NCLEX-RN Concept Review

Overview

This chapter covers how a registered nurse decides who to see first, which tasks can be handed to other team members, and how to protect each client's rights. These ideas are tested often, because a safe nurse must think about priorities and responsibility before acting.

When several clients need you, airway comes first, then breathing, then circulation. An unstable or newly changed client comes before a stable one, and an acute problem comes before a chronic one. When you delegate, you hand a stable, routine task with a predictable result to a licensed practical nurse or an assistive person, but you stay accountable. Assessment, teaching, care planning and judging results stay with the RN.

Clients have the right to make their own choices, including the right to refuse care. Before a procedure, the provider explains it and gets informed consent, and the nurse may witness the signature. Health information is shared only with people directly involved in care. An advance directive tells the team the client's wishes in advance, and a structured handoff such as SBAR keeps care continuous between shifts.

Overview

This chapter is about keeping clients and staff safe. You will learn how germs spread and which precautions stop them, how to identify clients correctly, and how to prevent falls and use restraints safely. Emergency steps, such as what to do in a fire, also belong here.

Standard precautions apply to every client, every time: clean your hands and use gloves and other protection when you may touch body fluids. Transmission-based precautions are added for certain germs. Airborne precautions need a fitted respirator and a special room, droplet precautions need a mask when close to the client, and contact precautions need a gown and gloves.

Before any medicine, test or treatment, check two client identifiers, such as name and date of birth, and never use the room number. Restraints are a last resort, need a provider order, and must be checked often. For a fire, remember RACE for the steps and PASS for using an extinguisher.

Overview

This chapter follows a person from before birth through old age. It covers normal growth and development, care during pregnancy, labor and the weeks after birth, and care of the newborn. Knowing what is normal helps you spot what is not.

During pregnancy, teach the client to report danger signs right away, such as vaginal bleeding, a severe headache, vision changes, sudden swelling of the face or hands, fluid leaking, or the baby moving less. High blood pressure with these signs may point to preeclampsia. During labor, watch the fetal heart rate pattern; a late deceleration suggests the baby is not getting enough oxygen through the placenta.

After birth, check the fundus often. It should be firm and in the middle; a soft fundus needs massage, and a fundus pushed to one side often means a full bladder. Lochia changes from red to pinkish-brown to whitish over the following weeks. For children, know the main milestones and Erikson's stages, so you can match care and teaching to the child's age.

Overview

This chapter is about keeping people healthy before illness starts or catching it early. It covers vaccines, health screening, risk factors and how to teach clients so they can care for themselves.

Prevention has three levels. Primary prevention stops a disease from starting, such as a vaccine or quitting smoking. Secondary prevention finds disease early through screening, such as a mammogram or a blood pressure check. Tertiary prevention limits harm from a disease the person already has, such as rehabilitation after a stroke.

Live vaccines, such as MMR and varicella, are generally avoided in pregnancy and in people with a badly weakened immune system. Good teaching starts by checking whether the client is ready to learn, then uses plain words, short sessions and the teach-back method.

Overview

This chapter teaches how to talk with clients in a way that helps them. It also covers how people cope with illness and loss, how to help in a crisis, how to respond to abuse, and how to respect culture and language.

Therapeutic responses keep the focus on the client's feelings. Open-ended questions and reflecting feelings invite the client to talk. Responses that block talk include 'why' questions, false reassurance, giving your own advice, changing the subject and talking about yourself.

Grief often moves through denial, anger, bargaining, depression and acceptance, but not always in order. In a crisis, focus on safety and the problem right now. Nurses must report suspected child abuse, and often elder abuse as state law requires, and a client facing partner violence should be interviewed alone. When a client speaks another language, use a trained medical interpreter, not a family member.

Overview

This chapter covers caring for clients with anxiety, mood disorders, psychosis, confusion and substance use. Safety is the main theme: protecting clients from harming themselves or others while treating them with respect.

