Memory tricks for NCLEX prep

Step 1: Is there an airway/breathing/circulation emergency? Always first. Step 2: Is there a safety risk? Step 3: Apply Maslow — physiological needs before psychosocial. Step 4: Actual (existing) problems before potential (risk for) problems. Step 5: Acute (sudden onset) before chronic (long-standing). Step 6: Unstable patients before stable ones. Exception: if a patient expresses suicidal ideation → safety overrides some physiological needs. NCLEX tip: if you see two patients and must choose who to see first — always go to the unstable one, the one with the airway problem, or the one with the newest/most acute change.

NCLEX Next Generation (NGGen): emphasizes clinical judgment over recall. Six clinical judgment cognitive skills: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes. Key mindset shifts: (1) You are always the RN — delegate appropriately. (2) You have unlimited time and resources — choose the best option, not the fastest. (3) You are in a perfect world — equipment works, staff is available. (4) Read the question COMPLETELY before looking at answers. (5) Eliminate clearly wrong answers first. (6) The answer is in the question — look for keywords.

Potassium: normal 3.5–5.0. Critical: <3.0 (cardiac dysrhythmias, muscle weakness) or >6.0 (peaked T waves, cardiac arrest). Sodium: normal 135–145. Critical: <120 (seizures) or >160 (brain shrinkage). Glucose: normal 70–110. Critical: <40 (severe hypoglycemia — seizure, coma) or >500 (DKA/HHS). Hemoglobin: normal male 14–18, female 12–16. Critical: <7 (transfusion typically indicated). Platelets: normal 150,000–400,000. Critical: <20,000 (spontaneous bleeding, no IM injections). INR: normal 1.0, therapeutic 2–3. Critical: >4 (bleeding risk). Creatinine: normal 0.6–1.2. Critical: >4 (dialysis consideration).

Eliminate these answer choices: (1) Any option that ignores or dismisses patient concerns. (2) Options that require a physician's order first (unless emergency). (3) Options that harm the patient. (4) Options that violate patient rights. (5) 'Don't worry' or false reassurance. Prioritize these answer choices: (1) Assess/gather data before intervening (unless emergency). (2) Therapeutic communication for psychosocial questions. (3) Least invasive before most invasive. (4) Nurse-initiated interventions over 'notify provider' (unless critical values). (5) 'Go to the bedside/check on the patient' before calling the doctor. Exception: life-threatening finding → notify provider immediately.

Standard precautions: for EVERY patient regardless of diagnosis — hand hygiene, gloves for body fluids. Common NCLEX traps: HIV/AIDS: standard precautions ONLY — no special isolation (unless co-infection like TB). C. diff: contact precautions — alcohol-based hand sanitizer does NOT kill C. diff spores — must use soap and water. Neutropenic precautions (reverse isolation): protect immunocompromised patient FROM environment — no fresh flowers, plants, or raw fruits/vegetables. TB reactivation: airborne precautions PLUS N95 (not surgical mask). Herpes zoster (shingles): contact + airborne if disseminated; contact only if localized. MRSA/VRE: contact precautions. Meningococcal meningitis: droplet (first 24 hours of antibiotics).

Original 5 rights: Right Patient (2 identifiers — name + DOB or MRN, never room number), Right Drug, Right Dose, Right Route, Right Time. Expanded 10 rights: add Right Documentation (chart immediately after giving — never before), Right Reason (know WHY the patient is receiving), Right Response (assess effectiveness and side effects), Right to Refuse (patient can refuse — document, notify provider, do not force), Right Education (patient understands what they're taking and why). NCLEX trap: always identify patient with TWO identifiers before giving ANY medication. Never chart before giving. Never give a medication you did not prepare yourself.

