NCLEX-RN Cram Sheet for Nursing Exams

Test Information

• Five hours is the maximum time allotted for the NCLEX-RN under the current test plan, which has been in effect since the Next Generation NCLEX (NGN) launched in April 2023 (National Council of State Boards of Nursing). That five hours includes the tutorial and the optional breaks.
• Breaks count against your five hours. The first optional break is offered after 2 hours of testing, the next after 3.5 hours.
• 85/150 are the minimum and maximum number of questions on the NCLEX-RN (NCSBN, 2023 test plan). The exam is computer-adaptive and ends when the algorithm is 95% confident you are above or below the passing standard. A portion of items are unscored pretest items used to field-test new questions.
• Read the full question and every choice before selecting. Do not jump to conclusions or guess wildly.
• Watch the keywords. Be wary of answers with absolutes: always, never, all, every, only, must, except, none, no.
• Don't read into the question. Never assume anything not specifically stated.
• Eliminate the clearly wrong answers to raise your odds on the rest.
• Watch grammatical inconsistencies. Subject and verb should agree; the right answer completes the stem grammatically.
• Rephrase the question in your own words to strip the noise and expose the core of the stem.
• Make an educated guess when stuck: choose the answer carrying the most information.
• New question types appear in the Special Research Section after you finish the exam. They do not count toward your score; they are field-testing the items, not you.

NCLEX Question Types

• Multiple-Choice: client data plus four options. The most common type.
• Fill-in-the-Blank: usually medication calculation or IV flow rate. Type only a number; round at the end or as the question specifies; include the decimal point if needed.
• Multiple-Response: select all options that apply. Two or more may be correct, and there is no partial credit.
• Ordered-Response: drag and drop nursing actions into priority order. Directions come with the question.
• Figure or Hotspot: a chart, table, or illustration where you click a specific area.
• Chart/Exhibit: a problem with three tabs to click for the information you need.
• Graphic Option: options are pictures rather than text; click the circle by your choice.
• Audio: listen through the headset and click the sound icon; replay as needed.
• Video: view an animation or clip to answer.

Vital Signs

• Heart rate: 60-100 bpm
• Respiratory rate: 12-20 rpm
• Blood pressure: 110-120/60 mmHg
• Temperature: 37 °C (98.6 °F)

Hematology Values

Serum Electrolytes

Acid-Base Balance

Use the ABG Tic-Tac-Toe method for interpretation.

Chemistry Values

Urine Test Normal Values

Normal Glucose Values

Therapeutic Drug Levels

Cardiac Markers

Anticoagulant Therapy

Unit Conversions

Maternity Normal Values

• Fetal Heart Rate: 120-160 bpm
• Variability: 6-10 bpm
• Amniotic fluid: 500-1200 ml
• Contractions: 2-5 minutes apart, duration < 90 seconds, intensity < 100 mmHg.
• APGAR Scoring: Appearance, Pulse, Grimace (reflex irritability), Activity, Respiration. Done at 1 and 5 minutes, scored 0 for absent, 1 for decreased, 2 for strongly positive. 7 and above is normal, 4 to 6 is fairly low, 3 and below is critically low.
• AVA: the umbilical cord has two arteries and one vein.

STOP: Maternal Hypotension After Epidural

• Stop the Pitocin infusion.
• Turn the client to her left side.
• Oxygen, administer.
• Push IV fluids if hypovolemia is present.

Pregnancy Category of Drugs

• Category A: no risk in controlled human studies.
• Category B: no risk in other studies. Examples: Amoxicillin, Cefotaxime.
• Category C: risk not ruled out. Examples: Rifampicin (Rifampin), Theophylline (Theolair).
• Category D: positive evidence of risk. Examples: Phenytoin, Tetracycline.
• Category X: contraindicated in pregnancy. Examples: Isotretinoin (Accutane), Thalidomide (Immunoprin).
• Category N: not yet classified.

Drug Schedules

• Schedule I: no accepted medical use, research only (heroin, LSD, MDMA).
• Schedule II: high abuse potential, written prescription required (Ritalin, hydromorphone/Dilaudid, meperidine/Demerol, fentanyl).
• Schedule III: new prescription after six months or five refills (codeine, testosterone, ketamine).
• Schedule IV: new prescription after six months (Darvon, Xanax, Soma, Valium).
• Schedule V: dispensed as any prescription or without one (cough preparations, Lomotil, Motofen).

