📋 Nursing · Fundamentals

Nursing techniques that make fundamentals stick

NCLEX priority frameworks, Maslow, ABC, infection control, and safety — memorized.

📋 Nursing Fundamentals

Memory Tricks

Proven Mnemonics & Acronyms — fast to learn, hard to forget.

Circulatory Checks
5 P's
Pain · Paresthesia · Paralysis · Pulse · Pallor
Neurovascular check — assess these 5 every time
Use the 5 P's for every neurovascular check — especially when a patient has a cast, or has had an orthopedic or vascular procedure. Any abnormality signals compromised circulation and requires immediate intervention.
P
Pain — assess location, severity, quality
P
Paresthesia — tingling or numbness indicates nerve compromise
P
Paralysis — inability to move indicates serious compromise
P
Pulse — compare bilaterally, note strength
P
Pallor — paleness or mottling indicates poor perfusion
Trauma Assessment
ABCDEFGHI
Airway · Breathing · Circulation · Disability · Expose · Full vitals · Give comfort · Head-to-toe · Inspect posterior
Systematic trauma assessment — never skip a step
Always begin with ABC and patient safety. Once those are secured move through the framework systematically. Rapid assessment is essential to trauma patient survival — this framework keeps you focused under pressure.
A
Airway — open and patent?
B
Breathing — rate, depth, effort
C
Circulation — pulse, bleeding, perfusion
D
Disability — neuro status, GCS, pupils
E
Expose/Examine — remove clothing, look for injuries
F
Full set of vitals — BP, HR, RR, temp, SpO2
G
Give comfort measures — pain management
H
Head-to-toe assessment — systematic exam
I
Inspect posterior — roll patient, check back
Trauma Surgery History
AMPLE
Allergies · Medications · Past medical history · Last meal · Events surrounding injury
Medical history for every trauma patient before surgery
AMPLE is your rapid medical history tool for trauma patients — especially before they go to surgery. Gathering this information quickly can prevent life-threatening complications during and after the procedure.
A
Allergies — especially medications and latex
M
Medications — current prescriptions, OTC, supplements
P
Past medical history — conditions, surgeries, hospitalizations
L
Last meal — aspiration risk for anesthesia
E
Events surrounding injury — mechanism, timeline
Altered Mental Status
AEIOU TIPS
Alcohol · Endocrine · Insulin · Overdose · Uremia · Trauma · Infection · Psychiatric · Shock
Never assume AMS is neurological — check all causes
Altered mental status has many causes beyond neurological injury. AEIOU TIPS ensures you systematically explore every possibility before concluding the cause. Missing a treatable cause like hypoglycemia or infection can be fatal.
A
Alcohol/drugs — intoxication or withdrawal
E
Endocrine — thyroid, adrenal disorders
I
Insulin — hypoglycemia or hyperglycemia
O
Overdose — medications or substances
U
Uremia — renal failure, toxin buildup
T
Trauma — head injury, hemorrhage
I
Infection — sepsis, meningitis, encephalitis
P
Psychiatric — psychosis, severe depression
S
Shock — any type causing cerebral hypoperfusion
Environmental Health
I PREPARE
Investigate · Present work · Residence · Environmental concerns · Past work · Activities · Referrals · Educate
Assess environmental health risk factors systematically
I PREPARE guides you through a complete environmental health assessment — identifying exposures at work, home, and during daily activities. Environmental factors are often overlooked but can be the root cause of many chronic conditions.
I
Investigate potential exposures
P
Present work — current job hazards
R
Residence — home environment, location
E
Environmental concerns — local pollution, water
P
Past work — previous job exposures
A
Activities — hobbies, recreational exposures
R
Referrals/resources — connect to specialists
E
Educate — teach patient about reducing exposure
Nursing Process
ADPIE
Assessment · Diagnosis · Planning · Implementation · Evaluation
A Delicious PIE — the 5 steps of the nursing process
ADPIE describes the complete nursing process from start to finish. Every patient encounter follows these five steps in order. Mastering ADPIE is essential for NCLEX and clinical practice.
A
Assessment — collect data holistically from the patient
D
Diagnosis — identify the nursing diagnosis from assessment data
P
Planning — create a long-term action plan with the medical team
I
Implementation — assist the patient in carrying out the plan
E
Evaluation — reassess the plan's effectiveness after the set timeframe
Acid-Base Balance
ROME
Respiratory Opposite · Metabolic Equal
Determine respiratory vs metabolic acidosis or alkalosis
ROME helps you interpret arterial blood gas results. Check the pH first, then compare to pCO2 (respiratory) or HCO3 (metabolic) to determine if the values move in opposite or equal directions.
R — Opposite
Respiratory: pH low + pCO2 high, OR pH high + pCO2 low
M — Equal
Metabolic: both pH and HCO3 low, OR both pH and HCO3 high
Health History
SAMPLE
Symptoms · Allergies · Medications · Past history · Last oral intake · Events
Collect a complete health history with SAMPLE