Complete metabolic panel: Sodium 135–145, Potassium 3.5–5.0, Chloride 98–106, CO2/Bicarb 22–26, BUN 10–20 (blood urea nitrogen), Creatinine 0.6–1.2 (women slightly lower), Glucose 70–110, Calcium 8.5–10.5, Magnesium 1.5–2.5. CBC: WBC 4,500–11,000 (neutrophils 55–70%), RBC male 4.5–6.2, female 4.0–5.5 (million/µL), Hemoglobin male 14–18, female 12–16 g/dL, Hematocrit male 42–52%, female 37–47%, Platelets 150,000–400,000. Coagulation: PT 11–13 sec, aPTT 25–35 sec, INR 1.0 (therapeutic 2–3). Thyroid: TSH 0.4–4.0 mIU/L.

Highest priority — see immediately: new onset chest pain, difficulty breathing, change in LOC, uncontrolled bleeding, vital signs outside normal range (especially hypotension, bradycardia, low SpO2), patient just returned from procedure, report of fall or injury, patient saying 'something feels wrong.' Medium priority: pain not yet addressed (30 min since last assessment), patient requesting information about procedure. Lower priority: routine medications due, discharge teaching for stable patient, family member questions, admission paperwork. Lowest priority: stable patients, routine scheduled tasks, patients with chronic expected symptoms. NCLEX tip: 'which patient do you see first?' = who is most unstable or has the most life-threatening situation.

DKA: Kussmaul respirations, fruity breath, glucose >250 with ketones → insulin drip + fluids + K+. HF: crackles (left), edema (right) → semi-Fowler's, O2, daily weights. MI: crushing chest pain → MONA, 12-lead ECG, troponin. Stroke: FAST → CT scan, tPA if ischemic within window. ARDS: refractory hypoxemia, bilateral infiltrates → prone positioning, low-tidal-volume ventilation. Sepsis: fever + tachycardia + hypotension → cultures first, then broad antibiotics, fluids. SCI (cervical): autonomic dysreflexia — sudden severe HTN, pounding headache → sit upright, find and remove stimulus. Preeclampsia: BP ≥140/90 + proteinuria → mag sulfate, quiet room. Thyroid storm: hyperthermia, tachycardia, agitation → PTU, beta blocker, cooling. Addisonian crisis: hypotension, hyponatremia, hyperkalemia → IV hydrocortisone.

NGN launched 2023 — emphasizes clinical judgment over recall. New question types: Extended Drag-and-Drop: match conditions to interventions — eliminate clearly wrong, then logic for remainders. Matrix/Grid: rows and columns, select appropriate cell — each row is independent (like SATA). Enhanced Hot Spot: click on the area of the image or chart with the finding — look for abnormalities. Bow-Tie: identify client condition (center) + actions to take (left) + parameters to monitor (right). Trend questions: given a series of data over time — identify what is changing and what it means. All NGN items test the 6 Clinical Judgment Measurement Model (CJMM) skills. Strategy: take your time, use all information provided, think out loud mentally.

Read the stem completely: identify the subject (who), the setting, the clinical situation, and the question being asked. Keywords: 'priority,' 'first,' 'best,' 'most important,' 'immediately' = priority question. 'EXCEPT' or 'NOT' = select the wrong answer (change mental set). Cover answers first: formulate your answer, then look. Eliminate 2: usually 2 options are clearly wrong — now choose between 2. Trust your first instinct: only change if you have a clear logical reason. Time management: ~1 min per question. Don't spend more than 2 min on any one question — mark and move. Don't read into questions: answer what is asked, not what could theoretically happen. No 'always' or 'never': if an option uses absolute language, it's usually wrong.

Call immediately (do not wait): Critical lab values, New chest pain (especially crushing/pressure), SpO2 <90% not responding to nursing intervention, SBP <90 mmHg (hypotension) or >180 mmHg (hypertensive crisis), HR <50 or >130, Acute change in LOC or neuro status, Signs of stroke (FAST), Uncontrolled bleeding, Severe allergic reaction/anaphylaxis, Signs of septic shock. Nursing action FIRST, then call: Respiratory distress → position + O2 first, then call. Fall → assess for injury first, then document and notify. Low blood sugar → treat first, then assess further. NCLEX tip: 'notify the provider' is often a distractor — exhaust nurse-initiated interventions first unless it's a true emergency.

