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

This free NCLEX-RN study guide walks through everything the National Council Licensure Examination for Registered Nurses tests, organized into the same NCSBN Client Needs categories used to build the exam from the 2026 NCLEX-RN 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 full RN scope the exam actually tests, from assessment and care planning to delegation and managing unstable clients.

Read it category by category, then round out your prep with our practice questions and flashcards. The NCLEX-RN licenses you as a Registered Nurse — a different, heavier exam from the NCLEX-PN, with its own weights and a scope built around directing and managing client care.

NCLEX-RN Exam Snapshot

Physiological Integrity is the heaviest block — its four subcategories sum to roughly 51% of the exam — and Management of Care is the single largest subcategory at 15–21%. Budget your study toward physiology, pharmacology, and safe prioritization and delegation decisions.^[1][2]

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-RN Works: CAT, NGN & the Pass Logic

The NCLEX-RN is delivered by computerized adaptive testing. 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

Next Generation NCLEX launched April 1, 2023 to measure clinical judgment using the NCSBN Clinical Judgment Measurement Model 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] The model rewards a structured think-like-a-nurse process: notice, interpret, respond, re-check — not rote recall.

How pass/fail is decided

There is no fixed passing percentage and no set number who pass — the standard is an ability level (currently 0.00 logits, upheld through March 31, 2029).^[5] Three rules end the exam:

Context for your prep: first-time, U.S.-educated RN candidates typically pass at roughly 85–88%, while repeat and internationally-educated candidates pass at lower rates — 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]

Safe & Effective Care Environment

This top-level category combines two subcategories that together make up roughly a third of the exam: Management of Care (15–21% — the single largest subcategory) and Safety and Infection Prevention and Control (10–16%).^[1] It is where the NCLEX-RN tests the judgment side of nursing: who do you see first, what do you delegate, how do you keep clients and staff safe.

RN Scope & Management of Care

The RN directs and manages client care. The RN performs the initial assessment, formulates the nursing diagnosis and care plan, provides the initial teaching, and evaluates outcomes — the five verbs that never leave the RN are Assess, Diagnose, Plan, Teach, Evaluate (the nursing process, or ADPIE). On the RN plan this subcategory is called Management of Care— never “Coordinated Care,” which is the PN term.

The master test rule: if an item says assess, diagnose, plan, teach (initial), evaluate, triage, or unstable, it is the RN’s job and cannot be delegated. The RN may delegate routine, predictable tasks for stable clients down to the LPN or UAP — but accountability stays with the RN. Scope is defined by the state Nurse Practice Act and Board of Nursing, not the employer.

Delegation & the Five Rights

Apply NCSBN’s five rights of delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. The RN who delegates retains accountability for the outcome.

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 assess first?” items are everywhere on the NCLEX-RN. Apply the frameworks in order: ABCs (airway, breathing, circulation) first — an airway problem outranks everything — then Maslow (physiologic before safety before psychosocial), then unstable before stable, acute before chronic, actual before potential, unexpected before expected.

Beware distractors that are merely time-consuming but not dangerous. The classic first client combines all of the filters — unstable, acute, actual, and unexpected. When two clients seem equally urgent, choose the one whose condition is most acute or unexpected.

Legal, Ethical & Advocacy Duties

Know the ethical principles: autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity (truthfulness). Maintain client confidentiality (HIPAA).

For informed consent, the provider explains the procedure and risks and obtains consent; the RN witnesses the signature and confirms the client is informed, competent, and voluntary. If the client expresses doubt or misunderstanding before signing, stop and notify the provider — do not re-explain to obtain consent.

Honor advance directives (a living will states wishes; a durable power of attorney names a decision-maker; a DNR is a separate provider order). Follow mandatory-reporting rules for abuse, neglect, gunshot/stab wounds, and certain communicable diseases — reasonable suspicion is enough, and you do not need proof.

Clarify any unclear or unsafe order with the prescriber before acting, and escalate up the chain of command. Malpractice requires four elements — duty, breach, causation, and damages. An incident report records an error or near-miss, is kept separate from the chart, and is never charted as having been filed.

