Nclex Study Guide

Preparation for the NCLEX

• Start preparing as soon as you finish school. Starting your studying too early/while you are still in school (and 

studying for exams) may cause burn out and lead to a more stressful NCLEX studying experience. On the other hand, if you take off a large amount of time in between school and NCLEX studying, you’ll start to forget key 

information you learned in nursing school that’s needed for the NCLEX. 

• Order your study material during the last couple of weeks of school to ensure you have all your resources ready 

for the upcoming weeks of studying (my favorite resources are listed below). 

• Read over the National Council of State Boards of Nursing detailed test plan (there is an overview of what you’ll be tested on and what percentage of the test is made up of what topics; e.g. 12% of the test will cover Safety and 

Infection Prevention + Control).

• Create a study schedule and stick to it – my study calendar is found on the next page. 

• Learn about the various alternate format questions and tips/tricks on how to answer them (e.g. Select All That Apply [SATA], hot spot questions, fill in the blank questions, chart/audio/graphic questions, and drag-and- drop/ordered questions). 

• Find a study space that works for you. Personally, I studied at a library every single day and found it to be very beneficial as I was able to focus without distractions and could also separate my study space and personal space.

• Remain positive and confident! If you find yourself over-worked, know that it’s okay to take a day off for self- care… it’ll benefit you in the long run.

The following are resources I personally used while studying for the NCLEX and would highly recommend: • Test-bank: uWorld o This is the #1 resource I recommend

o The layout of uWorld is essentially identical to the NCLEX o The test bank questions are slightly more difficult than the real NCLEX, which I believe will help prepare 

you best for the test. It will also have you thinking more critically! o You can go through the questions in a random order or system by system (which is what I chose to do) and once you’re finished with the test bank, you can write a mock NCLEX with results that show you 

the likelihood of you passing the NCLEX • Book: Saunders Comprehensive Review for the NCLEX-RN

o This book includes everything you need to know for the NCLEX o Not necessary to read every single page, but it’s a great resource to refer to when you are struggling 

with a particular system or concept. If I got a uWorld question wrong, not only would I read the 

rationale, but I would also read up on that particular information in my Saunders book

Study Material: • Cue cards: I wrote out all my lab values on cue cards and reviewed all lab values every single day before my 

study session began • Binder split into sections: writing out uWorld rationales and keeping them in a binder for you to review weekly 

is a great way to ensure that you don’t forget what you learned the previous week(s) • Calculator, pens, highlighter, sticky notes/tabs, and earplugs 

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Study Schedule

• I set aside 2 months for my NCLEX studying, however, 1.5 months would have been enough for me personally

• Monday – Saturday: 1. Review lab value cue cards 2. 10 uWorld questions 3. Read rationales, write out every single rationale in binder (unless you’re 100% confident in the topic) 4. Read extra information from Saunders book and add into the binder 5. 15 minute break

6. Repeat steps 2-5 for a total of 30-50 questions per day • Sunday: 1. Read over all the rationales in my binder 2. RELAX! • I started off my NCLEX studying with the section I was least confident in: maternity. I had the most energy and determination at the beginning (obviously), so I knew that I could tackle and conquer my weakest section with

ease. If you don’t have a particular “weak section” I suggest the following schedule: Month 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunday ADULT HEALTH ---------------- ------------------- ------------------- ------------------- ------------------- -------------------

------------------- ------------------- ------------------- ------------------- ------------------- ------------------- -------------------

------------------- ------------------- ------------------- ------------------- ------------------- ------------------- ----------------→

PEDIATRICS ---------------- ------------------- ------------------- ------------------- ------------------- ----------------→

Month 2 Monday Tuesday Wednesday Thursday Friday Saturday Sunday MATERNITY --------------- ----------------------- ------------------- ------------------ ------------------- ---------------→

CRITICAL CARE ---------------→ PHARMACOLOG --------------- ------------------ ---------------→ ------------------- MENTAL HEALTH ---------------→

DELEGATION/ LEADERSHIP ---------------→ REVIEW REVIEW BREAK TEST DAY

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General Nursing Vital Signs BP 120/80 HR 60-100 bpm SPO2 95-100% or 88-92% for COPD T 36.5-37.5 C or 96.8 F - 100.4 RR 12-20 rpm 

Therapeutic Medication Levels Acetaminophen 10-30 mcg/mL Carbamazepine 5-12 mcg/mL

Digoxin 0.5-2 ng/mL Gentamicin 5-10 mcg/mL

Lithium 0.5-1.2 mEq/L

Magnesium Sulfate 4-7 mg/dL

Phenobarbital 10-30 mcg/mL

Phenytoin 10-20 mcg/mL

Salicylate 100-250 mcg/mL Valproic acid 50-100 mcg/mL BURNS: Rule of 9s Head 9%

Arms 18% (9?ch) Back 18%

Chest 18%

Legs 36% (18?ch) Genitalia 1%

Parkland Formula: used to determine amount of fluid resuscitation needed in 24hrs after a burn o 4 mL x BSA (% of body burned) x kg ▪ Give half of this in the first 8 hours ▪ Remaining half is given over 16 hours Fluids and Electrolytes: Intravascular: fluid inside a blood vessel Intracellular: fluid inside a cell (most bodily fluids are inside the cells)