Medication Classifications

• Antacids: reduce hydrochloric acid in the stomach.
• Antianemics: increase blood cell production.
• Anticholinergics: decrease oral secretions.
• Anticoagulants: prevent clot formation.
• Anticonvulsants: manage seizures and bipolar disorders.
• Antidiarrheals: decrease gastric motility and reduce water in the bowel.
• Antihistamines: block the release of histamine.
• Antihypertensives: lower blood pressure and increase blood flow.
• Anti-infectives: treat infections.
• Bronchodilators: dilate large air passages in asthma and lung disease (COPD).
• Diuretics: decrease water and sodium from the Loop of Henle.
• Laxatives: promote passage of stool.
• Miotics: constrict the pupils.
• Mydriatics: dilate the pupils.
• Narcotics/analgesics: relieve moderate to severe pain.

Rule of Nines for Burns

Total Body Surface Area (TBSA) for burns:

• Head and neck: 9%
• Upper limbs: 18% (9% each)
• Trunk: 36%
• Legs: 36% (18% each)
• Genitalia: 1%

Medications

• Digoxin (Lanoxin): assess pulse for a full minute; hold the dose if less than 60 bpm. Check digitalis and potassium levels.
• Aluminum Hydroxide (Amphojel): GERD and kidney stones. Watch for (WOF) constipation.
• Hydroxyzine (Vistaril): anxiety and itching. WOF dry mouth.
• Midazolam (Versed): conscious sedation. WOF respiratory depression and hypotension.
• Amiodarone (Cordarone): WOF diaphoresis, dyspnea, lethargy. A missed dose can be taken any time that day or skipped; never double up.
• Warfarin (Coumadin): WOF bleeding, diarrhea, fever, rash. Stress compliance with the prescribed dose and followup appointments.
• Methylphenidate (Ritalin): ADHD. Assess for cardiac side effects and report immediately. The child may need a drug holiday because the drug stunts growth.
• Dopamine: hypotension, shock, low cardiac output. Monitor ECG for arrhythmias and watch blood pressure.
• Rifampicin: causes red-orange tears and urine.
• Ethambutol: causes vision and liver problems.
• Isoniazid: can cause peripheral neuritis; give vitamin B6 to counter it.

Developmental Milestones

• 2-3 months: lifts head and turns it side to side; coos and gurgles; turns head to sound.
• 4-5 months: grasps, rolls tummy to back; babbles and mimics sounds.
• 6-7 months: sits at 6 and waves bye-bye; recognizes familiar faces, wary of strangers; passes objects hand to hand.
• 8-9 months: stands at eight; has a favorite toy; plays peek-a-boo.
• 10-11 months: belly to butt.
• 12-13 months: drinks from a cup; cries when parents leave; cruises along furniture.

Cultural Considerations

• African Americans: may attribute illness to supernatural causes and seek faith healers; family-oriented; higher incidence of high blood pressure and obesity; high incidence of lactose intolerance.
• Arab Americans: may stay silent about STIs, substance abuse, and mental illness; a devout Muslim may read illness as the will of Allah and a test of faith; may try ritual cures before seeking care; after death, family may wash and wrap the body in unsewn white cloth, and postmortem exams are discouraged unless required by law; may avoid pork and alcohol; Islamic patients observe the monthlong Ramadan fast (begins approximately mid-October), though the chronically ill, pregnant, breastfeeding, or menstruating do not fast; females avoid eye contact with males and prefer same-sex interpreters.
• Asian Americans: may endure pain and grief with silent stoicism; family-oriented, with extended family involved in care of the dying; hot-cold yin/yang beliefs common; sodium intake often high from salted and dried foods; may view prolonged eye contact as rude; prefer a comfortable physical distance from the provider.
• Latino Americans: may view illness as weakness or punishment; may consult a curandero or voodoo priest; family is involved in decision-making, including terminal illness; may see no reason for mammograms or vaccinations.
• Native Americans: may turn to a medicine man to find the true cause of illness; may endure pain and grief stoically; diet may be deficient in vitamin D and calcium due to lactose intolerance; obesity and diabetes are major concerns; may avert eyes while praying or paying attention.
• Western Culture: may rely heavily on technology to conquer disease; health framed as the absence or control of disease; utensils are knife, fork, and spoon; three daily meals is typical.

