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FREE NCLEX-PN Study Guide 2026: A Complete, NCSBN-Aligned Walkthrough

The most important things the NCLEX-PN tests — an interactive study guide with built-in flashcards, aligned to NCSBN's Client Needs categories for the LPN/VN licensure exam.

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This free NCLEX-PN study guide walks through everything the National Council Licensure Examination for Practical/Vocational Nurses tests, organized into the same Client Needs categories used to build the exam from the 2026 NCLEX-PN Test Plan.[1]

It is interactive, not a wall of text: every category has worked clinical-judgment scenarios, lab-value and medication tables, diagrams, and built-in flashcards, so you learn by doing — and you learn within the scope the PN exam actually tests.

Read it category by category, then round out your prep with our practice questions and flashcards. The NCLEX-PN licenses you as an LPN or LVN — a different exam from the NCLEX-RN, with its own weights and a scope built around contributing to care under the direction of an RN or provider.

NCLEX-PN Exam Snapshot

NCLEX-PN exam at a glance (2026)
DetailNCLEX-PN exam
Items85–150 (variable length; 15 unscored pretest items)
Time limit5 hours total (includes all breaks)
FormatComputerized adaptive testing (CAT); one item at a time, no going back
Passing standardAbility at or above −0.18 logits (no fixed %)
Exam fee$200 (U.S. registration)
Retake45 test-free days between attempts; up to 8/year (states may be stricter)
CredentialLicensed Practical / Vocational Nurse (LPN/LVN)

is the heaviest block — its four subcategories sum to roughly 45% of the exam — and is the single largest subcategory at 18–24%. Budget your study toward physiology, pharmacology, and safe scope/prioritization decisions.[1][2]

NCLEX-PN weighting by NCSBN Client Needs category (PN midpoints)
Physiological Integrity (4 subcategories)45% · largest
Safe & Effective Care Environment (Coordinated Care + Safety)34% · 21% + 13%
Psychosocial Integrity12% · 9–15%
Health Promotion & Maintenance9% · 6–12%

Clinical-judgment items — 18 case-study items (three six-item cases) plus about 10% stand-alone — are counted separately from the content-area percentages above and can draw on any category.[1]

How the NCLEX-PN Works: CAT, NGN & the Pass Logic

The NCLEX-PN is delivered by . After each item, the algorithm re-estimates your ability and selects the next item to match the test plan and be appropriately challenging.[3] You answer one item at a time, every item must be answered to move on, and once you confirm an answer you cannot go back.

Because the exam is adaptive and variable length, length does not predict your result — a candidate can pass or fail at 85 items or at 150. On the minimum 85-item exam, 52 items come from the eight content areas, 18 are clinical-judgment case-study items, and 15 are unscored pretest items that look identical to scored ones.[2]

Next Generation NCLEX (NGN) and the NCJMM

launched April 1, 2023 to measure clinical judgment using the and its six cognitive steps. Clinical judgment appears as unfolding case studies (a six-item set on one client, one item per NCJMM step) and as stand-alone NGN items.[4]

NGN item types include extended multiple response (including select-all-that-apply), matrix/grid, cloze drop-down, drag-and-drop bow-tie, highlight, and trend items — many with partial-credit scoring (plus/minus, zero/one, or rationale).[4] For the LPN/VN, clinical judgment is applied within scope: recognize and report changes, prioritize within data collection, and act on stable, predictable findings.

How pass/fail is decided

There is no fixed passing percentage and no set number who pass — the standard is an ability level (currently −0.18 ).[5] Three rules end the exam:

NCLEX-PN pass/fail rules
RuleWhat happens
95% Confidence Interval RuleMost common — the exam stops once the algorithm is 95% certain you are clearly above or below the standard (after the minimum 85 items).
Maximum-Length Exam RuleIf your ability stays too close to the standard, the exam runs to 150 items and the final ability estimate alone decides the result.
Run-Out-Of-Time (R.O.O.T.) RuleIf time expires: fewer than 85 items answered = fail; 85 or more answered = scored on the final ability estimate.

