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 Exam | Key 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
- Airway
- Breathing
- Circulation
Always address airway first unless the question specifies otherwise.
Maslow's Hierarchy
- Physiological
- Safety
- Love/Belonging
- Esteem
- Self-Actualization
CURE Priority
- Critical (life-threatening)
- Urgent (significant change)
- Routine (stable needs)
- Expected (anticipated outcomes)
Therapeutic Communication
| Technique | Example |
|---|---|
| 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 listening | Nodding, maintaining eye contact, minimal prompts ("Go on…") |
| Silence | Allowing 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!
| Lab | Normal | Critical Low | Critical 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 |
| Glucose | 70–100 mg/dL | <40 mg/dL | >500 mg/dL |
| Hemoglobin | M: 13.5–17.5; F: 12–16 g/dL | <7 g/dL | >20 g/dL |
| Platelets | 150,000–400,000/μL | <50,000/μL | >1,000,000/μL |
| INR | 0.8–1.2 | — | >3.0 (on warfarin: >4.0) |
| Creatinine | M: 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