Safety, Restraints & Identification

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

A restraint 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. Tie a quick-release knot to the bed frame, never the side rail. For violent/behavioral restraints, a face-to-face evaluation is required within one hour.

For a fire, use RACE (Rescue, Alarm, Confine, Extinguish/Evacuate); for the extinguisher, PASS (Pull, Aim, Squeeze, Sweep). In a mass-casualty disaster, triage inverts to the greatest good for the greatest number.

Infection Control & Precautions

Standard precautions 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 for visibly soiled hands and for spore-forming organisms (C. difficile, norovirus, anthrax) — alcohol does not kill spores.

Transmission-based precautions are added on top of standard precautions for specific known or suspected infections — a frequent matrix-item task.^[9]

Memory hook for airborne: “My Chicken Has TB” — Measles, Chickenpox/varicella, disseminated Herpes-zoster, TB. A varicella client needs airborne and contact precautions. Don’t confuse isolation with protective (neutropenic) isolation, which protects an immunocompromised client from environmental organisms.

The order of putting on and taking off PPE is heavily tested:

Health Promotion & Maintenance

This category is 6–12% of the exam. Its scope: the RN provides care that incorporates expected stages of growth and development and the prevention or early detection of health problems across the lifespan.^[1] The RN performs the comprehensive health assessment, plans health-promotion care, and provides the initial teaching.

Growth & Development

The RN compares clients to developmental milestones and provides age-appropriate care. Erikson’s psychosocial stages are the most-tested framework.

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.

Play progresses solitary → parallel (toddler) → associative (preschool) → cooperative (school-age). Match safety teaching to age: infants → aspiration/SIDS (back to sleep); toddlers → poisoning, falls, drowning; school-age → helmets; adolescents → motor-vehicle and risk behaviors.

Maternal & Newborn Care

The RN manages antepartum, labor, and postpartum care. Use BUBBLE-HE to assess postpartum: Breasts, Uterus (firm, midline), Bladder, Bowel, Lochia(rubra → serosa → alba), Episiotomy/perineum, Homan’s/lower extremities, and Emotions.

A boggy fundus → massage first, then reassess and notify; uterine atony is the #1 cause of postpartum hemorrhage. Use Naegele’s rule (LMP − 3 months + 7 days + 1 year) for the due date and GTPAL (Gravida, Term, Preterm, Abortions, Living) for obstetric history.

For the fetus, use VEAL CHOP: late decelerations signal placental insufficiency — reposition to the left side, give oxygen, stop oxytocin, and notify. For the newborn, APGAR 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; jaundice within the first 24 hours is pathologic and must be reported. For preeclampsia, magnesium sulfate prevents seizures — watch for toxicity (loss of deep tendon reflexes, respiratory depression); the antidote is calcium gluconate.

Prevention & Screening

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

Immunizations

Identify clients in need of immunizations and provide education, always against the current CDC schedule, which is updated regularly.^[11] Live vaccines (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. The only true contraindication to any vaccine is a prior anaphylactic reaction to the vaccine or a component; a mild illness or low-grade fever is not a contraindication.

Teaching & Learning

The RN provides the initial teaching (the LPN reinforces it). Effective teaching assesses readiness first, sets mutual goals, addresses one topic at a time, and uses age-appropriate methods.

Confirm understanding with teach-back— “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, hypoxia, or a medication cause.

Psychosocial Integrity

Psychosocial Integrity is 6–12% of the exam. Its scope: the RN provides care that promotes and supports the emotional, mental, and social well-being of clients experiencing stressful events and clients with acute or chronic mental illness.^[1]

Therapeutic Communication

This is the most-tested skill in the category. Therapeutic communication 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. Safety always outranks insight.

Coping, Grief & Defense Mechanisms

Identify effective versus ineffective coping and help clients adapt to stressful events. Recognize defense mechanisms — 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. Distinguish palliative care (comfort at any stage) from hospice (a prognosis of six months or less).

