxation
• Always wrap ice packs in a towel to prevent frostbite/skin damage

Memory trick: Ice it right after — heat comes later.

Adequate dietary fiber (25-30 g/day) combined with sufficient fluid intake (2-3 L/day) softens stool and stimulates peristalsis to prevent constipation.

• Increase fiber gradually to avoid gas/bloating
• Fluid must accompany fiber intake
• Physical activity also promotes bowel motility

Memory trick: "Fiber needs fluid, or it turns to concrete."

When a nurse believes an assignment is unsafe, the first step is to voice concerns to the immediate supervisor (e.g., charge nurse); if unresolved, escalate up the chain of command.

• Always start with the immediate supervisor
• Document concerns and actions taken
• Escalate through management before external agencies
• Never abandon an accepted assignment without proper handoff

Memory trick: Climb the ladder one rung at a time.

The therapeutic aPTT for IV heparin is 1.5-2.5 times the control value; results above this range increase bleeding risk.

• Normal aPTT control ~25-35 seconds
• Antidote for heparin overdose is protamine sulfate
• aPTT is monitored every 6 hours until stable

Memory trick: '1.5 to 2.5 keeps you alive' — the safe multiplier zone

CNS depression from opioids reduces respiratory rate and depth, causing CO2 retention and acute respiratory acidosis with hypoxemia.

• ABG pattern: low pH, high PaCO2, normal HCO3 (acute, uncompensated)
• Airway/breathing support precedes naloxone administration
• Naloxone reverses opioid effect but ventilation must be supported first

Memory trick: Breathe for them before you reverse the drug

Restraints are a last resort requiring a time-limited physician order, regular reassessment, and documentation of less restrictive measures tried first, to protect client rights and safety.

• Restraint orders are time-limited and must be renewed per policy
• Nurse must reassess circulation, skin, and need for restraint frequently (e.g., every 2 hours)
• Least restrictive alternative must be tried and documented first

Memory trick: Restrain last, reassess always

A fluid resuscitation formula for burn clients: 4 mL/kg x %TBSA burned = total 24-hr fluid, with half given in the first 8 hours from the time of injury (not arrival) and the remaining half over the next 16 hours.

• Formula: 4 mL x weight (kg) x %TBSA burned
• Half of total volume given in first 8 hours from injury time
• Adjust infusion rate for any time already elapsed before treatment begins

Memory trick: Half by hour 8 from injury—not from arrival!

A severe, rapid-onset allergic reaction causing airway swelling, bronchospasm, and vasodilation leading to shock; epinephrine IM is first-line treatment.

• Stop the causative agent immediately
• Epinephrine 0.3-0.5 mg IM is first-line treatment
• Antihistamines and steroids are adjuncts, not first-line

Memory trick: Stop it, then shoot it—stop the drug, give epinephrine

Diabetic ketoacidosis treatment sequence is fluids, then insulin, then potassium replacement as needed.

• Isotonic saline corrects volume deficit first
• Insulin infusion stops ketogenesis and lowers glucose
• Monitor potassium closely as insulin drives K+ into cells
• Bicarbonate reserved for severe acidosis only

Memory trick: Fluids First, then Fix with Insulin

Gravity IV flow rate (gtt/min) = (Volume in mL x Drop factor in gtt/mL) / Time in minutes.

• Convert total infusion time to minutes or use hourly rate x drop factor / 60
• Always round drops per minute to the nearest whole number
• Drop factor varies by tubing: macrodrip 10-20 gtt/mL, microdrip 60 gtt/mL

Memory trick: 'Volume times drop factor, divide by the minutes'

For a conscious client with blood glucose under 70 mg/dL, give 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes; repeat if still low.

• Fast carbs: 4 oz juice, glucose tabs, hard candy
• Glucagon IM/IN reserved for unconscious/unable to swallow
• Recheck glucose 15 minutes after treatment
• Follow with complex carb/protein snack once stable

Memory trick: '15-15 rule: 15 grams, wait 15 minutes.'

A cane is held in the hand opposite the weaker/affected leg and advanced simultaneously with that weaker leg to provide support and a wider base of stability.

• Cane on strong side, moves with weak leg
• Cane tip should be about 4-6 inches to the side of the foot
• Elbow flexed 15-30 degrees when holding cane

Memory trick: "Cane on the strong, moves with the wrong (leg)."

Nurses have a professional and ethical duty to report unsafe staffing or practice conditions through proper channels, and whistleblower protections generally shield good-faith reporting from retaliation.

• Chain of command should be followed before external reporting
• Documentation of specific incidents strengthens the report
• Whistleblower protections apply to good-faith safety concerns
• Nurses must not abandon assignments even when advocating for change

Memory trick: Climb the chain, don't complain to the client's brain.

A life-threatening condition where widespread activation of clotting consumes platelets and clotting factors, causing simultaneous microthrombi formation and hemorrhage.