Context for your prep: in 2024, first-time U.S.-educated PN candidates passed at about 88.4%, while all PN candidates passed at about 79.1% — so a strong first attempt matters.[6] The U.S. registration fee is $200; if you must retake, you wait 45 test-free days and may test up to 8 times per year, though some state boards are stricter.[7][8]

Coordinated Care

Coordinated Care is the single largest subcategory on the NCLEX-PN at 18–24% of scored items — about a fifth of your exam.[1] Its official scope: the collaborates with health-care team members to facilitate effective client care. On the PN plan this subcategory is called — never “Management of Care,” which is the RN term.

Most items here turn on a single line: what is in the LPN/VN scope, and what must go to the RN? Get that distinction right and you win a fifth of the test.

LPN/VN Scope of Practice

The LPN/VN works under the direction of an RN, physician, or other provider. The LPN (the RN performs the full assessment), the RN started, performs routine predictable skills, and monitors stable clients.

The test rule is worth memorizing cold: if an item says assess, plan, teach (initial), evaluate (first time), or unstable, the answer is the RN. If it says collect data, reinforce, monitor a stable client, or perform a routine skill, the LPN/VN may do it. is defined by the state and Board of Nursing — not the employer, which cannot expand your legal scope.

Delegation & the Five Rights

The LPN/VN delegates to and is delegated to by the RN. Apply NCSBN’s : right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. The nurse who delegates retains accountability for the outcome.

What can — and cannot — be delegated to UAP
Can delegate to UAP (stable, predictable)Never delegate to UAP
Bathing, feeding (no swallowing risk), positioningAssessment & data interpretation
Ambulating, transferring, toiletingPlanning & nursing judgment
Measuring vital signs, intake & output, weightEvaluation of care
Routine specimen collection (e.g., urine)Teaching
Reporting observations to the nurseCare of an unstable client / first-time tasks

The memory rule: you cannot delegate the nursing process or what you can’t see. Anything that requires assessment, planning, evaluation, teaching, or judgment — or that involves an unstable client — stays with the nurse.

Prioritization Frameworks

“Who do you see first?” items are everywhere on the NCLEX-PN. Apply the frameworks in order: (airway, breathing, circulation) first — an airway problem outranks everything — then (physiologic before safety before psychosocial), then acute/unstable/unexpected before chronic/stable/expected.

Beware distractors that are merely time-consuming but not dangerous. The recurring theme is worst first: the most acute, unstable, or unexpected client wins. When the LPN identifies instability, the safe action is to notify the RN/provider — the LPN does not independently manage an unstable client.

Maintain client confidentiality (HIPAA) and disclose only on a need-to-know basis. For , the provider explains the procedure and risks and obtains consent; the nurse witnesses the signature and confirms the client is informed and competent. If the client expresses doubt before signing, stop and notify the provider.

Honor advance directives (living will, durable power of attorney for health care). Follow mandatory-reporting rules for abuse, neglect, gunshot/stab wounds, and certain communicable diseases — suspected abuse must be reported, and you do not need proof.

Advocate for client rights, recognize and report unsafe practice up the chain, and document objectively. An records an error or near-miss, is kept separate from the chart, and is never charted as having been filed.

Care Coordination, Hand-off & Orders

Give and receive report using (Situation, Background, Assessment/data, Recommendation) at hand-off, transfer, and shift change. Participate in admission, discharge, transfer, referral, and follow-up, and identify community resources.

Verify and process provider orders — and question or clarify an unclear, incomplete, or unsafe order with the prescriber before carrying it out. Never act on an order you believe is wrong. Function as a member of the interdisciplinary team and participate in quality improvement.

When the LPN identifies a problem: a safe-action flow
  1. 1

    Step 1

    Recognize the cue — an abnormal finding, a change, or an unsafe order.

  2. 2

    Step 2

    Is it an emergency (airway, severe bleeding, no pulse)? If yes, act immediately within scope (e.g., position, suction, start CPR) and call for help.

  3. 3

    Step 3

    If not an emergency, collect more focused data to confirm and characterize the finding.

  4. 4

    Step 4

    If the client is unstable/changing, or the task is outside LPN scope, notify the RN/provider.

  5. 5

    Step 5

    Document objectively and follow up — evaluate the client's response after the action.

Checkpoint · Coordinated Care

Question 1 of 10

Which of the following tasks can be assigned to an experienced certified nursing assistant (CNA) who is helping to care for a patient on a ventilator?

