- NCLEX-PN
- National licensure exam for Licensed Practical/Vocational Nurses (LPN/LVN), administered by NCSBN.
- Governing body
- National Council of State Boards of Nursing (NCSBN).
- Current test plan
- 2026 NCLEX-PN Test Plan, effective April 2026.
- Test format
- Computerized Adaptive Testing (CAT), variable length, one item at a time, no going back.
- Minimum items (PN)
- 85.
- Maximum items (PN)
- 150.
- Pretest (unscored) items
- 15 on every exam.
- Time limit (PN)
- 5 hours total (includes breaks).
- 85-item exam breakdown
- 52 content items + 18 case-study items + 15 pretest.
- Passing standard
- at or above the set ability level (−0.18 logits); no fixed % passes.
- 95% Confidence Interval Rule
- exam stops when 95% certain candidate is above/below standard.
- Maximum-Length Exam Rule
- at 150 items, use final ability estimate only.
- Run-Out-Of-Time (R.O.O.T.) Rule
- <85 items answered = fail; ≥85 = scored on final estimate.
- Exam length & result
- length does NOT indicate pass/fail.
- Registration fee
- $200 USD.
- Retake wait
- 45 test-free days between attempts (NCSBN); up to 8/year; states may be stricter.
- NGN launch
- April 1, 2023 (measures clinical judgment).
- NCJMM
- NCSBN Clinical Judgment Measurement Model.
- NCJMM 6 steps
- Recognize cues, Analyze cues, Prioritize hypotheses, Generate solutions, Take action, Evaluate outcomes.
- Case study
- 6-item set on one unfolding client, one item per NCJMM step.
- NGN item types
- extended multiple response, matrix/grid, cloze/drop-down, drag-and-drop, bow-tie, highlight, trend.
- Partial-credit scoring methods
- plus/minus, zero/one, rationale.
- Integrated processes
- Caring, Clinical Judgment, Nursing Process, Communication/Documentation, Culture/Spirituality, Teaching/Learning.
- PN nursing-process verb
- "data collection" (RN = full "assessment").
- Largest content subcategory
- Coordinated Care (18–24%).
- Largest major category
- Physiological Integrity (~45% combined).
- PN content variance
- distributions may vary ±3% per category.
- Coordinated Care
- PN name for the subcategory the RN plan calls "Management of Care."
- LPN/VN role
- collaborates with/under the direction of the RN and provider.
- LPN scope
- collect data, reinforce teaching, perform routine skills, monitor stable clients.
- RN-only (not LPN)
- initial assessment, care-plan creation, initial teaching, unstable clients, IV-push high-alert meds, blood initiation, triage, first evaluation.
- Data collection vs assessment
- LPN collects data; RN assesses.
- Reinforce teaching
- LPN repeats/clarifies education the RN/provider started.
- 5 Rights of Delegation
- right task, circumstance, person, direction/communication, supervision/evaluation.
- Delegate to UAP
- stable/predictable ADLs: bathing, feeding (no swallow risk), ambulating, positioning, toileting, vitals, I&O, weight, routine specimens.
- Never delegate to UAP
- assessment, planning, evaluation, teaching, nursing judgment, unstable clients.
- Delegation accountability
- the delegating nurse retains accountability for outcomes.
- Prioritization #1
- ABCs: Airway → Breathing → Circulation.
- Maslow
- physiologic needs before safety before psychosocial (physical before emotional).
- Stable vs unstable
- see the acute/unstable/unexpected client first; refer instability to RN.
- Scope of practice source
- state Nurse Practice Act / Board of Nursing (not the employer).
- Informed consent roles
- provider explains/obtains; nurse witnesses signature & confirms understanding.
- Consent doubt
- client unsure before signing → stop and notify the provider.
- Advance directive
- living will / durable power of attorney for health care; honor it.
- Mandatory reporting
- abuse, neglect, gunshot/stab wounds, certain communicable diseases.
- Suspected abuse
- report; proof not required.
- Confidentiality (HIPAA)
- disclose only on need-to-know; provide privacy.
- Unsafe order
- clarify with the prescriber before carrying it out.
- Unsafe practice by staff
- recognize, intervene, and report up the chain.
- Self-limitation
- recognize limits and seek assistance.
- Incident/occurrence report
- documents errors/near-misses; not part of the chart; don't chart that it was filed.
- SBAR
- Situation, Background, Assessment/data, Recommendation (hand-off communication).