SAMPLE is your guide for collecting a thorough patient health history during assessment. Each letter ensures you don't miss a critical area that could affect diagnosis or treatment decisions.
S
Symptoms — what is the patient currently experiencing?
A
Allergies — what allergies does the patient have?
M
Medications — what is currently being taken?
P
Past medical history — related diagnoses or family history?
L
Last oral intake — when was last medication or food taken?
E
Events — what occurred before the symptoms began?
Level of Consciousness
AVPU
Alert · Voice · Pain · Unresponsive
Rapid consciousness assessment — a condensed Glasgow Coma Scale
AVPU is a quick tool to assess a patient's level of consciousness based on their eye, vocal, and motor responses. It's faster than the full Glasgow Coma Scale and used in rapid assessments and emergencies.
A
Alert — awake, opens eyes voluntarily, moves body
V
Voice — responds to verbal stimuli (sentences or sounds)
P
Pain — only reacts to pain stimuli
U
Unresponsive — no reaction or response of any kind
Sprains & Strains
RICE
Rest · Ice · Compression · Elevation
First-line treatment for sprains and strains
RICE is the standard first-line treatment for musculoskeletal injuries like sprains and strains. Simple, effective, and always testable on NCLEX — every nurse needs to know this cold.
R
Rest — stop activity, protect the injured area
I
Ice — apply for 20 min on, 20 min off to reduce swelling
C
Compression — wrap to reduce swelling
E
Elevation — raise above heart level to reduce edema
Electrolytes
PISO
Potassium Inside · Sodium Outside
Remember where potassium and sodium live in the body
PISO helps you remember the normal location of the two most important electrolytes. This is foundational knowledge for understanding fluid balance, cardiac function, and IV therapy.
P — Inside
Potassium (K+) is found inside the cell (intracellular)
S — Outside
Sodium (Na+) is found outside the cell (extracellular)
Bleeding Precautions
BEEP
Bleeding gums · Epistaxis · Ecchymosis · Petechiae
Minor bleeding precaution signs every nurse must recognize
BEEP helps you remember the four signs of minor bleeding that indicate a patient needs bleeding precautions. These are especially important when caring for patients on anticoagulants or with low platelet counts.
B
Bleeding gums — check during oral care
E
Epistaxis — nosebleeds
E
Ecchymosis — bruising
P
Petechiae — tiny red/purple spots under the skin
NCLEX Priority — ABC
ABC first: Airway → Breathing → Circulation. Then Safety. Then Maslow. 'Airway always wins.'
ABC Priority Framework
The foundational NCLEX priority rule — what to assess and treat first every time
When multiple patients or problems: always prioritize in order. Airway: most critical — no airway = dead in minutes. Breathing: respiratory rate, effort, SpO2. Circulation: pulse, blood pressure, perfusion. Safety: falls, restraints, environment. Then Maslow's hierarchy: physiological → safety → love/belonging → esteem → self-actualization. NCLEX tip: physiological needs always come before psychosocial. Exception: if patient says 'I want to kill myself' — safety overrides physical needs. Actual problems before potential problems. Acute before chronic.
Airway
First — no airway = death
Breathing
Second — rate, effort, SpO2
Circulation
Third — pulse, BP, perfusion
Safety
Fourth — falls, environment
Maslow
Physiological before psychosocial
SATA Strategy
Select All That Apply (SATA): treat each option as True/False independently. Don't look for patterns — every option stands alone.
SATA Questions
The most feared NCLEX question type — and the strategy that makes them manageable
SATA questions have no partial credit — all correct options must be selected. Strategy: cover other options, read each one independently as True/False. Avoid: looking for patterns (2 and 4, all of the above thinking). Each option is its own T/F question. If unsure about one option — ask 'would a safe nurse do this?' Common trap: including an intervention that's appropriate but NOT the priority or NOT related to the specific scenario. Always re-read the stem after selecting to make sure your answers make clinical sense together.
Maslow's Hierarchy
Maslow: Physiological → Safety → Love/Belonging → Esteem → Self-Actualization. 'Please Send Love Every Saturday.'
Maslow's Hierarchy of Needs
The framework NCLEX uses to prioritize nursing care — physical needs always come first
Physiological: oxygen, food, water, shelter, sleep, elimination — ALWAYS first priority. Safety: security, protection from harm, falls prevention. Love/Belonging: relationships, family, social connection. Esteem: self-confidence, achievement, respect. Self-Actualization: reaching full potential. NCLEX application: patient with breathing problem AND anxiety → treat breathing first. Patient with pain AND loneliness → treat pain first. Exception: immediate safety threat (suicidal ideation) → safety before some physiological needs.
Physiological
Oxygen, food, water — ALWAYS first
Safety
Protection from harm
Love/Belonging
Relationships, family
Esteem
Self-confidence, respect
Self-Actualization