Common Diets

• Acute Renal Disease: protein-restricted, high-calorie, fluid-controlled, sodium- and potassium-controlled.
• Addison's disease: increased sodium, low potassium.
• ADHD and Bipolar: high-calorie, finger foods.
• Burns: high protein, high calorie, increased Vitamin C.
• Cancer: high-calorie, high-protein.
• Celiac Disease: gluten-free (no BROW: barley, rye, oat, wheat).
• Chronic Renal Disease: protein-restricted, low-sodium, fluid-restricted, potassium-restricted, phosphorus-restricted.
• Cirrhosis (stable): normal protein.
• Cirrhosis with hepatic insufficiency: restrict protein, fluids, and sodium.
• Constipation: high-fiber, increased fluids.
• COPD: soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings.
• Cystic Fibrosis: increased fluids.
• Diarrhea: liquid, low-fiber, regular, fluid and electrolyte replacement.
• Gallbladder disease: low-fat, calorie-restricted, regular.
• Gastritis: low-fiber, bland.
• Hepatitis: regular, high-calorie, high-protein.
• Hyperlipidemias: fat-controlled, calorie-restricted.
• Hypertension, heart failure, CAD: low-sodium, calorie-restricted, fat-controlled.
• Kidney Stones: increased fluid intake, calcium-controlled, low-oxalate.
• Nephrotic Syndrome: sodium-restricted, high-calorie, high-protein, potassium-restricted.
• Obesity, overweight: calorie-restricted, high-fiber.
• Pancreatitis: low-fat, regular, small frequent feedings; tube feeding or total parenteral nutrition.
• Peptic ulcer: bland.
• Pernicious Anemia: increase Vitamin B12 (Cobalamin), found in shellfish, beef liver, and fish.
• Sickle Cell Anemia: increase fluids to maintain hydration, since sickling rises with dehydration.
• Stroke: mechanical soft, regular, or tube-feeding.
• Underweight: high-calorie, high protein.
• Vomiting: fluid and electrolyte replacement.

Positioning Clients

• Asthma: orthopneic, sitting up and bent forward with arms supported on a table or chair arms.
• Post Bronchoscopy: flat with head hyperextended.
• Cerebral Aneurysm: high Fowler's.
• Hemorrhagic Stroke: HOB elevated 30 degrees to reduce ICP and aid venous drainage.
• Ischemic Stroke: HOB flat.
• Cardiac Catheterization: keep the site extended.
• Epistaxis: lean forward.
• Above Knee Amputation: elevate on a pillow for the first 24 hours, prone daily for hip extension.
• Below Knee Amputation: foot of bed elevated for the first 24 hours, prone daily for hip extension.
• Tube feeding with decreased LOC: right side to promote gastric emptying, HOB elevated to prevent aspiration.
• Air/Pulmonary embolism: turn to the left side and lower the HOB.
• Postural Drainage: the lung segment to be drained goes uppermost so gravity works.
• Post Lumbar puncture: supine and flat to prevent headache and CSF leak.
• Continuous Bladder Irrigation (CBI): tape the catheter to the thigh and keep the leg straight.
• After myringotomy: lie on the side of the affected ear to drain secretions.
• Post cataract surgery: sleep on the unaffected side with a night shield for 1-4 weeks.
• Detached retina: the area of detachment goes in the dependent position.
• Post thyroidectomy: low or semi-Fowler's, support head, neck, and shoulders.
• Thoracentesis: sitting and leaning over a table during the procedure; affected side up afterward.
• Spina Bifida: prone so the sac does not rupture.
• Buck's Traction: elevate the foot of the bed for counter-traction.
• Post Total Hip Replacement: do not sleep on the operated side, do not flex the hip more than 45-60 degrees, do not elevate the HOB more than 45 degrees. Keep hip abduction with pillows between the thighs.
• Prolapsed cord: knee-chest or Trendelenburg.
• Cleft-lip: on the back or in an infant seat to protect the suture line; hold upright while feeding.
• Cleft-palate: prone.
• Hemorrhoidectomy: lateral.
• Hiatal Hernia: upright.
• Preventing Dumping Syndrome: eat reclining, lie down after meals for 20-30 minutes, restrict fluids with meals, low-fiber diet, small frequent meals.
• Enema Administration: left side-lying (Sim's) with knees flexed.
• Post supratentorial surgery (incision behind hairline): elevate HOB 30-45 degrees.
• Post infratentorial surgery (incision at nape of neck): flat and lateral on either side.
• Increased ICP: high Fowler's.
• Laminectomy: back as straight as possible; log roll to move, sandbags on the sides.
• Spinal Cord Injury: immobilize on a spine board, head neutral. Immobilize the head with a padded C-collar, maintain manual traction and alignment, log roll, and do not let the client twist or bend.
• Liver Biopsy: right side-lying with a pillow or small towel under the puncture site for at least 3 hours.
• Paracentesis: flat or sitting.
• Intestinal Tubes: right side to ease passage into the duodenum.
• Nasogastric Tubes: elevate HOB 30 degrees to prevent aspiration; maintain elevation for continuous feeding or 1 hour after intermittent feedings.
• Pelvic Exam: lithotomy.
• Rectal Exam: knee-chest, Sim's, or dorsal recumbent.
• During internal radiation: bed rest while the implant is in place.
• Autonomic Dysreflexia: sit the client up (elevate HOB) before anything else.
• Shock: bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg).
• Head Injury: elevate HOB 30 degrees to decrease intracranial pressure.
• Peritoneal Dialysis with inadequate outflow: turn side to side before checking for kinks in the tubing.
• Myelogram:
  • Water-based dye: semi-Fowler's for at least 8 hours.
  • Oil-based dye: flat for at least 6-8 hours to prevent CSF leakage.
  • Air dye: Trendelenburg.