Safety & Infection Prevention and Control

This subcategory is 10–16% of the exam and, in the 2026 plan, is named Safety and Infection Prevention and Control(the 2023 plan called it “Safety and Infection Control”).[1] Its scope: the LPN/VN contributes to the protection of clients and personnel from health and environmental hazards.

Standard Precautions & Hand Hygiene

apply to every client, all the time — assume all blood and body fluids (except sweat), non-intact skin, and mucous membranes are potentially infectious.[9] Hand hygiene is the single most important infection-prevention measure.

Use soap and water when hands are visibly soiled and for spore-forming organisms (C. difficile, Bacillus anthracis) and norovirus; an alcohol-based hand rub is acceptable for routinely soiled, non-spore situations. Choose PPE based on anticipated exposure, and practice sharps safety: no recapping, dispose in a puncture-resistant container.[9]

Transmission-Based Precautions

are added on top of standard precautions for specific known or suspected infections. Match each client to the right type — a frequent matrix-item task.[9]

Memory hook for : “My Chicken Has TB” — Measles, Chickenpox/varicella, Herpes-zoster (disseminated), TB. For , use soap and water and bleach cleaning, because alcohol does not kill spores. A varicella client needs airborne and contact precautions.

PPE: Donning & Doffing

The order matters and is heavily tested. Don clean-to-dirty; doff most-contaminated-first; perform hand hygiene last.[10]

Don’t confuse this with , which protects an immunocompromised client from environmental organisms — a private room, possibly positive pressure, no fresh flowers or raw produce, and ill visitors screened out.

Falls, Restraints & Identification

Verify identity with (name plus DOB or MRN) before meds, procedures, specimens, and transfusions — never the room number alone. Prevent falls with the bed low and locked, the call light and needs within reach, nonskid footwear, clear pathways, bed/chair alarms, and scheduled toileting or hourly rounding.

A is a last resort: try less-restrictive alternatives first, obtain a provider order (it cannot be PRN and is time-limited), and monitor circulation, skin, range of motion, toileting, and nutrition on a schedule (e.g., every 15 minutes for behavioral restraints). Tie a quick-release knot to the bed frame, never the side rail. In a true emergency, a restraint may be applied first and the order obtained within the facility timeframe.

Fire, Oxygen & Environmental Safety

Two acronyms recur. For a fire, — Rescue clients, sound the Alarm, Confine (close doors), then Extinguish or Evacuate. For the extinguisher, — Pull the pin, Aim at the base, Squeeze, Sweep.

Environmental safety quick reference
HazardKey nursing action
FireRACE — rescue the client first, then alarm, confine, extinguish/evacuate
Fire extinguisherPASS — Pull, Aim at base, Squeeze, Sweep
Oxygen in useNo smoking, open flame, or sparks; signage; secure cylinders upright
Latex allergyIdentify, band the client, avoid all latex products
Mass-casualty triageGreatest good for the greatest number with available resources
Home safetyRemove scatter rugs; add grab bars, lighting, smoke/CO detectors; safe med storage

Checkpoint · Safety & Infection Prevention

Question 1 of 10

A nurse working in a remote setting relies on telemedicine communication to provide care and education for clients. What is a PRIMARY benefit of using telemedicine from the client's perspective?

Health Promotion & Maintenance

This category is 6–12% of the exam and has no subcategories. Its scope: the LPN/VN provides care that incorporates expected stages of growth and development and the prevention or early detection of health problems.[1] The LPN collects health-history and baseline data and reinforces prevention teaching across the lifespan.

Growth & Development

The LPN compares clients to developmental milestones and provides age-appropriate care. psychosocial stages are high-yield.

Erikson's psychosocial stages (high-yield)
Stage / ageConflictFavorable outcome
Infant (0–1)Trust vs. mistrustTrust, attachment
Toddler (1–3)Autonomy vs. shame/doubtIndependence
Preschool (3–6)Initiative vs. guiltPurpose
School-age (6–12)Industry vs. inferiorityCompetence
Adolescent (12–18)Identity vs. role confusionSense of self
Older adultIntegrity vs. despairAcceptance, wisdom

Motor/physical anchors: social smile ~2 months; sits unsupported ~6–8 months; walks ~12–15 months; birth weight doubles ~6 months and triples ~12 months; the anterior fontanel closes ~12–18 months. Match safety teaching to age: infants → aspiration/SIDS (back to sleep); toddlers → poisoning, falls, drowning; school-age → helmets; adolescents → motor-vehicle and risk behaviors.

