🩺 Nursing Notes

Test-Taking Strategies

  • Read the question twice – Identify the subject (who), the action needed, and any qualifying words (first, priority, best, most).
  • Eliminate distractors – Remove options that are clearly wrong; choose the best remaining answer.
  • Maslow first – Physiological needs (airway, breathing, circulation) take priority over psychosocial needs.
  • Assess before acting – Unless the patient is in immediate danger, gather data before implementing an intervention.
  • "Which client do you see first?" – Go to the most unstable or the one with the most acute change from baseline.
  • Delegation rules – RN: assessment, teaching, unstable patients, care planning. LPN: stable patients, routine medications. UAP: ADLs, vital signs on stable patients, basic hygiene.

NCLEX-RN Client Needs Framework

Category% of ExamKey Topics
Safe & Effective Care Environment~38%Management of care, safety & infection control
Health Promotion & Maintenance~9%Growth & development, prevention, screening
Psychosocial Integrity~9%Mental health, coping, therapeutic communication
Physiological Integrity~44%Basic care, pharmacology, reduction of risk, physiology adaptation

Priority Setting Frameworks

ABC Priority

  1. Airway
  2. Breathing
  3. Circulation

Always address airway first unless the question specifies otherwise.

Maslow's Hierarchy

  1. Physiological
  2. Safety
  3. Love/Belonging
  4. Esteem
  5. Self-Actualization

CURE Priority

  1. Critical (life-threatening)
  2. Urgent (significant change)
  3. Routine (stable needs)
  4. Expected (anticipated outcomes)

Therapeutic Communication

TechniqueExample
Open-ended questions"Tell me more about how you're feeling."
Reflection"It sounds like you're worried about the surgery."
Clarification"Can you help me understand what you mean by that?"
Active listeningNodding, maintaining eye contact, minimal prompts ("Go on…")
SilenceAllowing therapeutic pauses; do not rush to fill silence.
False reassurance ✗"Everything will be fine, don't worry."
Giving advice ✗"If I were you, I would…"
Closed questions ✗"Are you feeling better?" (yes/no only)

Critical Lab Values — Know These!

LabNormalCritical LowCritical High
Sodium (Na⁺)135–145 mEq/L<120 mEq/L>160 mEq/L
Potassium (K⁺)3.5–5.0 mEq/L<2.5 mEq/L>6.5 mEq/L
Glucose70–100 mg/dL<40 mg/dL>500 mg/dL
HemoglobinM: 13.5–17.5; F: 12–16 g/dL<7 g/dL>20 g/dL
Platelets150,000–400,000/μL<50,000/μL>1,000,000/μL
INR0.8–1.2>3.0 (on warfarin: >4.0)
CreatinineM: 0.7–1.3; F: 0.5–1.1 mg/dL>10 mg/dL
pH (arterial)7.35–7.45<7.2>7.6

Delegation Quick Reference

🩺 RN Only

  • Initial assessment
  • Care planning
  • Patient/family teaching
  • Unstable patients
  • IV push medications
  • Interpreting labs/data

💉 LPN/LVN

  • Stable patient care
  • Routine medications (oral, IM, SubQ)
  • Wound care
  • Urinary catheterization
  • NG tube management
  • Ongoing assessment (not initial)

🧹 UAP/CNA

  • ADLs (bathing, feeding)
  • Vital signs (stable patients)
  • Ambulation assistance
  • Intake & output recording
  • Specimen collection (urine)
  • Linen changes