Common Signs and Symptoms

• Pulmonary Tuberculosis (PTB): low-grade afternoon fever.
• Pneumonia: rust-colored sputum.
• Asthma: wheezing on expiration.
• Emphysema: barrel chest.
• Kawasaki Syndrome: strawberry tongue.
• Pernicious Anemia: red beefy tongue.
• Down syndrome: protruding tongue.
• Cholera: rice-watery stool and washerwoman's hands (wrinkled from dehydration).
• Malaria: stepladder fever with chills.
• Typhoid: rose spots on the abdomen.
• Dengue: fever, rash, headache; positive Herman's sign.
• Diphtheria: pseudomembrane formation.
• Measles: Koplik's spots (clustered white lesions on buccal mucosa).
• Systemic Lupus Erythematosus: butterfly rash.
• Leprosy: leonine facies (thickened folded facial skin).
• Bulimia: chipmunk facies (parotid gland swelling).
• Appendicitis: rebound tenderness at McBurney's point; Rovsing's sign (LLQ palpation elicits RLQ pain); psoas sign (pain on flexing the thigh to the hip).
• Meningitis: Kernig's sign (hamstring stiffness preventing leg extension when the hip is flexed to 90 degrees); Brudzinski's sign (forced neck flexion triggers reflex hip flexion).
• Tetany: hypocalcemia, [+] Trousseau's sign, Chvostek sign.
• Tetanus: risus sardonicus (rictus grin).
• Pancreatitis: Cullen's sign (umbilical ecchymosis), Grey Turner's sign (flank bruising).
• Pyloric Stenosis: olive-like mass.
• Patent Ductus Arteriosus: washing-machine murmur.
• Addison's disease: bronze skin pigmentation.
• Cushing's syndrome: moon face and buffalo hump.
• Grave's Disease (Hyperthyroidism): exophthalmos (bulging of the eye out of the orbit).
• Intussusception: sausage-shaped mass.
• Multiple Sclerosis: Charcot's triad (nystagmus, intention tremor, dysarthria).
• Myasthenia Gravis: descending muscle weakness, ptosis.
• Guillain-Barre Syndrome: ascending muscle weakness.
• Deep vein thrombosis (DVT): Homan's sign.
• Angina: crushing, stabbing pain relieved by NTG.
• Myocardial Infarction (MI): crushing, stabbing pain radiating to the left shoulder, neck, and arm; unrelieved by NTG.
• Parkinson's disease: pill-rolling tremors.
• Cytomegalovirus (CMV) infection: owl's-eye cells (huge nucleus).
• Glaucoma: tunnel vision.
• Retinal Detachment: flashes of light, a shadow or curtain across vision.
• Basilar Skull Fracture: raccoon eyes (periorbital ecchymosis) and Battle's sign (mastoid ecchymosis).
• Buerger's Disease: intermittent claudication.
• Diabetic Ketoacidosis: acetone breath.
• Pregnancy Induced Hypertension (PIH): proteinuria, hypertension, edema.
• Diabetes Mellitus: polydipsia, polyphagia, polyuria.
• Gastroesophageal Reflux Disease (GERD): heartburn.
• Hirschsprung's Disease (Toxic Megacolon): ribbon-like stool.
• Sexually Transmitted Infections:
  • Herpes Simplex Type II: painful vesicles on the genitalia.
  • Genital Warts: warts 1-2 mm in diameter.
  • Syphilis: painless chancres.
  • Chancroid: painful chancres.
  • Gonorrhea: green, creamy discharge and painful urination.
  • Chlamydia: milky discharge and painful urination.
  • Candidiasis: white, cheesy, odorless vaginal discharge.
  • Trichomoniasis: yellow, itchy, frothy, foul-smelling vaginal discharge.

