Topic guides
Plain-language study guides organized by the eight official client-needs categories. Filter to the category you’re weakest in — the test plan page shows how much of the exam each one fills.
- Aspirin (chewed) carries the mortality benefit — it leads when SpO₂ is adequate.
- Oxygen only if SpO₂ < 90% — then it jumps the queue.
- Nitroglycerin: check BP first and no PDE-5 inhibitors in the last 24–48 h.
- Morphine is for pain unrelieved by nitro, not a first move.
Exam red flagOrdering by the "MONA" letters instead of by the client's data — the sequence is priority-driven, not alphabetical.
MONA* — order by priority, not lettersPractice this →
- Tidaling (gentle rise/fall with breathing) in the water seal = normal.
- Continuous bubbling in the water seal = air leak — trace tubing, notify.
- Bubbling in the suction control chamber = expected.
- Tube pulls out of the chest: occlusive dressing taped on three sides.
Exam red flagMixing up the chambers — same word ("bubbling"), opposite meaning depending on where.
Water seal bubbles = troublePractice this →
- Earliest sign: declining level of consciousness — subtle drowsiness, confusion.
- Late: Cushing's triad — widened pulse pressure, bradycardia, irregular respirations.
- Fixed/dilated pupils and projectile vomiting are near-herniation signs.
- Care: HOB 30°, head midline, avoid clustering care, minimize suctioning.
Exam red flagChoosing the dramatic late sign when the question asks for the earliest — LOC always wins that phrasing.
LOC first, pupils lastPractice this →
- DKA: type 1, glucose often 250–600, ketones, Kussmaul respirations, fruity breath.
- HHS: type 2, glucose often >600, no significant ketones, profound dehydration.
- Both: isotonic fluids FIRST, then insulin — and watch potassium like a hawk.
- Insulin drives K⁺ into cells: a "normal" K⁺ can crash once the drip starts.
Exam red flagStarting insulin before fluids, or ignoring the potassium question hiding inside every DKA scenario.
Fluids → insulin → K⁺ watchPractice this →
- Normal 3.5–5.0 mEq/L — outside the range, think cardiac rhythm first.
- High K⁺: peaked T waves; anticipate calcium gluconate (cardiac protection), insulin + dextrose.
- Low K⁺: flat T waves, U waves; increases digoxin toxicity risk.
- IV potassium is never pushed — always diluted, always pumped.
Exam red flagAny option that IV-pushes potassium is instantly wrong. That single fact appears in many disguises.
K⁺ = heart. Always heart.Practice this →
- Earliest shock sign: rising heart rate — BP holds until compensation fails.
- Late shock: hypotension, mottling, oliguria (<30 mL/hr).
- Compartment syndrome: pain out of proportion, unrelieved by elevation/analgesia.
- The 5 P's — pain, pallor, paresthesia, pulselessness, paralysis. Pulselessness is LATE.
Exam red flagWaiting for the blood pressure to drop, or treating 9/10 cast pain as "expected." Both are the trap.
Catch it at the heart ratePractice this →
- Warfarin → monitor INR (therapeutic 2–3) → antidote vitamin K.
- Heparin → monitor aPTT (≈1.5–2.5× control) → antidote protamine sulfate.
- Heparin long-term: watch platelets for HIT.
- Bleeding precautions for both: soft toothbrush, electric razor, report dark stools.
Exam red flagThe antidote swap. If the question says warfarin and the option says protamine — wrong, every time.
War-K · Hep-ProPractice this →
- Toxicity signs: nausea/vomiting, visual halos (yellow-green), bradycardia, confusion.
- Hypokalemia dramatically increases toxicity risk — check K⁺ first.
- Hold and notify if apical pulse < 60 in adults (count a full minute).
- Therapeutic level is narrow (~0.5–2.0 ng/mL) — levels get drawn often.
Exam red flagAssessing anything before potassium when toxicity signs appear — the K⁺ drives the lethal dysrhythmia risk.
