NCLEX Strategy & High-Yield Content

Priority Framework 1: ABCs

Use for acute/unstable clients. Life-threatening issues first.

Airway — Always first. Obstructed airway = death in minutes. Reposition, suction, intubate.

Breathing — Assess respiratory rate, effort, SpO₂. Intervene for respiratory distress.

Circulation — Pulse, BP, bleeding, perfusion. Hemorrhage and shock are priorities.

Exception: If the airway is intact but the client has a life-threatening condition affecting circulation (e.g. internal hemorrhage, anaphylaxis), circulation may take equal priority.

Priority Framework 2: Maslow's

Use for stable clients when choosing which need to address first.

Physiological — Air, water, food, warmth, sleep. Always first if compromised.

Safety & security — Fall prevention, safe environment, freedom from harm.

Love & belonging — Social support, visitor access, spiritual needs.

Esteem — Self-image, independence, education, acknowledgment.

Self-actualization — Growth, purpose, quality of life. Addressed last.

SATA Strategy

Select all that apply — every option is independent. Never assume a fixed number of correct answers.

Read the stem and identify exactly what is being asked before looking at options.

Cover the options. Generate your own answer first, then compare.

For each option, ask: "Is this true or false for this specific client?"

Don't overthink. If it's true in most clinical situations, it's likely correct.

Absolute words (always, never, all) are usually wrong. Qualified words (usually, often, may) are usually correct.

Delegation rules — who can do what

Role	Can delegate to	Can do / cannot do	High-yield examples
RN	LPN/LVN, UAP	Assessment, teaching, care planning, IV push meds, blood admin, unstable clients — RN ONLY	Initial assessment, discharge teaching, interpreting lab results, adjusting care plan
LPN/LVN	UAP	Can do: routine/stable care, oral meds, wound care, catheter insertion. Cannot do: assessment, IV push (usually), unstable clients	Administering routine oral meds, changing a dressing, monitoring stable clients
UAP / CNA	No one	ADLs, vital signs on stable clients, ambulation, feeding, hygiene, I&O measurement	Bathing, taking BP on a stable post-op client, assisting with meals, emptying Foley bag

NCLEX delegation rule: Never delegate assessment, teaching, care planning, evaluation, or care for unstable/complex clients to LPN or UAP. The RN retains accountability for all delegated tasks.

✓ Therapeutic communication — DO use

Open-ended questions

"Tell me more about how you're feeling." — Encourages the client to elaborate.

Reflection

"It sounds like you're feeling anxious about the procedure." — Mirrors back emotions.

Clarification

"Can you tell me what you mean by that?" — Seeks understanding without judgment.

Silence

Allow the client time to gather thoughts. Sitting quietly communicates presence and support.

Focusing

"Let's focus on what's bothering you most right now." — Narrows to priority concern.

Acknowledgment

"I can see this is difficult for you." — Validates without agreeing or disagreeing.

✗ Non-therapeutic — NEVER use

False reassurance

"Everything will be fine." — Dismisses the client's concern. Always wrong on NCLEX.

Giving advice

"If I were you, I'd do X." — Removes client autonomy. Avoid unless teaching is appropriate.

Closed questions

"Do you feel better?" — Limits response to yes/no and cuts off communication.

Changing the subject

Redirecting away from the client's concern communicates disinterest and dismissal.

Asking "why"

"Why did you do that?" — Sounds judgmental and puts the client on the defensive.

Clichés

"Every cloud has a silver lining." — Trivializes the client's experience.

High-yield pharmacology — most tested drug classes

Digoxin

Cardiac glycoside for HF/AFib. Check apical pulse ≥60 before giving. Therapeutic level 0.5–2 ng/mL. Signs of toxicity: bradycardia, visual changes (halos), N/V.

Hold if apical pulse <60 or signs of toxicity

Warfarin (Coumadin)

Anticoagulant. Monitor INR (therapeutic 2–3 for most indications). Antidote: Vitamin K. Interactions with many foods (vitamin K-rich foods decrease effect).

Antidote: Vitamin K (phytonadione)

Heparin

Anticoagulant. Monitor aPTT (therapeutic 60–100 seconds). IV or SQ. Never IM. Antidote: Protamine sulfate.

Antidote: Protamine sulfate

Insulin

Onset/peak/duration varies by type. Regular insulin is the ONLY type given IV. Rapid + long-acting given together: draw clear (regular) before cloudy (NPH). Monitor for hypoglycemia.

Clear before cloudy · Regular = only IV insulin

Lithium

Mood stabilizer for bipolar. Narrow therapeutic range 0.6–1.2 mEq/L. Toxicity signs: tremors, ataxia, confusion, N/V. Maintain adequate sodium/fluid intake.

Therapeutic: 0.6–1.2 mEq/L · Toxic: >1.5

ACE inhibitors (-pril)

Antihypertensives (captopril, lisinopril, enalapril). Side effects: dry cough, hyperkalemia, angioedema. Contraindicated in pregnancy. Monitor K⁺ and renal function.

Stop immediately if angioedema develops

Beta-blockers (-olol)

Antihypertensives. Hold if HR <60 or SBP <90. Mask signs of hypoglycemia. Do not stop abruptly (rebound hypertension/angina).

Never stop abruptly · Hold if HR <60

Morphine / Opioids

Assess respiratory rate before administration — hold if <12/min. Antidote: Naloxone (Narcan). Side effects: respiratory depression, constipation, urinary retention, N/V.

Antidote: Naloxone (Narcan) · Hold if RR <12