Use a mnemonic as a tiebreaker

Mnemonics are compression, not understanding. They earn their keep in the last twenty seconds of an item where two options both look defensible and you need a rule to break the tie. They cost you marks when you reach for them first and stop reading the stem.

Read the body text under each one. That is where the rule lives; the acronym is just the handle.

Labs to Remember

Potassium is the tight one

Potassium has the narrowest safe range of the everyday electrolytes and the fastest route to cardiac arrest when it is wrong.

• Low: flat T waves, U waves, muscle weakness, digoxin toxicity risk
• High: peaked T waves, widened QRS, then arrest
• Always dilute and pump; confirm urine output before replacing

Which test for which anticoagulant

Match the study to the drug and the antidote to both.

• Warfarin -> PT/INR -> vitamin K
• Heparin -> aPTT -> protamine sulfate
• Enoxaparin needs no routine monitoring; watch the platelet count instead

Calcium and magnesium travel together

Low calcium and low magnesium both cause irritability, tetany and seizures. High levels of either cause sedation, weakness and lost reflexes.

• Chvostek sign: facial twitch when the cheek is tapped
• Trousseau sign: carpal spasm when the cuff is inflated
• Refractory low calcium usually means the magnesium needs replacing first

Reading a blood gas in four steps

Look at pH, then CO2, then bicarbonate, then decide whether compensation has happened.

• pH and CO2 moving in opposite directions = respiratory cause
• pH and bicarbonate moving in the same direction = metabolic cause
• Normal pH with abnormal CO2 and bicarbonate = fully compensated

Neutropenia is the number that matters

The white cell count alone can mislead. The absolute neutrophil count drives precautions.

• Fever is often the only sign of infection in a neutropenic client
• No fresh flowers, no raw fruit or vegetables, no crowds
• Report a temperature at or above 38 degrees Celsius immediately

Drug Class Tricks

Suffix shortcuts that hold up

Suffixes let you infer the class, the main risk and the teaching point even for a drug you have never seen.

• -pril = ACE inhibitor -> cough, high potassium, angioedema
• -sartan = ARB -> same risks, far less cough
• -olol = beta blocker -> hold for low heart rate, never stop abruptly
• -statin = lipid lowering -> muscle pain and liver enzymes
• -prazole = proton pump inhibitor -> take before the first meal

More suffix families

Second tier of suffixes, equally reliable on exam day.

• -azepam / -azolam = benzodiazepine -> sedation, antidote flumazenil
• -cillin = penicillin -> ask about allergy and watch for anaphylaxis
• -mycin = aminoglycoside or macrolide -> think ears and kidneys
• -dipine = calcium channel blocker -> ankle oedema, avoid grapefruit
• -ide (furosemide) = loop diuretic -> potassium loss, hearing loss

Antidotes worth memorising

These pairs appear constantly and are pure recall marks.

• Opioid -> naloxone
• Benzodiazepine -> flumazenil
• Warfarin -> vitamin K
• Heparin -> protamine sulfate
• Acetaminophen -> acetylcysteine
• Digoxin -> digoxin immune Fab
• Magnesium sulfate -> calcium gluconate
• Methotrexate -> leucovorin

Insulin timing at a glance

Peak time is when hypoglycaemia is most likely, so it drives when you check and when the client eats.

• Lispro / aspart: onset 15 minutes, peak 1 hour – food must be in front of the client
• Regular: onset 30 minutes, peak 2 – 4 hours – the only insulin given IV
• NPH: onset 1 – 2 hours, peak 4 – 12 hours – the classic mid-afternoon low
• Glargine / detemir: no pronounced peak, never mixed in a syringe

Drugs that end a pregnancy plan

These are contraindicated in pregnancy and appear often as teaching items.

• ACE inhibitors and ARBs cause fetal renal damage
• Warfarin crosses the placenta; heparin does not
• Isotretinoin requires two forms of contraception and monthly testing

Normal Values

Adult vital signs at rest

The baseline set every abnormal finding is measured against.