• Common triggers: sepsis, trauma, obstetric complications, malignancy
• Labs: low platelets, low fibrinogen, prolonged PT/aPTT, elevated D-dimer
• Treatment: treat underlying cause, transfuse platelets/FFP/cryoprecipitate as needed

Memory trick: Clot then bleed—DIC's deadly creed

Sudden pleuritic chest pain, dyspnea, tachycardia, and hypoxemia in a postoperative or immobile client suggest pulmonary embolism, a medical emergency.

• Risk factors: surgery, immobility, DVT history
• Immediate actions: oxygen, notify provider, prepare for imaging/anticoagulation
• Untreated PE can rapidly progress to cardiac arrest

Memory trick: Sudden SOB after surgery = think clot in the lung

When a client has documented donor status, the organ procurement organization coordinates discussion with family; the nurse's role is to support, not decide or announce.

• Documented donor status generally legally stands
• OPO representatives lead donation discussions with family
• Nurse's role is emotional support and communication facilitation
• Family objections require sensitive, specialized handling

Memory trick: Let OPO lead, nurse just feed support instead.

Proper technique for assisting ambulation using a transfer/gait belt to prevent falls in clients with weakness.

• Stand on the client's weaker side, slightly behind
• Hold the belt with an underhand grip
• Be prepared to ease the client to the floor if a fall begins, do not fight gravity

Memory trick: Weak side, close beside — that's where you guide.

A client's legally valid living will or advance directive reflects autonomous wishes and takes precedence over family member preferences when the client cannot communicate.

• Living wills are legally binding when properly executed
• Family cannot override a valid advance directive
• Ethics committee can help mediate conflicts
• Nurse's advocacy role is to honor documented client wishes

Memory trick: The living will speaks even when the client can't—family can't override that pact.

Progressive ECG changes correlate with severity of hyperkalemia, from peaked T waves to widened QRS to sine wave pattern.

• Peaked T waves are the earliest sign
• Widened QRS indicates worsening toxicity
• Sine wave pattern precedes cardiac arrest
• Calcium gluconate stabilizes the cardiac membrane

Memory trick: Tall Tents, Wide Tents, then Silence (K+ kills the heart's rhythm)

A segment of the chest wall becomes detached due to multiple rib fractures, causing paradoxical movement during breathing.

• Caused by 3+ adjacent ribs fractured in 2+ places
• Paradoxical movement impairs effective ventilation
• Often associated with underlying pulmonary contusion
• Treatment includes oxygen, pain control, and possible ventilatory support

Memory trick: Flail chest Flips the wrong way when you breathe

SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool that ensures continuity of care during handoffs by organizing critical client information.

• Situation: current problem/reason for report
• Background: relevant history and context
• Assessment/Recommendation: current findings and suggested next actions

Memory trick: Situation-Background-Assessment-Recommend: what, why, now, next

In mass casualty events, triage prioritizes salvageable clients needing immediate intervention over those in cardiac arrest, reversing normal single-client ABC prioritization due to limited resources.

• Red = immediate, salvageable with rapid intervention
• Yellow = delayed, stable but needing care
• Green = minor, walking wounded
• Black = expectant, unlikely to survive given resource constraints (includes cardiac arrest in mass casualty)

Memory trick: In disasters, save the savable, not the unsalvageable.

In diabetic ketoacidosis, serum potassium must be checked and corrected (if <3.3 mEq/L) before starting insulin, because insulin shifts potassium intracellularly, worsening hypokalemia.

• DKA labs: glucose >250, pH <7.3, HCO3 <18, ketones present
• Insulin lowers serum K+ by driving it into cells
• Hold insulin if K+ <3.3 mEq/L until replaced
• Fluids (0.9% NS) are started first, then K+, then insulin

Memory trick: 'Fluids first, potassium next, insulin last.'

Penicillins and cephalosporins (like cefazolin) share a similar chemical structure, leading to a risk of cross-reactivity. If a client has a penicillin allergy, especially a Type I (IgE-mediated) reaction like a rash, caution is warranted with cephalosporins. Provider notification is crucial to determine a safe alternative or management plan.

• Penicillins and cephalosporins related.
• Cross-reactivity risk.
• Rash indicates Type I allergy.
• Notify provider for alternative/plan.

Memory trick: Penicillin rash? Cefazolin clash! Tell the doc!

Heparin infusion rates are adjusted based on activated partial thromboplastin time (aPTT) to maintain a therapeutic anticoagulant effect. Protocols specify dosage changes (e.g., units/kg/hr) based on aPTT results, requiring weight conversion and careful calculation to prevent bleeding or clotting.

• aPTT monitors heparin effectiveness.
• Therapeutic range is client-specific.
• Protocols dictate dose adjustments.
• Requires weight conversion (lbs to kg).

Memory trick: aPTT high? Convert, calculate, then apply the right dose!