Newborn & Postpartum Care

The LPN assists with antepartum care and labor monitoring (the RN/provider manages complications) and monitors the stable postpartum client using : Breasts, Uterus (firm, midline), Bladder, Bowel, (rubra → serosa → alba), Episiotomy/perineum, Homan’s/lower extremities, and Emotions. A boggy fundus → massage first, then reassess and notify; saturating a pad in under an hour signals hemorrhage.

For the newborn, is scored at 1 and 5 minutes (heart rate, respiratory effort, tone, reflex, color; 7–10 is reassuring). Normal newborn vitals: heart rate 110–160, respiratory rate 30–60. Promote attachment and breastfeeding.

Prevention & Screening

Know the three levels of prevention: prevents disease (immunizations, education, seat belts); screens for early detection (blood pressure, mammogram, Pap, glucose, newborn screen); and limits disability after disease (rehab, support groups). Simple cue: primary prevents, secondary screens, tertiary rehabilitates.

Immunizations

Identify clients in need of required and voluntary immunizations and reinforce education, always against the current CDC schedule, which is updated regularly.[11] (MMR, varicella, intranasal influenza, rotavirus) are contraindicated or used with caution in pregnancy and immunocompromise — if one is ordered for such a client, hold it and notify the provider.

Teaching & Learning

The LPN reinforces standardized teaching the RN or provider initiated. Effective teaching assesses readiness, sets mutual goals, addresses one topic at a time, and uses age-appropriate methods. Confirm understanding with — “tell me in your own words.”

Identify barriers to learning: language, literacy, sensory deficits, pain, anxiety, developmental level, and cultural beliefs. Note that acute confusion in an older adult is not normal aging — investigate infection, dehydration, or a medication cause.

Checkpoint · Health Promotion & Maintenance

Question 1 of 10

The healthcare provider prepares to administer a pneumococcal vaccine to a 65-year-old patient who has a diagnosis of chronic bronchitis. The patient states, "I got that vaccine 5 years ago." What is the most appropriate response by the healthcare provider?

Psychosocial Integrity

Psychosocial Integrity is 9–15% of the exam. Its scope: the LPN/VN provides care that assists with the emotional, mental, and social well-being of clients.[1] Crisis assessment, diagnosis, and complex psychotherapy belong to the RN/provider; the LPN assists, supports, and reinforces.

Therapeutic Communication

This is the most-tested skill in the category. is client-centered, open-ended, and feeling-focused: open-ended questions (“Tell me more…”), active listening, silence, offering self, reflecting/restating, and acknowledging feelings. The rule: choose the response that acknowledges feelings and keeps the client talking, and address feelings before facts or teaching.

Therapeutic techniques vs. communication blocks
Therapeutic (choose these)Block (avoid these)
Open-ended questionsFalse reassurance ('Everything will be fine')
Active listening, silence, offering selfGiving advice ('If I were you…')
Reflecting / restating feelingsAsking 'why' (sounds accusatory)
Clarifying, validating, acknowledgingChanging the subject / minimizing
EmpathyApproval/disapproval, clichés

Coping, Grief & Defense Mechanisms

Identify effective versus ineffective coping and assist clients to adapt to stressful events. Recognize — denial, projection, rationalization, regression, displacement, sublimation, compensation. For grief, the Kübler-Ross stages — denial, anger, bargaining, depression, acceptance — are not linear; support the client wherever they are, because presence beats fixing.

Mental-Health Conditions

Anxiety escalates mild → moderate → severe → panic; for a panic-level client, stay, remain calm, use short simple sentences, reduce stimuli, and never leave them alone. For depression and suicide risk, ask directly about ideation and a plan — asking does not plant the idea — and a client with a specific plan and available means is at highest risk. A sudden mood lift in a depressed client can signal a decision to act, so increase vigilance.