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. Suicide risk is highest as depression lifts, when returning energy lets the client act, so a suddenly calm previously-suicidal client needs more monitoring, not less.

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. Distinguish delirium (acute, fluctuating, often reversible — find the cause, often a UTI in elders) from dementia (chronic, progressive, irreversible).

For alcohol withdrawal (delirium tremens at 48–96 hours can be fatal), give benzodiazepines and thiamine before glucoseto prevent Wernicke’s encephalopathy. Watch for psych-med emergencies: serotonin syndrome, neuroleptic malignant syndrome (rigidity + high fever — stop the antipsychotic), and lithium toxicity (level above 1.5).

De-escalation & End-of-Life

For an agitated client, use de-escalation: a calm voice, personal space and an exit route, choices, and firm limits — restraints are a last resort and need an order. Promote a therapeutic milieu.

When assessing for abuse, interview the client aloneand document objective findings plus the client’s own words in quotes. Plan care around 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.

Physiological Integrity

Physiological Integrity is the largest major category — its four subcategories sum to roughly 51% of the exam, making physiology, pharmacology, and risk-reduction your highest-yield study block.^[1] Its scope: the RN promotes physical health, provides care and comfort, reduces risk, and manages health alterations.

Basic Care & Comfort

The RN plans comfort and ADL care. For enteral feeding, verify placement (X-ray is the gold standard for initial placement), keep the head of the bed elevated 30–45° during and after, and check residuals per policy to prevent aspiration; if the client coughs or the SpO₂ drops, stop the feeding, raise the head of the bed, and assess for aspiration first.

Prevent a pressure injury by repositioning every 2 hours, offloading bony prominences, 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), FLACC (infants), or PAINAD (dementia) scales, and offer nonpharmacological relief (imagery, repositioning, heat/cold, music).

Pharmacological & Parenteral Therapies

At 13–19%, this is the single biggest subcategory after Management of Care. Follow the rights of medication administration — 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.

High-alert medications (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. Never give potassium chloride IV push — always dilute and infuse via pump.

Digoxin, lithium, and warfarin are narrow-therapeutic-index 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] For blood products, use normal saline only (never LR or dextrose), verify the unit with a second RN, take baseline vitals, and stay for the first 15 minutes.

Reduction of Risk Potential

This is the “numbers” subcategory (9–15%): the RN assesses vital-sign trends, interprets diagnostic and lab results, prepares clients for procedures, and prevents complications. INR, electrolytes, and arterial blood gas values are tested constantly — memorize the normals and decide normal vs. abnormal-stable vs. critical-emergent.

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.” For acid-base, use ROME:

Before IV contrast, check renal function (creatinine), iodine/shellfish allergy, and hold metformin. Prevent complications: sterile catheter technique to avoid CAUTI, compression stockings/SCDs for VTE, pre-op care (consent witnessed, NPO, baseline vitals) and post-op monitoring (airway, bleeding, pain, atelectasis with incentive spirometry, and VTE). For a post-op evisceration, cover the wound with sterile saline-soaked gauze, place the client supine with knees flexed, keep them NPO, and notify the surgeon stat.

Physiological Adaptation

At 11–17%, this subcategory is the conditions-and-emergencies block: the RN manages clients with acute, chronic, or life-threatening conditions. Respond to a life-threatening situation with CPR/BLS; improve respiratory status with breathing treatments, suctioning (apply suction on withdrawal only, ≤10–15 seconds, hyperoxygenate first), and positioning; and recognize and intervene on complications early.

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 1–3 L to avoid blunting the hypoxic drive), and diabetes (glucose, foot care, sick-day rules). For a transfusion reaction, the first action is always to stop the transfusion, keep the line open with normal saline, and notify — an acute hemolytic (ABO-incompatibility) reaction is the most dangerous.