Miscellaneous Tips

• Delegate sterile skills (such as a dressing change) to the RN or LPN.
• Delegate the stable client needing non-skilled care to the nursing assistant.
• Assign the most critical client to the RN.
• Clients being discharged get their final assessment from the RN.
• The LPN can monitor clients on IV therapy, insert urinary catheters and feeding tubes, and apply restraints.
• Assessment, teaching, medication administration, evaluation, and unstable patients cannot be delegated to unlicensed assistive personnel.
• Weight is the best indicator of dehydration.
• When a patient is in distress, medication is rarely the best first choice.
• Always check for allergies before giving antibiotics.
• Neutropenic patients should not receive vaccines, fresh fruit, or flowers.
• Nitroglycerine sublingual is given up to three times at five-minute intervals.
• Morphine is contraindicated in pancreatitis because it spasms the Sphincter of Oddi; give Demerol instead.
• Never give potassium (K+) by IV push.
• Infants born to an HIV-positive mother should receive all scheduled immunizations.
• Gravida is the number of pregnancies a woman has had, regardless of outcome.
• Para is the number of pregnancies that reached viability, whether the fetus was delivered alive or stillborn. A fetus is viable at 20 weeks' gestation.
• Lochia rubra is the nearly pure-blood vaginal discharge in the first few days after childbirth.
• Lochia serosa is the serous discharge 4 to 7 days after childbirth.
• Lochia alba is the final-stage discharge of decreased blood and increased leukocytes, 7 to 10 days after childbirth.
• In a fire, use RACE: Remove the patient, Activate the alarm, Contain the fire by closing the door, Extinguish if it can be done safely.
• Before signing informed consent, the patient should know other treatment options, understand the preoperative, intraoperative, and postoperative phases, the risks and possible complications, and the rough time from surgery to recovery, and have the chance to ask questions.
• The first intervention for a quadriplegic client in autonomic dysreflexia is to elevate the head as high as possible.
• Patients with the same infection in strict isolation can usually share a room.
• Veracity is truthfulness, essential to the therapeutic relationship.
• Beneficence is the duty to do good (and an equal obligation to do no harm and to assist the patient).
• Nonmaleficence is the duty to do no harm.
• Tyramine-rich foods (aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, beer) can cause severe hypertension in a patient on a monoamine oxidase inhibitor.
• Projection is unconsciously assigning a thought, feeling, or action to someone or something else.
• Sublimation is channeling unacceptable impulses into socially acceptable behavior.
• Repression pushes unacceptable or painful thoughts and feelings out of consciousness.
• People with obsessive-compulsive disorder know the behavior is unreasonable but cannot control it.
• A significant toxic risk of clozapine (Clozaril) is blood dyscrasia.
• Adverse effects of haloperidol (Haldol) include drowsiness, insomnia, weakness, headache, and extrapyramidal symptoms such as akathisia, tardive dyskinesia, and dystonia.
• Hypervigilance and déjà vu are signs of posttraumatic stress disorder (PTSD).

Frequently Asked Questions

How many questions are on the NCLEX-RN? The NCLEX-RN is computer-adaptive and ranges from a minimum of 85 to a maximum of 150 questions (NCSBN, 2023 test plan). It stops as soon as the scoring algorithm is 95% confident you are above or below the passing standard, so two test-takers can finish on very different question counts.

How long is the NCLEX-RN? The maximum testing time is five hours, including the opening tutorial and both optional breaks (NCSBN). The first optional break is offered after about 2 hours of testing and the second after about 3.5 hours.

Did the NCLEX change in 2023? Yes. The Next Generation NCLEX (NGN) took effect in April 2023 and added case-study and stand-alone item types that measure clinical judgment. The minimum and maximum question counts and the five-hour limit reflect that current test plan, not the older 75/265 format.

What is a passing score on the NCLEX? There is no percentage score. The exam is pass or fail, decided by the computer-adaptive algorithm against the current passing standard set by NCSBN, not by the number of questions you answer.

What is the fastest way to fail by overthinking? Reading information into the question that is not stated. Answer the scenario in front of you, watch for absolutes (always, never, all, only), and pick the response that fits the stem grammatically and clinically.

Are the lab values on this sheet what the NCLEX expects? Use them as quick reference ranges for studying. Reference ranges vary slightly by lab and source, so confirm against your nursing program's and clinical site's posted values for anything you will act on in practice.