For psychosis, acknowledge a hallucination’s reality to the client without reinforcing it (“I don’t hear the voices, but I understand they’re real to you”) and assess command hallucinations for safety; don’t argue with or agree with a delusion, and don’t touch a paranoid client without warning. Distinguish (acute, fluctuating, often reversible) from (chronic, progressive, irreversible). For alcohol withdrawal (24–72 hours, can be fatal) and opioid overdose (respiratory depression, pinpoint pupils → naloxone), monitor and report.

De-escalation & End-of-Life

For an agitated client, use : a calm voice, personal space, choices, and firm limits, ensuring everyone’s safety; restraints are a last resort and need an order. Promote a therapeutic and participate in reminiscence, validation, or reality therapy matched to the client.

Plan care with consideration of self-reported spiritual and cultural beliefs and gender identity. In end-of-life care, manage comfort, honor advance directives, support the family, and allow expression of grief.

Checkpoint · Psychosocial Integrity

Question 1 of 10

A client was admitted to the Mental Health Unit with a diagnosis of depression. After three days, the client is smiling and happy, telling the nurse, "I feel great! I'm ready to go home now." Based on the client's sudden change in behavior, what should the treatment plan include?

Physiological Integrity

Physiological Integrity is the largest major category — its four subcategories sum to roughly 45% of the exam, making physiology, pharmacology, and risk-reduction your highest-yield study block.[1] Its scope: the LPN/VN assists in promoting physical health, providing care and comfort, reducing risk, and helping clients manage health alterations.

Physiological Integrity subcategories (PN midpoints)
Pharmacological Therapies13% · 10–16%
Reduction of Risk Potential12% · 9–15%
Basic Care & Comfort10% · 7–13%
Physiological Adaptation10% · 7–13%

Basic Care & Comfort

The LPN provides comfort and ADL assistance. For , verify placement, keep the head of the bed elevated 30–45° during and after, and check residuals per policy to prevent aspiration. Prevent a by repositioning every 2 hours, offloading, and supporting nutrition.

Treat pain as the 5th vital sign — “pain is what the client says it is” — using 0–10 numeric, FACES (peds/nonverbal), or FLACC (infants) scales, and offer nonpharmacological relief (imagery, repositioning, heat/cold, music).

Pharmacological Therapies

Follow the — right client, drug, dose, route, and time, plus documentation, reason, response, the right to refuse, and education — verifying with two identifiers and three label checks. (insulin, anticoagulants, opioids, concentrated electrolytes) require an independent double-check. Know injection angles: intradermal 5–15°, subcutaneous 45–90°, intramuscular 90°; do not aspirate or massage a heparin subcutaneous site.

High-yield drug watch points and antidotes
Drug / classWatch for / teachAntidote / action
WarfarinMonitor INR (~2–3); bleeding; consistent vitamin K intakeVitamin K
HeparinMonitor aPTT; bleeding; HITProtamine sulfate
DigoxinApical pulse 1 min, hold if <60; halos, N/V; hypokalemia worsens itDigoxin immune Fab
LithiumNarrow range 0.6–1.2; maintain fluid & sodium; toxicity ≥1.5Hold & report; hydrate
InsulinHypoglycemia (shaky, sweaty, confused); only regular is IV15 g fast carb / glucagon
OpioidsRespiratory depression, constipation, sedationNaloxone
Furosemide (loop)Hypokalemia, dehydration, ototoxicity; monitor K⁺Potassium replacement
AcetaminophenHepatotoxicity; max doseN-acetylcysteine

Digoxin, lithium, and warfarin are drugs — their effective dose sits close to their toxic dose, so monitoring blood levels is essential.[12][13] For digoxin, count the apical pulse for a full minute and hold the dose for an adult rate below 60, watching for nausea, visual halos, and bradycardia.[13]

Reduction of Risk Potential

The LPN monitors vital signs, performs focused data collection (neuro and circulation checks), collects specimens, performs point-of-care testing, and recognizes and reports abnormalities within scope. , electrolytes, and arterial blood gas values are tested constantly — memorize the normals.