Select All That Apply (SATA) questions have no partial credit — you must select ALL correct answers and NO incorrect ones. Common mistakes: looking for a pattern or theme and selecting options that "fit together," selecting only 2 because it "feels safer," or selecting everything that "sounds medical." Correct approach: Cover all options. Read the stem. Uncover option A only — ask "Is this ALWAYS true for this patient/situation?" If yes, select it. Move to B. Repeat independently for each option. Do not let your answer on A influence B. Do not try to narrow to a certain number. Key: each option is a standalone true/false question. If you're unsure about one option, leave it unselected — a wrong addition costs more than a missed correct one in terms of overall accuracy. Practice: SATA makes up 20–25% of the NCLEX NGN.

NCLEX pharm questions don't require memorizing every drug — they test whether you can apply nursing judgment. Framework for any drug question: 1) Drug class (suffix often tells you — "-olol" = beta blocker, "-pril" = ACE inhibitor, "-statin" = lipid-lowering). 2) Mechanism — what does it do to the body? 3) Side effects — what's the most dangerous? What should the patient report? 4) Nursing considerations — what do you monitor, teach, or hold the drug for? High-yield pairs: Digoxin → hold if HR <60, check K+. Lithium → check levels, Na+ and hydration. Warfarin → INR 2–3, bleeding precautions. Metformin → hold before contrast dye. Steroids → glucose, infection, never stop abruptly. NCLEX rarely asks the dose — it asks the nurse's response to a drug effect or adverse reaction.

Informed consent: voluntary, patient competent, adequate information given — nurse witnesses signature but physician obtains consent. If patient changes mind = notify provider immediately, document. Competency: all adults assumed competent unless legally declared incompetent. Refusing treatment ≠ incompetent. Advance directives: living will, healthcare proxy/durable POA — override family wishes when patient incapacitated. DNR: still provide comfort care — DNR ≠ do not treat. Confidentiality: HIPAA — do not discuss in hallways, do not release to family without permission, exceptions: child abuse, communicable disease reporting, court order, imminent danger to self/others. Mandatory reporting: abuse (child, elder, domestic violence in some states), communicable diseases. Restraints: last resort, requires order, Q2h assessment, release Q2h, document behavior requiring restraint. NCLEX: autonomy questions — respect the patient's informed decision even if you disagree.

Memorize these critical values: Sodium: 135–145 (critical: <120 or >160 — seizure risk). Potassium: 3.5–5.0 (critical: <2.5 = cardiac arrhythmia, >6.0 = lethal). Glucose: 70–100 fasting (critical: <40 = hypoglycemia emergency, >500 = DKA/HHS). Hemoglobin: M 14–18, F 12–16 (critical: <7 = transfusion likely). Platelet: 150,000–400,000 (critical: <50,000 = bleeding risk, <20,000 = spontaneous bleed). INR: 0.8–1.2 normal; 2–3 therapeutic anticoagulation (critical: >3 = bleeding risk). PTT: 25–35 sec (heparin therapeutic: 60–100). BUN: 10–20, Creatinine: 0.6–1.2 (elevated = renal dysfunction). WBC: 5,000–10,000 (critical: <1,000 = neutropenia → reverse isolation). Troponin: any elevation = myocardial damage. NCLEX action: report critical values to provider immediately.