- Client advocacy
- advocate for client rights/needs; promote self-advocacy.
- Interdisciplinary team
- RN, provider, PT, OT, RD, pharmacy, social work.
- Quality improvement
- participate (data collection, committees) for cost-effective care.
- Equal-access care
- unbiased regardless of culture, ethnicity, sexual orientation, gender identity/expression.
- Continuity of care
- participate in admission, discharge, transfer, referral, follow-up.
- Documentation rule
- objective, factual, timely; charts validate care.
- Standard Precautions
- apply to ALL clients; assume blood/body fluids infectious.
- #1 infection-prevention measure
- hand hygiene.
- Soap & water required
- visibly soiled hands, C. difficile, spores, norovirus.
- Alcohol-based rub
- acceptable for routinely soiled (non-spore) hands.
- Contact Precautions
- gown + gloves (MRSA, VRE, C. diff, RSV, scabies).
- C. difficile
- contact precautions; soap & water; bleach cleaning (alcohol won't kill spores).
- Droplet Precautions
- surgical mask within ~6 ft (flu, pertussis, mumps, meningococcus, group A strep).
- Airborne Precautions
- N95 + negative-pressure (AIIR) room, door closed.
- Airborne diseases
- Measles, Chickenpox/Varicella, TB (+ disseminated zoster) = "My Chicken Has TB."
- Varicella precautions
- airborne + contact.
- Don PPE order
- gown → mask → goggles → gloves.
- Doff PPE order
- gloves → goggles → gown → mask; hand hygiene last.
- Protective/reverse isolation
- protects the immunocompromised client (no raw produce/fresh flowers).
- Two identifiers
- verify name + DOB/MRN before meds, procedures, specimens, blood.
- Fall prevention
- bed low/locked, call light in reach, nonskid footwear, alarms, rounding.
- Restraints
- least restrictive; need a provider order (not PRN); try alternatives first.
- Restraint emergency
- may apply first, obtain order within facility timeframe.
- Restraint monitoring
- circulation/skin/ROM/toileting; q15min behavioral; quick-release knot to bed frame, not side rail.
- RACE (fire)
- Rescue, Alarm, Confine, Extinguish/Evacuate.
- PASS (extinguisher)
- Pull, Aim, Squeeze, Sweep.
- Oxygen safety
- no smoking/flame/sparks; combustion hazard; secure cylinders.
- Latex allergy
- identify, band, avoid latex products.
- Body mechanics
- bend at knees, load close, push > pull, get help.
- Transfer devices
- gait/transfer belt, slide board, mechanical lift.
- Mass-casualty triage
- greatest good for greatest number.
- Security alerts
- infant abduction, elopement/flight risk.
- Sharps safety
- no recapping; puncture-resistant container.
- Timed monitoring
- safety checks (e.g., q15min suicide precautions).
- Home safety
- remove scatter rugs, add grab bars/lighting, smoke/CO detectors, safe med storage.
- Equipment safety
- ensure safe functioning; remove/report malfunctioning devices.
- Scope
- growth/development knowledge + prevention/early detection.
- PN role
- collect health history/baseline data; reinforce prevention teaching.
- NCSBN age bands
- newborn <1 mo, infant/toddler ≤2 yr, 3–17 yr, adult 18–64, older adult 65+.
- Erikson infant
- trust vs. mistrust.
- Erikson toddler
- autonomy vs. shame/doubt.
- Erikson preschool
- initiative vs. guilt.
- Erikson school-age
- industry vs. inferiority.
- Erikson adolescent
- identity vs. role confusion.
- Erikson older adult
- integrity vs. despair.
- Social smile
- ~2 months.
- Sits unsupported
- ~6–8 months.
- Walks
- ~12–15 months.
- Birth weight doubles
- ~6 months; triples ~12 months.
- Anterior fontanel closes
- ~12–18 months.
- Primary prevention
- prevent disease (immunizations, education, seat belts).
- Secondary prevention
- screening/early detection (BP, mammogram, Pap, glucose).
- Tertiary prevention
- limit disability (rehab, support groups).
- APGAR
- HR, respiratory effort, tone, reflex, color at 1 & 5 min (7–10 reassuring).
- Newborn vitals
- HR 110–160, RR 30–60.
- BUBBLE-HE
- postpartum assessment (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homan's, Emotions).
- Lochia progression
- rubra → serosa → alba.
- Boggy fundus
- massage first, then notify.
- Live vaccines
- MMR, varicella, intranasal flu, rotavirus.