Normal lab values to memorize
LabNormal range
Sodium (Na⁺)135–145 mEq/L
Potassium (K⁺)3.5–5.0 mEq/L
Calcium9.0–10.5 mg/dL
Fasting glucose70–110 mg/dL
BUN10–20 mg/dL
Creatinine0.6–1.2 mg/dL
WBC5,000–10,000 /µL
Platelets150,000–400,000 /µL
ABG pH7.35–7.45
INR (therapeutic)~2–3

Critical signs: hyperkalemia → peaked T-waves and dangerous dysrhythmias (a reportable emergency); hypokalemia → flat T/U-waves, weakness, and increased digoxin toxicity; hyponatremia → confusion and seizures; hypercalcemia → “stones, bones, and groans.” Prevent complications: sterile catheter technique to avoid CAUTI, compression stockings/SCDs for VTE, and pre-op (consent witnessed, NPO, baseline vitals) and post-op (airway, bleeding, pain, VTE) monitoring.

Physiological Adaptation

The LPN participates in caring for clients with acute, chronic, or life-threatening conditions: respond to a life-threatening situation with CPR/BLS, improve respiratory status (breathing treatments, suctioning, repositioning), and care for a (suction as needed, humidify, stoma care, keep a spare tube and obturator at the bedside). Recognize and report a change in condition early — early recognition saves lives. Perform wound care and dressing changes, care for drainage devices and ostomies, and assist with dialysis.

For acid-base, use — Respiratory Opposite (pH and CO₂ move opposite ways), Metabolic Equal (pH and bicarbonate move the same way). Reinforce chronic-disease teaching: heart failure (daily weights — report a gain over 2–3 lb/day or 5 lb/week, low sodium), COPD (pursed-lip breathing, low-flow oxygen), and diabetes (glucose, foot care, sick-day rules). For a , the first action is to stop the transfusion, keep the line open with normal saline, and notify.

Checkpoint · Physiological Integrity

Question 1 of 10

A client presents to the Emergency Department with an oxygen saturation (SaO2) of 78%. The client is able to breathe without assist. What oxygen delivery system will BEST increase the client's SaO2?

How to Use This Study Guide

Work through the guide one Client Needs category at a time. After each category, check it off in the contents to raise your exam-readiness score, then drill the same content in our free practice questions and flashcards — active recall and timed practice are what move knowledge into exam-day performance.

  • Weight your time by the blueprint. Physiological Integrity (~45%) and Coordinated Care (18–24%) carry the most points — start there.
  • Drill scope and prioritization until they’re automatic. A large share of items hinge on LPN-vs-RN scope and “who do you see first.”
  • Memorize the high-frequency facts. Lab values, drug watch points, isolation precautions, and PPE order appear again and again.
  • Practice clinical judgment. Use the NCJMM steps on every scenario: recognize cues, prioritize, take the safe action, evaluate.
  • Aim past the standard. Because length doesn’t predict the result, study to consistent mastery rather than a target percentage.

Common questions candidates search and get asked — each answered briefly and backed by an official source (NCSBN, CDC, FDA, or NIH/NLM). Tap any card to test yourself.

NCLEX-PN Concept Questions

NCLEX-PN Glossary

Key NCLEX-PN terms in one place. Hover any dotted term throughout the guide for its definition; the full list is below.