Extracellular: fluid outside the cells (includes interstitial fluid [fluid in between cells], blood, bone, connective 

tissue, water) Isotonic 0.9% NS, D5W, Lactated Ringers No osmotic force = cells neither swell nor shrink Hypotonic 0.45% NS, 0.33% NS More dilute solutions (more water than solute) = causes water to enter cells *watch for edema Hypertonic 3% NS, 5% NS, D10W, D5W with ½ NS, D5LR More concentrated solution (more solute than water) = water is removed from cells Colloid Dextran, Albumin Fluid moves from interstitial to intravascular compartment *given in severe hypovolemia 

Monitor your patients with severe diarrhea and vomiting for electrolyte imbalance* 

Lab Values K 3.5-5.0 mEq/L Na 135-145 mEq/L Ca 8.5-10.5 mg/L Cl 95-105 mEq/L Mg 1.5-2.5 mEq/L

Phos 2.5-4.5 mg/dL RBC 4.5-5.0 million WBC 5K-10K

Plt 200K-400K

Hgb 12-16 g (female) 14-18 g (male) pH 7.35-7.45 CO2 35-45 mEq/L HCO3 24-26 mEq/L

PaO2 80-100% Glucose 70-110 mg/dL or 4-6 mmol/L HBA1C <7>

LDH 100-190 U/L

Triglycerides 40-50 mg/dL

Total chol 130-200 mg/dL Bilirubin <1>

Protein 6.2-8.1 g/dL Albumin 3.4-5.0 g/dL

PTT 20-36 seconds If on heparin: 1.5-2.5x normal PT 9-11 s

INR 0.9-1.8

2-3 if on warfarin

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Electrolyte Foods that will increase the electrolyte ECG changes Notes Sodium bacon, butter, canned food, cheese, 

milk, condiments, salt, bread 

Low Na = Low H20 (dry mucous membranes High Na = High H20 Potassium avocado, banana, carrots, fish, oranges, potatoes, pork/beef, 

spinach, tomato 

Low: ST dep., shallow/flat/

inverted T wave, U wave High: tall peaked T wave, flat P wave, wide QRS 

Potassium is never given by IV

push (IVP)!! It is always diluted 

in a minibag!! 

*never given greater than 10meq/hr Calcium cheese, milk, spinach, yogurt, tofu, sardines, greens Low: prolonged ST + QT

High: shortened ST, wide T wave 

Low calcium = Positive Trousseau’s and Chvostek’s Magnesium avocado, leafy greens, milk, wheat, 

peanut butter, pork/beef/chicken, potatoes, yogurt 

Low: tall T wave, depressed ST High: prolonged ST, wide QRS Antidote for magnesium toxicity

= calcium gluconate 

Phosphorus fish, pumpkin, nuts, 

pork/beef/chicken, whole grain, dairy

Decrease in phosphorus levels results in increase in calcium lvls Sodium/Potassium – inverse relationship; high Na = low K Calcium/Phosphorus – inverse relationship; high Ca = low Phos Calcium/Vit D – similar relationship; high Ca = high Vit D Magnesium/Calcium – similar relationship; low Mg = low Ca

Magnesium/Potassium – similar relationship; low Mg = low K 

Magnesium/Phosphorus – inverse relationship; low Mg = high Phos Acid and Base Balance: 1. Look at pH – is it too low or too high?

• Too low = acidosis

• Too high = alkalosis 2. Look at CO2 and see if it’s an opposite relationship from the pH (e.g. if pH was low and CO2 was high, or if pH 

was high and CO2 was low) • If YES, you have a respiratory imbalance • If NO (pH and CO2 have same relationship – either both are high or both are low) move to #3 3. Look at HCO3 and see if it has the same relationship as pH (both pH + bicarb are high both pH + bicarb are low) • If YES, you have a metabolic imbalance 4. COMPENSATED: pH will be within the normal range (body has corrected the problem) 5. PARTIALLY COMPENSATED: pH is not normal. Look at the system that is supposed to fix the problem (if you 

have a respiratory problem, the metabolic system will try to compensate and vice versa) and see if it is

abnormal, which means it is trying to compensate • If YES, then you have PARTIAL compensation

• If NO, then you have UNCOMPENSATION Low pH + high CO2 = respiratory acidosis • Any condition causing airway obstruction or depression

Low pH + low HCO3 = metabolic acidosis

• Insufficient insulin in pt w DM = DKA

• Severe diarrhea can cause metabolic acidosis High pH + low CO2 = respiratory alkalosis • Any condition causing overstimulation of the respiratory system (e.g. hyperventilation, hysteria, overventilation, etc.)