Delegation questions appear on every NCLEX. Rules: RN delegates tasks, not nursing process steps. Never delegate: initial assessment, care planning, patient teaching, evaluating outcomes, unstable patients, complex procedures. UAP (CNA/PCT) can do: vital signs (stable patients), ADLs, ambulation (stable), I&O, specimen collection, post-mortem care. LPN can do: stable patients, routine medications (oral, subQ, IM — varies by state), wound care, data collection, reinforcing teaching (not initial). Assignments — consider: stability (unstable = RN), complexity, acuity, risk. NCLEX tip: new admission = RN (needs assessment). Post-op day 1 = RN (monitoring for complications). Chronic stable patient on routine care = LPN or UAP appropriate. The RN remains accountable — delegation ≠ abandonment of responsibility. Always the right answer: RN assesses first before delegating if patient condition is uncertain.

NGN launched in 2023 and tests clinical judgment using the NCSBN Clinical Judgment Measurement Model (NCJMM). Six cognitive skills tested: Recognize cues (what data matters?), Analyze cues (what do these findings mean?), Prioritize hypotheses (most likely/urgent problem?), Generate solutions (what interventions?), Take actions (implement), Evaluate outcomes (did it work?). New item types: Extended drag-and-drop, Matrix/grid (row and column selections), Enhanced hot spots (click on image), Trend questions (evaluate changes over time), Bow-tie items (cause → nursing action → outcome). Unfolding case studies: 6 items about one evolving patient scenario — tests how you think through a patient situation as it develops. Scoring: some items have partial credit. Strategy: read ALL provided data before answering, think like a nurse caring for the actual patient, avoid "test taking" tricks — NGN rewards real clinical reasoning.

Layer 1 — ABCs: Airway always first (obstruction, stridor, secretions). Breathing (respiratory distress, SpO2 <90%). Circulation (active bleeding, hemodynamic instability, chest pain). Layer 2 — Safety: Immediate life threats that don't fit ABC (suicide risk, seizure, anaphylaxis). Layer 3 — Maslow's physiological needs: pain, fluid/nutrition, elimination. Layer 4 — Maslow's safety/psychological/social needs. Triage mnemonics: CURE — Critical, Unstable, Routine, End-of-life (not for treatment). "Most acute change from baseline" often takes priority over "most obviously ill." NCLEX traps: a patient with a chronic severe-sounding condition (end-stage COPD) may be stable while a patient with new-onset mild dyspnea post-op is the real emergency. Always assess for change from baseline. Actual problems before potential problems — but life-threatening potential problems (aspiration risk) before non-urgent actual ones (constipation).

Post-MI standard discharge regimen: A = Aspirin (antiplatelet, daily, low dose — reduces clot risk). B = Beta-blocker (metoprolol, carvedilol — reduces cardiac workload, prevents remodeling. Hold if HR less than 60). C = Cholesterol medication (statin — atorvastatin, rosuvastatin — plaque stabilization. Monitor for myopathy). D = Diet (low sodium, low fat) and Diabetes management. E = Exercise (cardiac rehab) and Education (signs of recurrence, when to call 911). Also: ACE inhibitor or ARB is commonly added. Dual antiplatelet therapy (DAPT = aspirin + clopidogrel) for stented patients.

Master drug suffixes: -olol (metoprolol, atenolol) = Beta-blocker. Hold if HR less than 60. Monitor bradycardia/hypotension. Never stop abruptly. -pril (lisinopril, enalapril) = ACE inhibitor. Side effects: dry cough (bradykinin), hyperkalemia, angioedema. -sartan (losartan, valsartan) = ARB. No cough (use instead of ACE-I). -statin (atorvastatin, simvastatin) = Statin. Monitor LFTs and myopathy. -dipine (amlodipine, nifedipine) = Calcium channel blocker. Watch for peripheral edema, flushing, hypotension. -mycin/-micin (gentamicin, tobramycin) = Aminoglycoside. Nephrotoxic + ototoxic. Monitor creatinine and hearing. -cillin (amoxicillin) = Penicillin. Allergy check — cross-reactive with cephalosporins.

