NCLEX Cram Sheet
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1. Lab Values
Basil Metabolic Panel (BMP)
Sodium (Na): 135-145 mEq/L
• Hyponatremia – low
• Hypernatremia – high
Potassium (K): 3.5-5.3 mEq/L
• Hypokalemia – low
• Hyperkalemia – high
Calcium (Ca): 9-11 mg/dL (total),
4.5-5.6 mg/dL (ionized)
Chloride (Cl): 95-105 mEq/L
Albumin: 3.9-5.0 g/dL
Alkaline phosphatase (ALP): 44-147
IU/L
ALT: 8-37 IU/L
AST: 10-34 IU/L
BUN: 7-20 mg/dL
CO2: 20-29 mmol/L
Creatinine: 0.8-1.4 mg/dL
Glucose: 70-100 mg/dL
Total bilirubin: 0.2-1.9 mg/dL
Total protein: 6.3-7.9 g/dL
Arterial Blood Gases (ABGs)
pH: 7.35-7.45
• <7.35 = acidosis
• >7.45 = alkalosis
PaCO2: 35-45 mm Hg
• <35 = alkalosis
• >45 = acidosis
HCO3: 22-26 mEq/L
• <22 = acidosis
• >26 = alkalosis
PaO2: 80-100%
Oxygen saturation: > 95%
Complete Blood Cell Count (CBC)
RBC: Male = 4.5-6.0 µL;
Female = 4.0-5.0 µL
WBCs: 3.5-10 x 103/mm3
Hgb: Male = 13.5-18.0 g/dL
Female = 12.0-16.0 g/dL
Hct: Male = 40-54%
Female = 36-46%
Cardiac Labs
Troponin: <0.012 mcg/L
CK-MP: 0-6%
BNP: <100 pg/mL
Urinalysis
Color: straw (cloudiness may be due to
phosphates/urates)
Turbidity: clear
Specific Gravity: 1.001-1.02
• Low: sickle cell, DM, diabetes insipidus
Dipstick: pH 4.5-7.5
Protein: negative
• Positive: nephritic syndrome, renal
tubular disease, pyelonephritis, and
polycystic kidney disease
Sugar: negative
• Positive: diabetes or other endocrine
diseases
Acetone/ketones: negative
• Positive: non controlled diabetes, alcoholism, starvation
Bile: negative
Hemoglobin: negative
• Positive: bleeding,
kidney/bladder irritation
Nitrite: negative
• Positive: indicates bacteria
Leukocyte esterase: negative
Urobilinogen: positive
Urine output: 800-2000 mL/day (with
intake of 2000 mL)
Lipid Profile
Total cholesterol: <200 mg/dL
• Moderate Risk: 200-240 mg/dL
• High Risk: >240 mg/dL
High-density lipoprotein (HDL): 29 77 mg/dL
Low-density lipoprotein (LDL): 60 160 mg/dL
Triglyceride level: 10-190 mg/dL
BMI
Scores for adults 20+
• Underweight: <18.5
• Normal weight: 18.5-24.9
• Overweight: 25.0-29.9
• Obese: 30+
Scores for <20
• Underweight: <5th percentile
• At risk for overweight: 85th<95th percentile
• Overweight: > 95th percentile
2. Assessments
Burns – Depth of Injury
1st degree—superficial: reddened skin,
but intact
2nd degree—partial thickness; loss of
skin, into dermis (most painful)
3rd degree—full thickness; all skin is lost,
can see fat/muscle
4th degree—full thickness + underlying
tissue; can see to bone
• 3rd and 4th degree are not painful
since nerves are lost
Rules of Nines
Head and neck – 9%
• children = 18%
Anterior torso - 18%
Posterior torso - 18%
Each leg - 18%
• children = 13.5%
Each arm - 9%
Genitalia/perineum - 1%
Pain Assessment/Pain Scales
Visual Analog Scale (VAS) (non-numeric)
• Used to determine baseline pain.
Patient Comfort Assessment Guide:
• To assess pain status and pain relief,
response to medications.
Wong-Baker FACES
• Graphic depictions of pain through
different facial expressions
• Appropriate for children, non-English
speakers, and some illiterate patients
or patients with cognitive impairment
• Pediatric version and an adult version
Brief Pain Inventory
• Assesses the effect pain has on activities.