• Heart rate 60 – 100 beats per minute
• Respiratory rate 12 – 20 breaths per minute
• Blood pressure under 120/80 mmHg
• Temperature 36.5 – 37.5 degrees Celsius
• Oxygen saturation 95 – 100 percent

Haemodynamic and pressure numbers

Common invasive values that appear in critical care items.

• Central venous pressure 2 – 6 mmHg
• Mean arterial pressure at least 65 mmHg to perfuse organs
• Intracranial pressure 5 – 15 mmHg
• Cerebral perfusion pressure 60 – 100 mmHg
• Urine output at least 30 mL per hour in an adult

Fluid rules of thumb

Daily weight is the most reliable measure of fluid status, more so than intake and output charts.

• A gain of 1 kg equals roughly 1 L of retained fluid
• A 2 kg gain in 24 hours in heart failure is reportable
• Weigh at the same time, on the same scale, in the same clothing

Pediatric Values

Vital signs shift with age

Heart and respiratory rates fall and blood pressure rises as a child grows.

• Newborn: heart rate 100 – 160, respirations 30 – 60
• Infant: heart rate 90 – 150, respirations 25 – 40
• Toddler / preschool: heart rate 80 – 140, respirations 20 – 30
• School age: heart rate 70 – 120, respirations 18 – 25
• Adolescent: approaching adult values

Developmental milestones anchor points

A handful of anchors lets you place most milestone questions.

• 2 months: social smile
• 4 months: rolls front to back, holds head steady
• 6 months: sits with support, transfers objects, first teeth
• 9 months: pincer grasp developing, crawls, stranger anxiety
• 12 months: pulls to stand, one to three words, triples birth weight

Paediatric dehydration signs

Children compensate well and then decompensate quickly, so early signs matter.

• Sunken anterior fontanelle in an infant under 18 months
• No tears when crying, dry mucous membranes
• Fewer than one wet nappy in six to eight hours
• Tachycardia comes before hypotension – hypotension is a late sign

Safety by developmental stage

The leading injury risk follows whatever the child has just learned to do.

• Infant: falls, suffocation, aspiration of small objects
• Toddler: drowning, poisoning, burns – they can now reach and climb
• Preschool: road traffic, playground falls
• School age: bicycle and sport injury
• Adolescent: motor vehicles, substance use, firearms

Postpartum Values

Postpartum assessment head to toe

Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy or incision, Homan sign or lower limbs, Emotional state.

• Fundus firm and midline at or just below the umbilicus in the first day
• A boggy fundus means massage first, then reassess
• A deviated fundus almost always means a full bladder

Lochia progression

Colour moves from red to pinkish-brown to creamy white over roughly six weeks.

• Rubra: days 1 – 3, dark red
• Serosa: days 4 – 10, pinkish brown
• Alba: day 10 to about six weeks, white or yellowish
• Saturating a pad in under an hour, or any return to bright red, is reportable

Postpartum haemorrhage: the four Ts

Uterine atony is by far the most common cause, so massage the fundus first.

• Tone: boggy uterus -> massage, then uterotonics
• Trauma: laceration or haematoma -> firm fundus but continued bleeding
• Tissue: retained placenta
• Thrombin: coagulation disorder

Newborn transition red flags

Findings in the first day that are never normal.

• Jaundice within the first 24 hours
• Respiratory rate over 60 at rest, grunting, flaring or retracting
• Temperature instability or glucose under 40 mg/dL
• No urine in 24 hours or no meconium in 48 hours

Preeclampsia warning signs

New severe headache, visual changes or right upper quadrant pain in the third trimester are reported immediately.

• Blood pressure 140/90 or higher after 20 weeks with proteinuria
• Severe features: 160/110, platelets under 100,000, raised liver enzymes
• Magnesium sulfate is for seizure prophylaxis, not blood pressure control

More NCLEX practice and review

Everything on this site tagged NCLEX lives in the NCLEX category.

Sources

• NCSBN — NCLEX Test Plans (official blueprint and category weights)
• NCSBN — The NCLEX examination (official candidate information)