- Live vaccine contraindication
- pregnancy and immunocompromise.
- Immunization source
- current CDC schedule (updated regularly).
- Teach-back
- confirm understanding ("tell me in your own words").
- Learning barriers
- language, literacy, sensory deficit, pain, anxiety, developmental level, culture.
- Normal aging
- presbyopia, presbycusis, slower reaction, reduced renal/hepatic clearance.
- Acute confusion in elder
- NOT normal aging → investigate cause (infection, dehydration, drugs).
- Community resources
- home health, Meals on Wheels, hospice, support groups.
- High-risk behavior prevention
- substance misuse, unsafe sex, smoking cessation education.
- Scope
- assist with emotional, mental, social well-being.
- Therapeutic communication goal
- acknowledge feelings, keep client talking.
- Open-ended question
- therapeutic ("Tell me more…").
- Offering self
- "I'll sit with you."
- Reflecting/restating
- therapeutic.
- False reassurance
- NON-therapeutic ("Everything will be fine").
- Giving advice
- NON-therapeutic.
- "Why" questions
- NON-therapeutic (accusatory).
- Feelings before facts
- address emotion before teaching.
- Empathy vs sympathy
- choose empathy.
- Defense mechanisms
- denial, projection, rationalization, regression, displacement, sublimation.
- Kübler-Ross grief
- denial, anger, bargaining, depression, acceptance (not linear).
- Anxiety levels
- mild, moderate, severe, panic.
- Panic anxiety
- never leave the client alone; reduce stimuli; short sentences.
- Suicide assessment
- ask directly about ideation/plan; asking does NOT plant the idea.
- Highest suicide risk
- specific plan + available means.
- Sudden mood lift in depression
- may signal decision to act → increase vigilance.
- Suicide precaution
- ensure safety, remove means, timed checks/one-to-one.
- Mania care
- decrease stimulation, structure, finger foods, set limits.
- Hallucination
- false sensory perception; acknowledge experience, present reality.
- Command hallucination
- assess safety risk (commands to harm).
- Delusion
- fixed false belief; don't argue or agree; focus on feelings/reality.
- Paranoid client
- don't touch without warning.
- Alcohol withdrawal
- 24–72 h; tachycardia, tremor, hallucinations, seizures, DTs (can be fatal).
- Opioid overdose
- respiratory depression, pinpoint pupils → naloxone.
- Delirium
- acute, fluctuating, often reversible (infection, drugs, dehydration, hypoxia).
- Dementia
- chronic, progressive, irreversible.
- De-escalation
- calm voice, space, choices, set limits; restraints last resort.
- Therapeutic milieu
- safe, structured, supportive environment.
- Reminiscence/validation/reality therapy
- match technique to cognitively impaired client.
- Culture/spirituality
- treat as client self-reported; honor preferences.
- End-of-life care
- comfort, honor advance directives, support family/grief.
- Nonadherence
- explore reasons rather than judge.
- Self-esteem
- give genuine, specific recognition.
- Reinforce caregiver education
- managing client with behavioral disorders.
- Scope
- comfort and ADL assistance.
- Enteral feeding safety
- HOB ≥30–45∘ during/after; verify placement; check residuals.
- Aspiration prevention
- upright, thickened liquids, chin-tuck, no straws.
- Pressure injury prevention
- reposition q2h, offload, moisture/nutrition.
- Pressure injury stages
- 1–4 + unstageable + deep tissue.
- Pain
- "what the client says it is"; 5th vital sign.
- Pain scales
- 0–10 numeric; FACES (peds/nonverbal); FLACC (infants).
- Nonpharmacological pain relief
- imagery, massage, repositioning, heat/cold, music, distraction.
- Low-sodium diet
- heart failure, hypertension.
- Renal diet
- limit potassium, phosphorus, protein (per stage).
- Diabetic diet
- carbohydrate-consistent.
- I&O monitoring
- track intake and output.
- Irrigation
- catheter, bladder, wound, ear, nose, eye.
- Sleep/rest
- provide measures to promote.
- Postmortem care
- provide after death.
- Immobility complications
- pressure injury, VTE, atelectasis, constipation, contractures.
- ROM
- maintain joint mobility in immobilized client.
- Complementary therapy
- music, pet therapy as appropriate.
- Rights of med administration
- client, drug, dose, route, time (+documentation, reason, response, refuse, education).
- High-alert meds
- insulin, anticoagulants, opioids, concentrated electrolytes (KCl); double-check.