Ask about suicide directly and clearly. A client with a plan and a way to carry it out is at high risk, and a sudden calm after deep depression can be a warning sign. Keep the area free of harmful objects. Delirium starts suddenly and often has a physical cause, while dementia develops slowly over time.

Alcohol withdrawal can begin within hours of the last drink and can become life-threatening, with tremors, sweating, fast heart rate and seizures; it is treated with benzodiazepines and thiamine. Some psychiatric drugs need close watching: lithium needs steady fluid and salt intake and blood levels, MAO inhibitors require avoiding foods high in tyramine, and clozapine can lower white blood cells.

Overview

This chapter covers everyday care that keeps clients comfortable and prevents problems. It includes moving and positioning, elimination, eating and drinking safely, hygiene, sleep and comfort measures that do not use medicine.

Lying still for long periods harms almost every body system. It can cause pressure injuries, blood clots, pneumonia, constipation and weak muscles. Turn and reposition clients regularly, help them walk as early as allowed, and teach coughing and deep breathing. When using a cane, hold it on the strong side and move it with the weak leg.

Aspiration happens when food or fluid goes into the lungs. Sit the client upright to eat, have clients with swallowing problems tuck the chin, and use thickened liquids if a swallowing specialist orders them. Comfort can also come from non-drug methods such as heat or cold, position changes, massage, music, guided imagery and distraction.

Overview

This chapter covers giving medicines safely by any route, watching for side effects and interactions, giving blood products, caring for IV lines and managing pain. Errors here can be fatal, so the exam tests safety checks and early warning signs.

Every dose is checked against the rights of medication administration, including the right client, drug, dose, route, time and documentation. Some drugs need a check before each dose. Take an apical pulse for one full minute before digoxin. Warfarin is monitored with the INR and reversed with vitamin K, while heparin is monitored with the aPTT and reversed with protamine sulfate. When mixing insulins, draw up the clear insulin before the cloudy one.

High-alert drugs such as insulin, heparin, opioids and concentrated potassium chloride cause the most harm when given wrong; potassium chloride is never pushed IV. During a blood transfusion, stay with the client at the start, when reactions are most likely. If a reaction appears, stop the blood at once, keep the IV open with normal saline, and notify the provider and the blood bank.

Overview

This chapter is about lowering the chance that a test, procedure or treatment harms the client. It covers vital sign changes, common lab values, preparing clients for tests, and spotting early complications after surgery and procedures.

Lab ranges differ a little between labs, so learn the commonly cited adult values and what a value far outside them means. Potassium is about 3.5 to 5.0 and sodium about 135 to 145 mEq/L. Fasting blood glucose is about 70 to 99 mg/dL. Platelets are about 150,000 to 400,000 per cubic millimeter.

Before a procedure, confirm consent, allergies such as to contrast dye, and fasting status as ordered. After a cardiac catheterization, check the insertion site for bleeding and the pulses below it, and keep the limb straight. After thyroid surgery, watch for low calcium. After any surgery, encourage the incentive spirometer and early walking. If a wound opens and organs come through, cover them with sterile saline-moistened dressings and call the surgeon.

Overview

This chapter covers clients whose bodies are failing to keep balance, such as those with fluid and electrolyte problems, shock, breathing or heart emergencies, and brain injuries. The exam asks you to spot changes early and act in the right order.

High potassium can cause tall, peaked T waves and dangerous rhythms, while low potassium causes muscle weakness and flat T waves. Too much fluid shows as crackles, swelling and weight gain; too little shows as a fast pulse, dry mouth and low urine output. In shock, an early sign is a rising heart rate and restlessness, and low blood pressure often comes later. In sepsis, draw blood cultures before starting antibiotics, and do not delay either.

For heart rhythms, ventricular fibrillation needs CPR and defibrillation, while asystole needs CPR and medicine but no shock. In normal sinus rhythm, a P wave comes before every evenly spaced QRS, while atrial fibrillation is irregular and raises stroke risk. Rising pressure in the skull often first shows as a change in level of consciousness. If a chest tube comes out of the chest, cover the site with a sterile dressing taped on three sides. Know how DKA and HHS differ.