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 (~51%) and Management of Care (15–21%) carry the most points — start there.
• Drill prioritization and delegation until they’re automatic. A large share of items hinge on “who do you assess first” and what an RN can delegate to an LPN or UAP.
• Memorize the high-frequency facts. Lab values and critical values, antidotes, isolation precautions, and PPE order appear again and again.
• Practice clinical judgment. Use the NCJMM steps on every scenario: recognize cues, analyze, 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-RN Glossary

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

NCLEX-RN

The National Council Licensure Examination for Registered Nurses — the exam a candidate must pass to be licensed as an RN.

RN

Registered Nurse — the nurse who performs the initial assessment, formulates the care plan, provides initial teaching, evaluates outcomes, triages, and manages unstable clients.

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.

Management of Care

The Safe & Effective Care Environment subcategory (RN plan) in which the RN provides and directs nursing care that protects clients and personnel; the PN plan calls it 'Coordinated Care.'

assessment

The RN activity of collecting and analyzing comprehensive client data to identify problems and form the nursing diagnosis; the RN assesses, while the LPN performs focused data collection.

nursing process

Assessment, Diagnosis (analysis), Planning, Implementation, Evaluation (ADPIE) — the systematic framework that guides RN care.

delegation

Transferring responsibility for a task to a competent person (an LPN or UAP) while the delegating RN 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.

LPN/LVN

Licensed Practical / Vocational Nurse — works under RN direction, reinforcing teaching, giving most routine meds, and caring for stable clients; the RN may delegate to the LPN.

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 RN's legal scope.

informed consent

The provider explains the procedure, risks, and alternatives and obtains consent; the RN witnesses the signature and confirms the client is informed, competent, and voluntary.

advance directive

A legal document (living will or durable power of attorney for health care) stating a client's wishes; a DNR is a separate provider order.

SBAR

Situation, Background, Assessment, Recommendation — a structured hand-off communication format.

triage

Sorting clients by acuity so the sickest are seen first; in a mass-casualty disaster the logic inverts to the greatest good for the greatest number.

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, rubella, 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/neutropenic 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, colonoscopy, 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 assessment 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.

VEAL CHOP

A fetal heart-rate mnemonic: Variable=Cord compression, Early=Head compression, Accelerations=Okay, Late=Placental insufficiency.

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.

autonomic dysreflexia

A spinal-cord-injury emergency (severe hypertension, pounding headache, bradycardia); sit the client up and remove the trigger, often a full bladder.

Cushing's triad

Late signs of increased intracranial pressure: rising systolic blood pressure with widening pulse pressure, bradycardia, and irregular respirations.

logits

The unit on the NCLEX ability scale; the current RN passing standard is 0.00 logits, upheld through March 31, 2029.

NCLEX-RN Study Guide FAQ

References

1. 1.National Council of State Boards of Nursing (NCSBN). “2026 NCLEX-RN Test Plan (effective April 2026).” NCSBN. ↑
2. 2.National Council of State Boards of Nursing (NCSBN). “2026 NCLEX-RN 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). “Passing Standard (0.00 logits, effective through March 31, 2029).” 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. ↑
15. 101.National Institutes of Health / National Library of Medicine. “Pressure Injury / Pressure Ulcer (StatPearls, NIH/NLM).” ncbi.nlm.nih.gov, accessed 18 June 2026. ↑
16. 102.National Institutes of Health / National Library of Medicine. “Hyponatremia (StatPearls, NIH/NLM).” ncbi.nlm.nih.gov, accessed 18 June 2026. ↑
17. 103.National Institutes of Health / National Library of Medicine. “Physical Restraint Use (StatPearls, NIH/NLM).” ncbi.nlm.nih.gov, accessed 18 June 2026. ↑
18. 104.National Institutes of Health / National Library of Medicine. “Hyperkalemia / electrolyte reference (StatPearls, NIH/NLM).” ncbi.nlm.nih.gov, accessed 18 June 2026. ↑
19. 105.National Institutes of Health / National Library of Medicine. “Stroke (ischemic) — tPA and emergency care (MedlinePlus).” medlineplus.gov, accessed 18 June 2026. ↑

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