- Three label checks
- verify drug 3 times before giving.
- Pre-administration data
- allergies, contraindications, current meds, relevant vitals/labs.
- Controlled substances
- count and report discrepancies.
- ID injection angle
- 5–15°.
- Subcut injection angle
- 45–90°.
- IM injection angle
- 90°.
- Heparin subcut
- don't aspirate, don't massage; rotate sites.
- Insulin IV
- only regular insulin is IV-compatible.
- Med calc
- Desired/Have×Quantity.
- IV rate
- total mL÷hours=mL/hr.
- Warfarin
- monitor INR (~2–3); antidote vitamin K.
- Heparin
- monitor aPTT; antidote protamine sulfate.
- Digoxin
- check apical pulse 1 min; hold if <60 bpm (adult).
- Digoxin toxicity
- N/V, visual halos, bradycardia, anorexia; worsened by hypokalemia.
- Digoxin therapeutic level
- 0.5–≤1.0 ng/mL; antidote digoxin immune Fab.
- Lithium therapeutic range
- 0.6–1.2 mEq/L; toxicity ≥1.5.
- Lithium teaching
- maintain fluid and sodium intake; report tremor/GI/confusion.
- Insulin hypoglycemia
- shaky, diaphoretic, confused → 15 g fast carb / glucagon.
- Opioids
- respiratory depression, constipation; antidote naloxone.
- Acetaminophen toxicity
- hepatotoxic; antidote N-acetylcysteine.
- Benzodiazepines
- sedation/resp depression; antidote flumazenil.
- Loop diuretics (furosemide)
- hypokalemia, ototoxicity; monitor K⁺.
- ACE inhibitors (-pril)
- dry cough, hyperkalemia, angioedema, first-dose hypotension.
- Beta blockers (-olol)
- bradycardia, hypotension; don't stop abruptly; mask hypoglycemia.
- Aminoglycosides/vancomycin
- nephro/ototoxic; monitor trough.
- Corticosteroids
- hyperglycemia, infection masking, taper, take with food.
- MAOIs
- avoid tyramine (aged cheese, wine) → hypertensive crisis.
- Statins
- report muscle pain (rhabdomyolysis), liver monitoring.
- Transfusion reaction
- stop, run normal saline, notify; fever/chills/back pain/dyspnea.
- PCA/epidural
- maintain; monitor; don't adjust beyond scope.
- Medication reconciliation
- prescriptions + OTC + herbals.
- IV piggyback
- secondary infusion (state-dependent LPN scope).
- Expired/incompatible meds
- check storage, dates, compatibility.
- Scope
- reduce complications from treatments/procedures/conditions.
- Sodium normal
- 135–145 mEq/L.
- Potassium normal
- 3.5–5.0 mEq/L.
- Calcium normal
- 9.0–10.5 mg/dL.
- Magnesium normal
- 1.5–2.5 mEq/L.
- Fasting glucose normal
- 70–110 mg/dL.
- HbA1c
- <5.7% normal; diabetes goal often <7%.
- BUN normal
- 10–20 mg/dL.
- Creatinine normal
- 0.6–1.2 mg/dL.
- WBC normal
- 5,000–10,000 /µL.
- Platelets normal
- 150,000–400,000 /µL.
- Hgb normal
- M 14–18, F 12–16 g/dL.
- INR therapeutic
- ~2–3.
- ABG pH
- 7.35–7.45.
- PaCO₂
- 35–45 mmHg.
- HCO₃⁻
- 22–26 mEq/L.
- PaO₂
- 80–100 mmHg.
- Hyperkalemia ECG
- peaked T-waves; emergency dysrhythmia risk.
- Hypokalemia
- flat T/U-wave, weakness, ↑digoxin toxicity.
- Hyponatremia
- confusion, seizures.
- Hypercalcemia
- "stones, bones, groans."
- Point-of-care tests
- glucose, pregnancy, troponin, urine dipstick.
- Specimen collection
- blood, urine, stool, sputum.
- Venipuncture
- collect blood specimens.
- EKG/ECG
- perform per scope; report abnormalities.
- Bladder scan
- check for urinary retention.
- Urinary catheter
- sterile insertion → prevent CAUTI.
- NG tube
- verify placement before use.
- SCDs/compression stockings
- VTE prevention.
- Pre-op care
- consent witnessed, NPO, baseline vitals, reinforce teaching.