Heparin (IV/SQ): monitor aPTT (goal 60-100 sec, or 1.5-2.5x normal). Antidote: Protamine sulfate. Works immediately. Enoxaparin (Lovenox): SQ only, monitor anti-Xa or no routine monitoring. Warfarin (Coumadin): monitor PT and INR (goal INR 2-3 for most; 2.5-3.5 for mechanical valves). Antidote: Vitamin K (slow) or FFP (fast). Takes days to work — bridge with heparin. DOACs (rivaroxaban, apixaban): no routine lab monitoring. Antidote: andexanet alfa. Bleeding precautions for ALL anticoagulants: soft toothbrush, electric razor, fall precautions, no IM injections, avoid NSAIDs.

Ready — Rapid-acting (lispro/aspart): onset 15 min, peak 1-2 hr. Give WITH meal — food must be right in front of patient. Set — Short-acting (Regular): onset 30-60 min, peak 2-4 hr. Give 30 min BEFORE meal. ONLY insulin that can be given IV. Inject — Intermediate (NPH): onset 1-2 hr, peak 4-12 hr (nocturnal hypoglycemia risk). CLOUDY — roll, don't shake. Love — Long-acting (glargine/detemir): onset 1-2 hr, NO peak, duration 20-24 hr. Do NOT mix. Same time daily. Mixing rule: clear before cloudy (Regular before NPH). Always check blood glucose before giving. Always ensure patient eats after rapid or short-acting insulin.

Assess all 5 P's distal to any cast, splint, traction, or vascular procedure: Pain — increased or unrelieved pain, especially with passive stretch (compartment syndrome red flag). Pulse — compare bilateral, note strength. Absent pulse = emergency. Pallor — pale, mottled, or cyanotic skin distal to injury. Paresthesia — numbness, tingling, burning (nerve compression). Paralysis — inability to move distal extremity (late and very serious sign). Compartment syndrome: increasing pain despite pain medication + tight swollen extremity = call provider NOW. Nursing action: bivalve cast, elevate to heart level (NOT above — reduces perfusion). Fasciotomy may be needed.

All shock: low BP, tachycardia, altered LOC, urine output less than 30 mL/hr. Hypovolemic: fluid loss (dehydration, burns, GI). Rx: IV fluids. Hemorrhagic: blood loss. Rx: blood products + stop bleeding. Distributive — 3 types: Septic (vasodilation, warm early/cold late) = cultures FIRST then antibiotics + fluids. Anaphylactic = epinephrine FIRST then diphenhydramine + steroids. Neurogenic (spinal cord injury) = bradycardia + hypotension (unique!) = vasopressors + atropine. Obstructive: physical obstruction. Cardiac tamponade = Beck's triad (hypotension, JVD, muffled heart sounds). Tension pneumothorax = tracheal deviation away from injury. NCLEX position: shock = supine/legs elevated EXCEPT cardiogenic = HOB 30-45 degrees.

PISO: Potassium Inside (intracellular, normal 3.5-5.0). Sodium Outside (extracellular, normal 135-145). Hypokalemia (less than 3.5): muscle weakness, leg cramps, constipation, U wave on EKG, dysrhythmias. Causes: diuretics, vomiting, NG suction. Tx: KCl — NEVER IV push (cardiac arrest risk). Hyperkalemia (greater than 5.0): peaked T waves, wide QRS, cardiac arrest risk. Causes: renal failure, ACE inhibitors, K+ sparing diuretics. Tx: calcium gluconate (cardiac protection), insulin + glucose (drives K+ into cells). Hyponatremia (less than 135): confusion, seizures, headache. Causes: SIADH, excess water. Tx: fluid restriction. Hypernatremia (greater than 145): thirst, agitation, dry membranes. Tx: hypotonic fluids (correct SLOWLY — cerebral edema risk).