Halos + nausea → check K⁺Practice this →
- ACE inhibitors: dry cough = annoying; lip/tongue swelling = angioedema, emergency.
- Statins: muscle pain + dark urine = rhabdomyolysis — stop and check CK.
- Aminoglycosides: ringing ears or creatinine rise = oto/nephrotoxicity.
- Any first-dose IV drug + itching/chest tightness: STOP the infusion first.
Exam red flagTreating (or calling) before stopping the offending drug. Remove the trigger, then everything else.
Stop first, then treatPractice this →
- Rapid (lispro/aspart): onset ~15 min, peak ~1 h — eat immediately.
- Regular: peak 2–4 h. NPH: peak 4–12 h (the sneaky afternoon crash).
- Glargine: no pronounced peak — basal coverage.
- Hypoglycemia looks like: shaky, sweaty, tachycardic, confused → 15 g fast carbs.
Exam red flagThe question gives an injection time and asks when to worry — the answer is always the peak window.
Peak = when it drops themPractice this →
- Variable decels → Cord compression: reposition first.
- Early decels → Head compression: benign, keep monitoring.
- Accelerations → OK — the reassuring finding.
- Late decels → Placental insufficiency: reposition, O₂, IV fluids, stop oxytocin, notify.
Exam red flagTreating early decels (do nothing) like late decels (do everything). The timing word is the whole question.
VEAL CHOPPractice this →
- Preeclampsia: new hypertension after 20 weeks + proteinuria or organ signs (headache, visual changes, RUQ pain).
- Magnesium sulfate prevents seizures — it is not an antihypertensive.
- Mag toxicity: lost deep tendon reflexes → RR < 12 → urine < 30 mL/hr.
- Antidote at the bedside: calcium gluconate.
Exam red flagMissing the reflex check — absent DTRs are the first toxicity sign, before breathing slows.
Reflexes → resps → renalPractice this →
- Social smile ~2 mo · rolls ~4–6 mo · sits alone ~6–8 mo · pincer grasp ~9–10 mo.
- Walks ~12–15 mo · two-word phrases by 2 yr · rides tricycle ~3 yr.
- Standardized screening at 9, 18, and 30 months — routinely.
- Safety by stage: back to sleep (infant), choking hazards (toddler), water safety (all).
Exam red flagNo words at age 2 or loss of previously gained skills at any age = refer, not reassure.
9-18-30 screening rhythmPractice this →
- Winners: open-ended questions, reflection, silence, "tell me more."
- Losers: false reassurance ("it'll be fine"), "why" questions, giving advice, changing the subject.
- In panic: stay, short calm sentences, slow breathing — teach later, not mid-attack.
- In dementia: validate the feeling, then redirect — don't hard-reorient.
Exam red flagThe option that tells instead of asks. The therapeutic answer almost always explores the client's feeling.
Ask, don't tellPractice this →
- RN keeps: assess, evaluate, teach, plan, and anything on an unstable client.
- UAP takes: measuring, recording, assisting, ambulating — stable clients, predictable outcomes.
- LPN/LVN: reinforce established teaching, care for stable/predictable clients.
- Float staff get the most stable, least specialty-dependent assignment.
Exam red flagA delegation option starting with assess/evaluate/teach is wrong no matter how harmless the scenario sounds.
A-E-T never leaves the RNPractice this →
- Airborne (N95, negative pressure): measles, TB, varicella — "My Chicken Hez TB."
- Droplet (surgical mask): influenza, pertussis, meningococcal, mumps, rubella.
- Contact (gown + gloves): C. diff, MRSA, scabies, RSV.
- C. diff hands: soap and water only — alcohol doesn't kill spores.
Exam red flagSanitizer after C. diff, or a surgical mask for TB. Both look reasonable; both are wrong.
My Chicken Hez TB (airborne)Practice this →
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All 75 practice questions are free — every one with a full rationale.