CPOT
• Used in critical care settings (ventilated patients)
Pain Assessment in Advanced Dementia Scale (PAINAD)
• Appropriate for adults with cognitive
impairment
CRIES
• Crying
• Requires O2
• Increased vital sign
• Expression
• Sleepiness
• Assesses pain in neonates
FLACC
• Face
• Legs
• Activity
• Cry
• Consolability
• Appropriate for children to 3 years of
age and older children
with cognitive impairment.
3. Newborn
Vital Signs
Heart rate: 100-160 (avg. 140-160)
Resp: 30-60
BP: systolic 70-90 mm Hg
APGAR Score
Appearance (color):
• 0, pale blue
• 1, body pink, extremities bluish
• 2, completely pink
Pulse (heart rate):
• 0: absent
• 1: slow or below 100
• 2: >100
Grimace (reflex irritability):
• 0: none
• 1: grimace
• 2: vigorous cry
Activity (muscle tone):
• 0: flaccid
• 1: some extremity flexion
• 2: active motion
Respirations (resp. effect):
• 0: absent
• 1: slow and irregular
• 2: vigorous crying
Newborn Reflexes
Babinski: Toes should hyperextend if side
of sole of foot stroked from heel to ball of
foot.
Blinking: Eyes should close if light flashed
in eyes.
Moro (startle): Infant should extend
limbs and neck symmetrically and then
pull back in response to loud noise or jolt.
Palmar grasp: Infant should grasp finger
if palm stroked.
Rooting: Infant should open mouth and
turn to the side of touch when the infant’s
cheek is stroked.
Sucking: Infant should suck if mouth
touched. Reflex may be weak in premature
infants.
Tongue extrusion: Infant should push
tongue out of mouth if tip of tongue
touched.
Tonic neck (fencing): With infant lying
flat and the head turned to one side, the
infant should flex limbs on opposite side
and extend limbs on the side to which
head is turned.
Trunk incurvation: With infant prone,
stroking down one side of spine (1 inch
from spine) should result in the pelvis turning to stroked side.
4. Pharmacology
Prefixes/Suffixes & Roles
Blood Pressure Medication
ACE Inhibitor (-pril): relaxes blood vessels, decreasing workload of the heart
Beta Blockers (-lol): reduce blood pressure by slowing the heart rate and reducing myocardial contractility
Calcium Channel Blocker (-dipine):
relax blood vessels increasing blood supply
and oxygen to the heart
Angiotensin Blocker (-sartan): inhibit
blood vessel constriction
Potassium-sparing diuretics (-actone):
increase the fluid passed out by the kidneys, while retaining potassium in the body
Thiazide diuretics (-thiazide): treats
blood pressure
Cardiovascular Medication
Anticoagulant (-arin): prevent blood
coagulation or prolong clotting time
Antilipidemic (-statin): reduce LDL cholesterol and cardiovascular disease
Thrombolytic (-ase): clot-buster drugs
that break down unwanted blood clots
Antibiotics
Aminoglycosides (-mycin): treats aerobic gram-negative infections
Cephalosporin (Ceph- OR Cef-):
treats bacterial infections
Fluoroquinolones (-floxacin):
broad-spectrum antibiotic to treat bacterial
infections (i.e. respiratory and urinary tract
infections)
Penicillin (-cillin): treat bacterial infections
Tetracyclines (-cycline): broad-spectrum
antimicrobial drugs to treat/prevent bacterial infections by slowing bacterial growth
Sulfonamides (Sulfa-): treat bacterial and
some fungal infections
Intestinal Medication
Antiemetic (-azine): treats nausea and
vomiting
Proton pump inhibitors (-prazole):
anti-ulcer drugs that reduce gastric acid
production
H2 receptor antagonists (-tidine): block
action of histamine in stomach, decreasing
production of stomach acid
Respiratory Medication
Antihistamines (-ine): treat allergy symptoms (i.e. sneezing, runny nose, itching, or
hives)
Bronchodialators (-terol): treat asthma
and symptoms; dilate the bronchi and
bronchioles, which increases airflow to the
lungs and makes breathing easier
Methylxanthine (-phylline): treat airway
obsruction and asthma symptoms; relax
smooth muscle of bronchioles, resulting in
dilation of airway
Anti-anxiety and Antidepressant Medication
Benzodiazepine (-pam OR -lam): treat
anxiety
SSRI (-pram OR -ine): treat major depressive disorders and anxiety disorder;
block or delay reabsorption of serotonin
Tricyclic antidepressants (-triptyline
OR -ipramine): treat depression, bipolar
disorder, anxiety, OCD, and other mood