NCLEX-PN
The National Council Licensure Examination for Practical/Vocational Nurses — the exam a candidate must pass to be licensed as an LPN or LVN.
LPN/VN
Licensed Practical Nurse / Licensed Vocational Nurse — the entry-level nurse who collects data, reinforces teaching, performs routine skills, and monitors stable clients under the direction of an RN or provider.
NCSBN
National Council of State Boards of Nursing — the organization that owns the NCLEX and writes the test plan.
CAT
Computerized Adaptive Testing — the delivery model that assembles each candidate's exam in real time, one item at a time, with no going back.
NGN
Next Generation NCLEX — the version (launched April 2023) that adds item types measuring clinical judgment.
NCJMM
NCSBN Clinical Judgment Measurement Model — the six-step framework (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes) NGN uses to score clinical judgment.
Coordinated Care
The Safe & Effective Care Environment subcategory on the PN plan in which the LPN/VN collaborates with the health care team to facilitate effective client care (the RN plan calls it 'Management of Care').
data collection
The PN-scope activity of gathering focused client information (vital signs, intake/output, history) that contributes to the RN's full assessment; the LPN collects data, the RN assesses.
reinforce teaching
Repeating, reviewing, or clarifying standardized education the RN or provider already initiated; the LPN reinforces but does not perform the initial teaching.
delegation
Transferring responsibility for a task to a competent person (often unlicensed assistive personnel) while the delegating nurse retains accountability for the outcome.
UAP
Unlicensed assistive personnel — a nursing assistant or aide who may perform stable, predictable tasks (bathing, feeding, ambulating, vital signs) but never assessment, planning, teaching, or care of an unstable client.
five rights of delegation
NCSBN's framework for safe delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.
ABCs
Airway, Breathing, Circulation — the first prioritization framework; an airway problem outranks everything else.
Maslow's hierarchy
A prioritization tool placing physiologic needs before safety before psychosocial needs — physical needs come before emotional ones.
scope of practice
The legal boundaries of nursing practice defined by the state Nurse Practice Act and Board of Nursing, not by the employer.
Nurse Practice Act
The state law that defines and regulates nursing practice and sets the LPN/VN's legal scope.
informed consent
The provider explains the procedure, risks, and alternatives and obtains consent; the nurse witnesses the signature and confirms the client is informed and competent.
SBAR
Situation, Background, Assessment/data, Recommendation — a structured hand-off communication format.
incident report
An occurrence report documenting an error or near-miss; it is kept separate from the chart, and the chart never notes that one was filed.
standard precautions
Infection-control measures applied to every client at all times, treating all blood and body fluids as potentially infectious; hand hygiene is the most important.
transmission-based precautions
Contact, droplet, and airborne precautions added on top of standard precautions for specific known or suspected infections.
contact precautions
Gown and gloves for organisms spread by touch (MRSA, VRE, C. difficile, RSV, scabies); a private room or cohort is used.
droplet precautions
A surgical mask within about 6 feet for organisms spread by respiratory droplets (influenza, pertussis, mumps, meningococcus).
airborne precautions
An N95 respirator and a negative-pressure room with the door closed for airborne organisms — measles, chickenpox/varicella, and tuberculosis.
negative-pressure room
An airborne-infection isolation room (AIIR) in which air flows inward so airborne organisms cannot escape; the door stays closed.
protective isolation
Reverse isolation that protects an immunocompromised client from environmental organisms (no fresh flowers, raw produce, or ill visitors).
two identifiers
Verifying a client with two pieces of identifying information (name plus date of birth or medical record number) before meds, procedures, specimens, or transfusions — never the room number alone.
restraint
A device or method that restricts movement; it requires a provider order (not PRN), is time-limited, and is used only after less-restrictive alternatives fail.
RACE
The fire-response sequence: Rescue, Alarm, Confine, Extinguish/Evacuate.
PASS
The fire-extinguisher technique: Pull the pin, Aim at the base, Squeeze, Sweep.
Erikson
Erik Erikson's eight psychosocial stages of development, each a conflict (e.g., trust vs. mistrust in infancy) used to judge age-appropriate care.
primary prevention
Preventing disease before it occurs — immunizations, education, seat belts, healthy diet.
secondary prevention
Early detection through screening — blood-pressure checks, mammograms, Pap tests, blood glucose.
tertiary prevention
Limiting disability after disease is established — rehabilitation, cardiac rehab, support groups.
live vaccine
A vaccine made from a weakened live organism (MMR, varicella, intranasal influenza, rotavirus) that is contraindicated or used with caution in pregnancy and immunocompromise.
teach-back
A method of confirming understanding by having the client explain or demonstrate the information in their own words.
BUBBLE-HE
A postpartum data-collection mnemonic: Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homan's/lower extremities, Emotions.
lochia
Postpartum vaginal discharge that progresses from rubra (red) to serosa (pink-brown) to alba (white-yellow).
APGAR
A newborn scoring tool at 1 and 5 minutes rating heart rate, respiratory effort, muscle tone, reflex, and color; 7–10 is reassuring.
therapeutic communication
Client-centered, open-ended, feeling-focused communication (open-ended questions, active listening, offering self, reflecting) that keeps the client talking.
communication block
A non-therapeutic response such as false reassurance, giving advice, asking 'why,' or minimizing feelings.
defense mechanism
An unconscious coping strategy (denial, projection, rationalization, regression, displacement, sublimation) that protects against anxiety.
delirium
An acute, fluctuating, often reversible confusion (from infection, drugs, dehydration, hypoxia) — distinct from the chronic, progressive, irreversible decline of dementia.
dementia
A chronic, progressive, irreversible decline in cognition; care emphasizes routine, simple choices, and a safe environment.
de-escalation
Calming an agitated client with a calm voice, personal space, choices, and firm limits — restraints are a last resort.
milieu
A safe, structured, supportive therapeutic environment used in mental-health care.
enteral feeding
Nutrition delivered through a feeding tube; keep the head of the bed elevated 30–45° during and after feeding to prevent aspiration.
pressure injury
Localized skin and tissue damage over a bony prominence from pressure; prevented by repositioning every 2 hours, offloading, and good nutrition.
rights of medication administration
The verification checklist — right client, drug, dose, route, and time, plus documentation, reason, response, the right to refuse, and education.
high-alert medication
A drug with a heightened risk of serious harm if given in error (insulin, anticoagulants, opioids, concentrated electrolytes), requiring an independent double-check.
narrow therapeutic index
A drug (digoxin, lithium, warfarin) whose effective dose is close to its toxic dose, requiring close monitoring of blood levels.
INR
International Normalized Ratio — the lab used to monitor warfarin therapy; the therapeutic range is roughly 2–3.
ROME
An acid-base memory aid: Respiratory Opposite (pH and CO₂ move opposite ways), Metabolic Equal (pH and bicarbonate move the same way).
transfusion reaction
An adverse response to transfused blood (fever, chills, back pain, dyspnea, hives); the first action is to stop the transfusion and keep the line open with normal saline.
tracheostomy
A surgical airway in the trachea; care includes suctioning as needed, humidification, stoma care, and keeping a spare tube and obturator at the bedside.
logits
The unit on the NCLEX ability scale; the current PN passing standard is −0.18 logits.

