NCLEX-RN Cheat Sheet.
The night-before summary, built like the exam.

NCLEX-RN Cheat Sheet: Must-Know Priority Frameworks

When a question asks "what does the nurse do first?", walk these hierarchies in order.

• ABCs — Airway → Breathing → Circulation. A patent airway always outranks a circulation problem.
• Maslow — Physiological needs before safety, before psychosocial. A physical need (oxygen, fluids, elimination) outranks an emotional one.
• Nursing Process (ADPIE) — Assessment → Diagnosis → Planning → Implementation → Evaluation. When unsure, assess before you act (unless an ABC intervention is obvious).
• Safety / Least-restrictive — Choose the option that protects the patient without over-restricting.

Delegation: The 5 Rights

Right task, right circumstance, right person, right direction/communication, right supervision.

• RN keeps: assessment, teaching, evaluation, unstable patients, anything requiring nursing judgment.
• LPN/LVN can: stable patients, routine meds (per scope), reinforce teaching, dressing changes.
• UAP/CNA can: ADLs, vitals on stable patients, ambulation, intake/output, positioning.
• Rule of thumb: delegate the stable, routine, and predictable; keep the unstable, novel, and judgment-based.

Vital Sign Reference Ranges (Adult)

• Heart rate: 60–100 bpm
• Respiratory rate: 12–20 breaths/min
• Blood pressure: <120/80 mmHg (normal)
• Temperature: ~98.6°F (37°C)
• SpO₂: 95–100%

Key Lab Values

• Sodium (Na⁺): 135–145 mEq/L
• Potassium (K⁺): 3.5–5.0 mEq/L — the "danger" electrolyte; both high and low cause fatal arrhythmias
• Calcium (Ca²⁺): 9.0–10.5 mg/dL
• Magnesium (Mg²⁺): 1.5–2.5 mEq/L
• Chloride (Cl⁻): 98–106 mEq/L
• Fasting glucose: 70–110 mg/dL
• Creatinine: 0.6–1.2 mg/dL
• BUN: 10–20 mg/dL
• Hemoglobin: 12–18 g/dL (F 12–16, M 14–18)
• Hematocrit: 37–52%
• Platelets: 150,000–400,000/µL
• WBC: 5,000–10,000/µL
• pH: 7.35–7.45 · PaCO₂ 35–45 mmHg · HCO₃⁻ 22–26 mEq/L
• INR (therapeutic on warfarin): 2.0–3.0

ABG Interpretation (ROME)

Respiratory Opposite, Metabolic Equal.

• Respiratory: pH and PaCO₂ move in opposite directions (↓pH + ↑CO₂ = respiratory acidosis).
• Metabolic: pH and HCO₃⁻ move in the same direction (↓pH + ↓HCO₃⁻ = metabolic acidosis).

Med-Math Formulas

• Desired ÷ Have × Quantity = amount to administer.
• IV drip rate (gtt/min) = (volume in mL × drop factor) ÷ time in minutes.
• IV pump rate (mL/hr) = total volume ÷ total hours.
• Always double-check units and safe-dose ranges before administering.

High-Alert Safety Rules

• Rights of medication: right patient, drug, dose, route, time, documentation, reason, response.
• Verify identity with two patient identifiers.
• Airborne precautions (negative-pressure room, N95): Measles, TB, Varicella — mnemonic "My Chicken Hez TB" / MTV.
• Droplet precautions: influenza, pertussis, meningitis, mumps, rubella.
• Contact precautions: MRSA, VRE, C. diff (use soap and water — alcohol gel doesn't kill spores).

Position Quick-Reference

• Semi-Fowler's: respiratory distress, post-op, tube feedings (aspiration prevention).
• Left lateral (Sims'): enemas, pregnancy (improves placental perfusion).
• Trendelenburg / supine legs raised: shock/hypotension.
• High-Fowler's: eating, severe dyspnea.
• Flat, no pillow: post-lumbar puncture / spinal.

Test-Taking Strategy

• If two answers are opposites, the correct one is often in that pair.
• Choose assessment over intervention unless an ABC/emergency is stated.
• Never select an answer that abandons or delays care, passes the buck, or asks "why" (avoid "why did you…" therapeutic-communication traps).
• Pick the least invasive, safest effective option first.