disorders
Miscellaneous
Antifungal (-azole): treats a fungal infection
Antiviral (-vir): treats a viral infection
Barbiturates (-barbital): increase effect
of GABA in CNS, reducing excitability
and producing sedation
Corticosteroids (-sone OR -lone):
anti-inflammatory drugs used to control
many different symptoms
Local anesthetics (-caine): prevent
transmission of nerve impulses or pain
w/o causing unconsciousness
Oral hypoglycemic (-ide): lower blood
sugar for diabetic patient
Protease inhibitor (-navir): antiretroviral agents
Avoidances
ACE Inhibitors: avoid potassium supplements of foods high in potassium
Antibiotics: avoid milk, caffeine, and
products and vitamins/minerals containing iron
Anticoagulants: avoid foods high in Vitamin K and vitamin E supplements
Antifungals: avoid milk products and
alcohol
Antihistamines, antidepressants,
anti-anxieties: avoid alcohol and grapefruit juice
Beta blockers, nitrates, narcotics,
NSAIDs: avoid alcohol
Bronchodilators, histamine blockers:
avoid caffeine and alcohol
Carbamazepine, cyclosporine
and tacrolimus, HIV medications,
statins: avoid grapefruit juice
Diuretics, potassium sparing: avoid
food high in potassium
MAO inhibitors: avoid alcohol and
non-alcoholic substitute for beer/wine,
food high in tyramine, and products containing caffeine
Toxicity Reversal Agents
Acetaminophen: N-Acetylcysteine
Alcohol withdrawal: Librium
Ammonia: Lactulose
Warfarin: Vitamin K
Digoxin: Digibind
Heparin: Protamine Sulfate
Iron: Deferoxamine
Narcotics: Naloxone
Therapeutic Drug Levels
Digoxin: 0.5-2 ng/mL
Lithium: 0.8-1.5 mEq/L
Dilantin: 10-20 mcg/dL
Theophylline: 10-20 mcg/dL
Warfarin:
• INR levels of 2-3 (A-fib, MI, DVT,
PE)
• INR levels of 2.5-3.5 (for mechanical
heart valves)
Eight Rights of Medication Administration
Right Patient
Right Medication
Right Dose
Right Route
Right Time
Right Documentation
Right to Education
Right to Refuse
Intravenous Infusions
Drop factor: number of drops in 1mL of
solution
Microdrip: For small or precise infusions;
60 gtts/mL
Macrodrip: For quick or large infusions;
10-20 gtts/mL
• 25-28 g; 5/8 inch long
• 0.5-1 mL of fluid; insulin, heparin,
enoxaparin, etc.
Intramuscular (IM)
• Deep into muscle; ventrogluteal, dorsogluteal, vastus lateralis, or deltoid
muscle
• Angle: 90°
• 23 g; 1-1½ inch length
• <3 mL of fluid; only 2 mL in deltoid
• MUST aspirate for blood prior to
giving an IM injection to ensure medication will not be delivered intravenously
5. Positioning Post-operatively
Injections
Intradermal (ID)
• Dermal layer of the skin; shallow,
causes “bleb”; given into skin of inner
forearm, or back, rarely chest.
• Angle: 10-15°
• 27-30 g; 1/4 - 3/8 inch length
• < 1 mL fluid: Mantoux test for TB
exposure, allergy testing, etc.
Subcutaneous (SQ)
• Adipose (fat) tissue; upper, outer arm,
the anterior thigh, and the abdomen
• Angle: 45° (90° for insulin and heparin)
Angiography: if an extremity is used,
place restraint to keep the extremity
straight for 6-8 hours
Bronchoscopy: place in semi-Fowler’s
position to prevent aspiration
Myelogram: with air contrast, place in
Trendelenburg position; with oil contrast,
place flat for 6-8 hours; with water-based
contrast, place with head of bed elevated
for 8 hours
Liver biopsy: position on right side with
pillow placed beneath the puncture site
Arteriovenous fistula formation: elevate
extremity
Abdominal aneurysm: elevate head of
bed to <45 degrees
Ear irrigation: position client on affected
side to promote drainage
Lumbar puncture: keep flat for 4-12
hours
Appendectomy: place in Fowler’s position
Cataract removal: place in semi-Fowler’s
or Fowler’s position on back or opposite
side of surgery
Kidney transplant: place in SemiFowler’s position on back or turned to
opposite side of surgery
Mitral valve replacement: place in
semi-Fowler’s position
Thyroidectomy: place in high Fowler’s or
semi-Fowler’s
Tonsillectomy: prone or side-lying
Amputation of leg (AK,BK): elevate
limb for 24 hours; place in prone position
at least 2 times/day
Insertion nasogastric tube: keep head
elevated to at least 30°
6. Psychology
Kubler-Ross Phases of Grief
Denial: does not really believe loss has
happened, talks as if nothing has changed.