NCLEX-PN Study Guide FAQ

The NCLEX-PN is variable length: you answer between 85 and 150 items, including 15 unscored pretest items, within a 5-hour limit. It uses computerized adaptive testing, so no two candidates take the same exam, and you cannot return to a previous question.

References

  1. 1.National Council of State Boards of Nursing (NCSBN). “2026 NCLEX-PN Test Plan (effective April 2026).” NCSBN.
  2. 2.National Council of State Boards of Nursing (NCSBN). “2026 NCLEX-PN Test Plan — full PDF.” NCSBN.
  3. 3.National Council of State Boards of Nursing (NCSBN). “Computerized Adaptive Testing (CAT).” NCSBN.
  4. 4.National Council of State Boards of Nursing (NCSBN). “Next Generation NCLEX (NGN).” NCLEX.com.
  5. 5.National Council of State Boards of Nursing (NCSBN). “2024 NCLEX Examination Statistics (Research Brief, Vol. 94).” NCSBN.
  6. 6.National Council of State Boards of Nursing (NCSBN). “NCLEX Pass Rates.” NCSBN.
  7. 7.National Council of State Boards of Nursing (NCSBN). “NCLEX Fees & Payment.” NCLEX.com.
  8. 8.National Council of State Boards of Nursing (NCSBN). “NCLEX Results & Retake Policy.” NCLEX.com.
  9. 9.Centers for Disease Control and Prevention (CDC). “Transmission-Based Precautions.” CDC.
  10. 10.Centers for Disease Control and Prevention (CDC). “Isolation Precautions — Sequence for Donning and Doffing PPE.” CDC.
  11. 11.Centers for Disease Control and Prevention (CDC). “Immunization Schedules for Health Care Providers.” CDC.
  12. 12.U.S. Food and Drug Administration (FDA). “Setting and Implementing Standards for Narrow Therapeutic Index Drugs.” FDA.
  13. 13.National Institutes of Health / National Library of Medicine. “Digoxin Monitoring and Therapeutic Levels (PMC).” NIH/NLM.
  14. 14.National Institutes of Health / National Library of Medicine. “MedlinePlus — Drug and Lab Reference.” NIH/NLM.
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