Intravenous immunoglobulin (IVIG) infusions can cause infusion-related reactions, including headache, chills, and muscle aches. These reactions are often milder than anaphylaxis and are frequently associated with the infusion rate. Slowing the rate can often mitigate these symptoms.

• Common IVIG side effects.
• Often rate-dependent.
• Symptoms: headache, chills, myalgia.
• Slow infusion rate first.

Memory trick: IVIG chills? Slow the drip!

Vancomycin is an antibiotic with narrow therapeutic index that is primarily eliminated by the kidneys. In clients with renal impairment, vancomycin accumulation can occur, significantly increasing the risk of nephrotoxicity (kidney damage) and ototoxicity (hearing damage). Dosage adjustments are essential based on renal function.

• Vancomycin is renally excreted.
• Nephrotoxic and ototoxic.
• Impaired renal function increases toxicity risk.
• Creatinine clearance indicates renal function.

Memory trick: Vancomycin's kidneys clear, if they're weak, toxicity is near!

Vancomycin is a nephrotoxic drug primarily excreted by the kidneys. Significant renal impairment (elevated BUN/creatinine) necessitates dosage adjustment or withholding of the drug to prevent toxicity.

• Normal creatinine: 0.6-1.2 mg/dL.
• Normal BUN: 10-20 mg/dL.
• Vancomycin toxicity can cause ototoxicity and nephrotoxicity.
• Dosage adjustments are crucial in renal dysfunction.

Memory trick: Vancomycin + Kidneys = Danger Zone if not careful with dose.

Abrupt cessation of Total Parenteral Nutrition (TPN) can cause rebound hypoglycemia due to the body's continued high insulin production. Administering Dextrose 10% in Water (D10W) prevents this complication.

• TPN is hypertonic and glucose-rich.
• Pancreas continues insulin production after TPN stops.
• D10W provides temporary glucose support.
• Never abruptly stop TPN if new bag is not ready.

Memory trick: TPN is Done? Give D10W, Don't Drop the Glucose!

Norepinephrine (Levophed) is a vasopressor that can cause severe local vasoconstriction if it extravasates (leaks out of the vein) into surrounding tissues. Phentolamine, an alpha-adrenergic blocker, is the specific antidote administered subcutaneously to induce local vasodilation and prevent tissue necrosis.

• Norepinephrine is a vasoconstrictor.
• Extravasation causes tissue ischemia.
• Phentolamine is an alpha-blocker.
• Phentolamine reverses vasoconstriction.

Memory trick: Pressor leaks, phentolamine gets the blood flowing back!

A pre-existing fever in a client scheduled for a blood product transfusion can obscure the signs of a febrile non-hemolytic transfusion reaction (FNHTR). If the provider clears the transfusion despite the fever, administering an ordered antipyretic can help differentiate between the baseline fever and a new transfusion-related febrile event.

• Fever can mask transfusion reactions.
• Antipyretics reduce baseline fever.
• Provider approval is key.
• FNHTR is a common transfusion reaction.

Memory trick: Fever before blood? Medicate, then proceed if okay'd!

Weight-based dosage calculation involves converting a client's weight to kilograms, then calculating the total dose in milligrams, and finally determining the volume to administer based on the available concentration.

• 1 kg = 2.2 lbs.
• Formula: (Weight in kg x Dose per kg) / Concentration = Volume.
• Always round client's weight to the nearest tenth or hundredth.
• Double-check all calculations, especially conversions.

Memory trick: Weight-KG, Dose-MG, Volume-ML: Convert, Calculate, Confirm.

An acute hemolytic transfusion reaction is a severe, life-threatening immune response to incompatible blood. After stopping the transfusion, the priority is to maintain IV access, usually with normal saline, to support circulation, prevent renal damage, and allow for rapid administration of emergency medications.

• Life-threatening immune reaction.
• Signs: fever, chills, flank pain.
• Stop transfusion immediately.
• Maintain IV access with NS.

Memory trick: Transfusion reaction? Stop, then keep that line flowing!

Nurses must recognize red flags of elder mistreatment, including unexplained injuries, malnutrition, and fearful behavior around a caregiver, and prioritize the client's safety.

• Fearful behavior specific to caregiver presence is a key red flag
• Private, separate assessment allows honest disclosure
• Nurses are mandatory reporters of suspected elder abuse
• Confronting caregiver before assessment can endanger the client

Memory trick: Fear near caregiver = separate first, ask questions after.

Infiltration occurs when IV fluid leaks into surrounding tissue, causing swelling, coolness, and pallor. Phlebitis is inflammation of the vein, characterized by pain, redness, and warmth. Both render the IV site unusable and require prompt discontinuation and re-siting.

• Infiltration: swelling, cool, pallor.
• Phlebitis: pain, redness, warmth.
• IV no longer patent or safe.
• Discontinue and restart IV.

Memory trick: Red, painful, swollen? Pull it out and start anew!