- Post-op monitoring
- airway, bleeding, pain, VTE, vitals.
- Focused data collection
- neuro checks, circulation checks per condition.
- Central venous catheter
- maintain per scope.
- Peripheral IV
- maintain/remove; monitor for infiltration/phlebitis.
- Prenatal complication signs
- identify and report.
- Scope
- care for acute, chronic, life-threatening conditions.
- Life-threatening response
- CPR/BLS; recognize arrest, high-quality compressions.
- Change in condition
- recognize and report early.
- Respiratory intervention
- breathing treatments, suctioning, repositioning.
- Tracheostomy care
- suction PRN, humidify, stoma care, keep spare trach/obturator at bedside.
- Ventilator client
- provide care per scope; monitor.
- Cardiac monitor
- recognize/report basic abnormalities (RN/provider interprets complex).
- Wound care
- perform dressing changes; remove sutures/staples per order.
- Drainage devices
- care for wound drains, chest tubes.
- Ostomy care
- skin protection, appliance care, output monitoring (colostomy/ileostomy/urostomy).
- Pacing device
- assist in care.
- Dialysis
- care for peritoneal/hemodialysis (monitor access, weights, complications).
- Fluid/electrolyte imbalance
- provide care and monitor.
- Cooling/warming
- restore normal body temperature.
- Heart failure teaching
- daily weights; report >2–3 lb/day or 5 lb/week; low sodium.
- COPD teaching
- pursed-lip breathing, low-flow O₂, energy conservation.
- Diabetes teaching
- glucose, foot care, sick-day rules, hypo/hyperglycemia.
- Hypoglycemia signs
- shaky, sweaty, confused, tachycardia.
- Hyperglycemia/DKA signs
- polyuria, polydipsia, fruity breath, Kussmaul respirations.
- ROME (acid-base)
- Respiratory Opposite, Metabolic Equal.
- Respiratory acidosis
- ↓pH, ↑CO₂ (hypoventilation, COPD).
- Respiratory alkalosis
- ↑pH, ↓CO₂ (hyperventilation, anxiety).
- Metabolic acidosis
- ↓pH, ↓HCO₃ (DKA, diarrhea, renal failure).
- Metabolic alkalosis
- ↑pH, ↑HCO₃ (vomiting, antacids).
- Stroke/neuro deficit
- reinforce care; monitor; aspiration precautions.
- Two clients, one airway issue
- airway client first (ABCs).
- Unstable/changing client (LPN)
- notify the RN/provider.
- Unsafe/unclear order
- clarify with prescriber before acting.
- Task needing judgment offered to UAP
- do not delegate.
- Client doubts consent
- stop, notify provider.
- Digoxin + apical <60
- hold and notify.
- Tube feeding + cough/flat HOB
- stop feeding, raise HOB, suction.
- Transfusion reaction
- stop transfusion, run NS, notify.
- Hyperkalemia peaked T-waves
- emergency, report immediately.
- Suicidal hint
- ask directly, ensure safety first.
- Agitated client
- de-escalate before restraints; restraints need order.
- Acute new confusion
- suspect delirium; find reversible cause.
- Live vaccine + pregnancy
- hold and notify.
- Boggy postpartum fundus
- massage first.
- C. diff isolation
- contact precautions + soap & water.
- Suspected TB/measles/varicella
- N95 + negative-pressure before entry.
- Fire
- RACE; rescue client first.
- Doffing PPE
- gloves off first; hand hygiene last.
- Client distress
- respond to the feeling (open-ended/empathic), no false reassurance.
- Visibly soiled hands
- soap and water (not alcohol rub).
- Abnormal finding, stable client
- LPN collects more data and reports.
- Initial assessment / care plan / initial teaching / triage
- RN, not LPN.
- Worst-first prioritization
- least stable/most acute client first.
- Assess
- RN (LPN collects data).
- Plan (initial)
- RN (LPN updates/contributes).
- Teach (initial)
- RN (LPN reinforces).
- Evaluate (first)
- RN (LPN monitors/reports response).
- Unstable client
- RN.
- Blood initiation / TPN / chemo / titrated drips / IV-push high-alert
- RN (state-dependent).
- Routine skills (wound care, catheter, NG, ostomy, glucose, suction)
- LPN within scope.
- Stable client monitoring
- LPN.
- Med administration (PO, topical, subcut, IM, many IV)
- LPN (IV scope varies by state).
- Scope authority
- defined by state Nurse Practice Act / Board of Nursing.