Fat-soluble ADEK (All Dogs Eat Kibble) — stored in fat tissue and liver, can build up and cause toxicity. A (Retinol): vision and immune. Deficiency = night blindness. Toxicity = liver damage, teratogenic (avoid in pregnancy). D (Calciferol): calcium absorption, bone health. Deficiency = rickets (children), osteomalacia (adults). E (Tocopherol): antioxidant, immune. K (Phylloquinone): clotting and bone. Warfarin works by BLOCKING Vitamin K. Water-soluble (B vitamins + C): not stored, excreted in urine, rarely toxic. B12: pernicious anemia (needs intrinsic factor — vegetarians at risk). Folate (B9): neural tube defects if deficient in pregnancy. C (ascorbic acid): scurvy (poor wound healing, collagen synthesis).

Airborne (N95, negative pressure room): TB, Measles, Varicella, COVID (aerosol). Droplet (surgical mask, private room): influenza, meningitis, pertussis, mumps, rubella, strep. Contact (gloves + gown): C. diff, MRSA, VRE, wound infections, RSV. Standard: ALL patients, ALL the time. C. diff requires soap and water — alcohol gel does NOT kill spores.

Autonomy: competent adults decide for themselves — always. Beneficence: act in the patient's best interest. Non-maleficence: do no harm (Hippocratic). Justice/Equity: fair, equal care. Fidelity: keep promises, be honest. Veracity: tell the truth. NCLEX trap: autonomy almost always outweighs beneficence — a competent patient can refuse any treatment even if it kills them.

The Next Generation NCLEX measures clinical judgment using 6 cognitive skills — not just memorization. Every NGN question maps to one or more of these steps. Bowtie questions test all 6 simultaneously. Key insight: you must RECOGNIZE before you can ANALYZE, and ANALYZE before you PRIORITIZE. Jumping to action without assessment is always wrong on NCLEX.

ROME: Respiratory Opposite (pH↑ CO₂↓ = alkalosis; pH↓ CO₂↑ = acidosis). Metabolic Equal (pH↑ HCO₃↑ = alkalosis; pH↓ HCO₃↓ = acidosis). Causes: Resp Acidosis = hypoventilation (COPD, opioids). Resp Alkalosis = hyperventilation (anxiety, pain). Met Acidosis = diarrhea, DKA, renal failure (MUDPILES). Met Alkalosis = vomiting, NG suction, antacids.

HypoKalemia (K+ below 3.5): muscle weakness, flat T waves, U waves on EKG, constipation. HyperKalemia (K+ above 5.0): peaked T waves, muscle cramps, cardiac arrest. HypoNatremia (Na+ below 135): confusion, seizures, cerebral edema. HyperNatremia (Na+ above 145): thirst, dry mucous membranes, agitation, "fried brain." HypoCalcemia: Trousseau's and Chvostek's signs, tetany, numbness.

Narcan (naloxone) = opioid antidote. Flumazenil (Romazicon) = benzodiazepine antidote — use cautiously; can trigger seizures in chronic benzo users. Vitamin K (phytonadione) = warfarin antidote. Protamine sulfate = heparin antidote (1mg per 100 units heparin). Acetylcysteine (Mucomyst) = acetaminophen (Tylenol) overdose. Digoxin immune Fab = digoxin toxicity. Atropine = organophosphate/nerve agent antidote.

GCS scores 3 (deep coma) to 15 (fully awake). Eyes (4): 4=spontaneous, 3=to voice, 2=to pain, 1=none. Verbal (5): 5=oriented, 4=confused, 3=words, 2=sounds, 1=none. Motor (6): 6=obeys, 5=localizes, 4=withdraws, 3=flexion (decorticate), 2=extension (decerebrate), 1=none. GCS below 8 = intubate. Decorticate = arms curl IN to core (cortex damage). Decerebrate = arms extended OUT (brainstem damage — worse prognosis).

Stage 1: intact skin, non-blanchable redness. Stage 2: partial thickness — open blister or shallow crater (no slough). Stage 3: full thickness — subcutaneous fat visible, no bone/tendon. Stage 4: full thickness — bone, tendon, or muscle exposed. Unstageable: covered by slough or eschar — cannot stage until debrided. Deep Tissue Injury (DTI): purple/maroon intact skin or blood-filled blister from pressure. KEY: Wounds do NOT reverse-stage as they heal — a healing Stage 4 does NOT become Stage 3.

