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Tip 01 — Priority Setting

Always Apply the ABCs First

When a question asks you to prioritize care for multiple patients or multiple problems in the same patient, always begin with Airway → Breathing → Circulation. This fundamental triage principle mirrors ACLS (Advanced Cardiovascular Life Support) and ATLS priorities and forms the backbone of NCLEX priority-setting questions.

• Airway: Is the airway open and patent? Stridor, choking, or unconsciousness = immediate action.
• Breathing: Check respiratory rate, oxygen saturation, use of accessory muscles, and breath sounds.
• Circulation: Assess pulse quality, capillary refill, skin color, temperature, and blood pressure.

Example: A patient with SpO₂ of 88% and a patient with mild pain rated 4/10 — always address the oxygen saturation problem first.

Tip 02 — Needs Hierarchy

Use Maslow's Hierarchy to Rank Nursing Priorities

Abraham Maslow's hierarchy of needs translates directly into nursing prioritization. Physiological needs (survival) always come before psychological or social needs. When the ABCs are stable, use this hierarchy to decide what to address next:

• Level 1 – Physiological: Oxygen, hydration, nutrition, elimination, temperature regulation, rest
• Level 2 – Safety & Security: Fall prevention, infection control, medication safety, pain management
• Level 3 – Love & Belonging: Social support, family involvement, therapeutic communication
• Level 4 – Esteem: Patient dignity, autonomy, informed consent, cultural sensitivity
• Level 5 – Self-Actualization: Health education, discharge planning, self-care ability

Tip 03 — Delegation Rules

The Five Rights of Delegation

NCLEX-RN tests delegation extensively. The National Council of State Boards of Nursing (NCSBN) defines five rights that must all be met before a task can be safely delegated to unlicensed assistive personnel (UAP) or licensed practical/vocational nurses (LPN/LVN):

• Right Task: Is this task within the UAP's job description and scope of practice?
• Right Circumstances: Is the patient's condition stable and predictable?
• Right Person: Does this UAP have documented competency for this task?
• Right Direction: Were clear, complete instructions provided?
• Right Supervision: Is follow-up and feedback occurring?

RNs can NEVER delegate: Assessment, nursing diagnosis, care planning, evaluation, patient education, or any complex, unstable, or high-risk interventions.

Tip 04 — Infection Control

Transmission-Based Precautions: A Quick Reference

Infection control is a major NCLEX category. The CDC and HICPAC guidelines define three tiers of transmission-based precautions, always used in addition to Standard Precautions:

• Contact Precautions: Gown + gloves. Used for MRSA, VRE, C. difficile, scabies, wound drainage. C. diff: soap & water handwashing only — alcohol gels are insufficient.
• Droplet Precautions: Surgical mask within 3 ft. Used for influenza, pertussis, meningococcal disease, mumps, rubella, pneumonic plague.
• Airborne Precautions: N95 respirator + negative pressure room. Used for tuberculosis, measles (rubeola), varicella, smallpox, and disseminated herpes zoster.

Memory trick: "My Chicken Has TB" → Measles, Chickenpox, Herpes zoster, Tuberculosis = Airborne.

Tip 05 — Lab Values

Critical Lab Values Every Nurse Must Know

Recognizing abnormal lab values and understanding their clinical implications is essential for NCLEX and safe patient care. Memorize these critical ranges:

• Potassium (K⁺): Normal 3.5–5.0 mEq/L. Critical: <2.5 or >6.5 → cardiac arrhythmias
• Sodium (Na⁺): Normal 136–145 mEq/L. Critical: <120 or >160 → seizures, coma
• Blood Glucose: Hypoglycemia <70 mg/dL → give 15g fast carbs; Hyperglycemia >250 + ketones → DKA protocol
• INR: Therapeutic for anticoagulation: 2.0–3.0. Hold warfarin if INR >3.5, notify provider
• Hemoglobin: Transfusion threshold typically <7.0 g/dL (symptomatic) or <8.0 g/dL (cardiac disease)
• Troponin I: Any elevation above normal is significant; rising troponin = myocardial injury

Tip 06 — ABG Interpretation

Interpret ABGs in 5 Systematic Steps

Arterial Blood Gas (ABG) interpretation is a high-frequency NCLEX topic and a critical bedside skill. Follow this systematic approach every time:

• Step 1 – pH: Normal 7.35–7.45. Below 7.35 = acidosis; above 7.45 = alkalosis.
• Step 2 – PaCO₂: Normal 35–45 mmHg. CO₂ is the respiratory acid. High CO₂ = respiratory acidosis.
• Step 3 – HCO₃⁻: Normal 22–26 mEq/L. Bicarbonate is the metabolic base. Low HCO₃⁻ = metabolic acidosis.
• Step 4 – Match: Which value (CO₂ or HCO₃⁻) matches the pH direction? That's the primary disorder.
• Step 5 – Compensation: Is the other value moving in the same direction? If so, partial or full compensation is occurring.

Example: pH 7.28, PaCO₂ 55, HCO₃⁻ 24 → Respiratory acidosis, uncompensated (PaCO₂ high matches low pH; HCO₃⁻ normal).