Anger: upset about loss, may act out, exhibit previously unfelt aggression at the lost
individual; may blame caregivers for loss
Bargaining: trying to change results of
loss/avoid consequences of loss;
may ask God to change what happened
Depression: loss of interest, may feel life
is not worth living/fatalistic, withdraw
from friends/family
Acceptance: come to terms with loss and
able to cope, accepted consequences; back
into a pattern of daily living
Maslow’s Hierarchy of Needs
• Psychological Needs
• Safety Needs
• Love Needs
• Esteem Needs
• Self-Actualization
Needs
Cultural Health Considerations
Proxemics (space considerations):
• North Americans and Northern Europeans tend to want the most space
• Latin Americans, Asians, Middle
Easterners, and Southern Europeans
often feel comfortable standing very
close to others
Eye contact
• Direct eye contact = cultural norm in
North American and many European
countries
• Native Americans, Asians, and Mexicans often avoid eye contact to show
respect
Time
• Punctuality = cultural norm in U.S.
• Latin Americans and Mexicans may
consider time in relation to day/night
or before/after meals rather than
clock
Complementary/Folk Medicine
• People from other cultures may utilize
alternative medical systems:
» Chines herbal medication
» Healers
» Meditation
» Body-based therapies
» Coining/Cupping
Touch
• Restrictions in touch between male
and females in some culture (i.e. Middle Eastern)
• Asian cultures may be upset if head is
touched without permission because
they believe the spirit resides in the
head
Family Hierarchy:
• In some cultures (Mexican, Asian, &
Middle Eastern) decisions are made
by the males or head of the family
rather than the individuals
7. Miscellaneous
ANA 6 ethical principles
• Autonomy
• Beneficence
• Nonmaleficence
• Justice
• Veracity
• Fidelity
Levels of Disease Prevention
Primary: goal is to prevent initial occurrence of a health problem (i.e. disease or
injury) through activities such as:
• Immunizations, smoking cessation,
fluoride supple-mentation of water,
promotion of seat belt use, and use of
child care seat restraints
Secondary: goal is to identify diseases or
conditions quickly and provide prompt intervention for treatment and prevention of
further disability through such activities as:
• BP screenings, breast and testicular
self-examinations, hearing and vision
screenings, mammography, and pregnancy testing
Tertiary: goal is to assist those who already have disease or disability to prevent
further progress of the disease and to allow
people to achieve the maximum quality of
life through activities such as:
• Support groups, counseling, diet and
exercise, stress management, and supportive services
Acronyms
Drainage Amount: C-COAL
• Color
• Consistency
• Odor
• Amount
• Location
Wound Assessment: OREEDA
• Odor
• Redness
• Edema
• Ecchymosis
• Drainage
• Approximation
Pathogens: SPIDERMAN
• S: sepsid, scarlet fever, streptococcal
pharyngitis
• P: parvovirus B19, pneumonia, pertussis
• I: influenza
• D: diphtheria (pharyngeal)
• E: epiglottis
• R: rubella
• M: mumps, meningitis, mycoplasma,
meningeal pneumonia
• AN: adenovirus
8. About the Tests
General
• Exam is computer adaptive
• Unoffical results can be accessed 48
hours after exam date and time (small
fee required)
• Offical resuls received approximately
6 weeks after exam
NCLEX-PN
• Used to determine if you’re ready
to begin practicing as an entry-level
registered nurse
• 85-205 questions (with 25 being pretest questions that are not scored)
• Time limit = 5 hours with breaks
• Test Plan: https://www.ncsbn.
org/2020_NCLEXPN_TESTPLAN.
pdf
NCLEX-RN
• Used to determine if you’re ready
to begin practicing as an entry-level
practical/vocational nurse
• 75-265 questions (with 15 pre-test
questions that are not scored)
• Time limit = 6 hours with breaks
• Test Plan: https://www.ncsbn.
org/2019_RN_TestPlan-English.pdf
9. Resources
https://www.mometrix.com/academy/
nclex-exam/ - free resources
www.mometrix.com/university - online
prep course that contains instant access to:
• over 1,100 practice questions (8 fulllength practice tests)
• dozens of review videos
• hundreds of digital flashcards
• audio versions of all lessons
• a progress tracker
• and more!