Digoxin: 0.5–2 ng/mL. Lithium: 0.6–1.2 mEq/L. Theophylline: 10–20 mcg/mL. Phenytoin (Dilantin): 10–20 mcg/mL. Vancomycin trough: 10–20 mcg/mL. These drugs have narrow therapeutic windows — slight overdose causes toxicity, slight underdose is ineffective. Always draw trough levels (just before next dose) unless otherwise specified.

On NCLEX, if the answer choices include both an assessment action and an intervention, assessment is almost always first — UNLESS the patient has a failing ABC (airway, not breathing, no pulse) or is in immediate danger. Example: patient reports chest pain — assess first (location, quality, radiation, onset) before calling the physician. Exception: patient is unresponsive and not breathing — intervene immediately (call code, start CPR).

Living Will: patient's written wishes for treatment if incapacitated. Healthcare Proxy/Durable POA: designates a person to make decisions. DNR: no CPR if heart stops. DNI: no intubation. POLST: physician order (not just a directive — it's an order). KEY NCLEX rules: (1) DNR does NOT mean "do not treat" — continue comfort care, medications, pain control. (2) Family cannot override a valid advance directive. (3) Nurse must ensure documents are in the chart before surgery.

Day 1–2: Wind (atelectasis — incentive spirometry). Day 3–5: Water (UTI from catheter — urinalysis). Day 5–7: Wound infection (inspect site). Day 5+: Walking/DVT (Homan's sign unreliable — use Doppler). Day 7+: Wonder drugs (drug fever from medications). Other early post-op complications: hemorrhage (first 24 hours), ileus (no bowel sounds, no flatus), urinary retention. Teach: turn-cough-deep breathe, early ambulation, IS.

Mandatory reporting means the nurse MUST report regardless of patient or family wishes, or confidentiality. Reportable: child abuse/neglect, elder abuse, domestic violence (varies by state), communicable diseases (TB, STDs, COVID, hepatitis), gunshot wounds, certain drug-related injuries. Suspicion is enough — you do NOT need proof. Failure to report is a legal violation. Confidentiality does NOT protect these situations.

Hospice = comfort only, no curative treatment. Palliative = comfort alongside curative treatment. NCLEX priorities at end of life: (1) Pain and symptom control — do NOT withhold opioids due to respiratory depression concerns in actively dying patients. (2) Dignity and privacy. (3) Family presence. (4) Spiritual/cultural needs. (5) Honest communication. Most common dying signs: Cheyne-Stokes breathing, mottling, jaw relaxation, cooling extremities.

The chain of infection has 6 links — break any one and infection stops. Agent (pathogen), Reservoir (where it lives — patient, equipment, water), Portal of Exit (body fluids, respiratory droplets), Mode of Transmission (contact, droplet, airborne, vector), Portal of Entry (skin break, mucous membrane, respiratory tract), Susceptible Host. Hand hygiene breaks the transmission link — most effective infection control measure. PPE protects the portal of entry.

Maslow on NCLEX is about PRIORITY — not theory. If a patient is hypoxic, treat the hypoxia before addressing their anxiety about the diagnosis. If a patient is safe physiologically but scared and alone at night, address safety/fear before their curiosity about their prognosis. Classic trap: patient asks for spiritual counselor while also having an oxygen saturation of 88% — physiological need first. Chaplain can wait; hypoxia cannot.

Right Task: is it in the delegatee's scope of practice? Right Circumstance: is the patient stable enough? Right Person: does this person have the training and competency? Right Direction: give clear, specific, complete instructions. Right Supervision: RN monitors outcomes and remains accountable — delegation transfers responsibility but NOT accountability. Never delegate: initial assessment, care planning, patient teaching, evaluation of unstable patients, or anything requiring RN judgment.