Reaching full potential
Infection Control — Transmission Precautions
Contact (gloves+gown), Droplet (surgical mask), Airborne (N95 + negative pressure room). 'My Aunt Takes Careful, Droplet, Airborne steps.'
Transmission-Based Precautions
Three types of isolation — knowing which goes with which infection is essential NCLEX content
Standard precautions: for ALL patients — hand hygiene, gloves for body fluids. Contact precautions (gloves + gown): MRSA, VRE, C. diff, scabies, RSV. Private room preferred. Droplet precautions (surgical mask within 3 feet): influenza, pertussis, meningitis (meningococcal), mumps, rubella, strep pharyngitis. Airborne precautions (N95 + negative pressure room): TB, measles (rubeola), varicella (chickenpox), disseminated zoster. Mnemonic for airborne: MTV — Measles, TB, Varicella. N95 must be fit-tested. Patient wears surgical mask when transported.
Contact
Gloves + gown — MRSA, VRE, C. diff
Droplet
Surgical mask — flu, meningitis, mumps
Airborne
N95 + neg pressure — MTV: Measles, TB, Varicella
Vital Signs — Normal Ranges
Normal adult vitals: BP 120/80, HR 60–100, RR 12–20, Temp 36.5–37.5°C (97.7–99.5°F), SpO2 ≥95%.
Normal Adult Vital Signs
The baseline every nurse must know cold — and when to call the provider
Blood pressure: normal <120/80, hypertension ≥130/80, hypotension <90/60. Heart rate: 60–100 bpm. Tachycardia >100 (pain, fever, hypovolemia, anxiety). Bradycardia <60 (athletes normal, beta blockers, increased ICP). Respiratory rate: 12–20 breaths/min. Tachypnea >20 (fever, pain, anxiety, respiratory distress). Bradypnea <12 (opioids — hold medication). Temperature: 36.5–37.5°C. Fever >38°C (100.4°F). SpO2: ≥95% normal, <90% concerning, <88% critical. Pulse pressure: systolic - diastolic = 40 mmHg normal. Widening pulse pressure = increased ICP.
Pain Assessment
Pain: 5th vital sign. OLDCART — Onset, Location, Duration, Character, Aggravating, Relieving, Treatment. Always ask before giving meds.
Pain Assessment
Comprehensive pain assessment — NCLEX expects nurses to assess before and after every intervention
OLDCART: Onset (when did it start?), Location (where? does it radiate?), Duration (constant or intermittent?), Character (sharp, dull, burning, crushing?), Aggravating factors (what makes it worse?), Relieving factors (what helps?), Treatment (what have you tried?). Pain scales: NRS 0–10 (adults), FACES (children 3+), FLACC (infants/non-verbal — Face, Legs, Activity, Cry, Consolability). Reassess: 30–60 min after oral meds, 15–30 min after IV. Document: location, quality, severity, response to treatment. Pain is subjective — believe the patient.
O
Onset
L
Location + radiation
D
Duration
C
Character — quality
A
Aggravating factors
R
Relieving factors
T
Treatment tried
Fall Prevention
Fall risk: MORSE scale. High risk interventions: bed in lowest position, call light within reach, non-slip footwear, hourly rounding.
Fall Prevention
The most common adverse event in hospitals — preventing falls is a core nursing responsibility
MORSE Fall Scale risk factors: history of falls, secondary diagnosis, ambulatory aid (cane/walker), IV access, gait (weak/impaired), mental status (forgets limitations). High score = high risk. Interventions: bed lowest position and locked, call light within reach, non-slip footwear (socks with grips), keep personal items close, hourly rounding (4 Ps: Pain, Position, Potty, Personal items), bed alarm, yellow armband/door sign. High-risk medications: sedatives, opioids, antihypertensives, diuretics, antidiabetics. Do NOT restrain to prevent falls.
Restraints
Restraints: last resort, require MD order, release every 2 hours, neurovascular checks every 30 min, document every hour.
Restraint Use
Restraints are heavily regulated — the NCLEX tests safe and legal restraint use
Restraints: physical or chemical limitation of movement. Must have: MD order (time-limited), documented clinical justification, less restrictive alternatives tried first. Nursing responsibilities: restraint as LAST resort (try redirection, call family, sitter first). Check every 30 minutes: neurovascular status (circulation, sensation, movement). Release every 2 hours: reposition, ROM, toileting, skin care. Tie to bed frame (NOT side rail) with quick-release knot. Document every hour. Wrist restraints: keep 2 fingers under. Never restrain in prone position. Reassess need every shift.
IV Access and Complications
IV complications: infiltration (swelling, cool), phlebitis (red, warm, cord), extravasation (vesicant leaks — tissue damage).
IV Complications
Three common IV complications — assess the site with every intervention
Infiltration: IV fluid leaks into surrounding tissue (non-vesicant). Signs: swelling, cool, pale, pain at site. Stop infusion, remove IV, elevate extremity, warm compress. Phlebitis: vein inflammation. Signs: redness, warmth, pain along vein, palpable cord. Stop infusion, remove IV, warm compress, document. Extravasation: vesicant (tissue-damaging drug) leaks — most serious. Signs: burning, blistering, tissue necrosis. STOP immediately, leave IV in place, aspirate, give antidote per protocol. Examples of vesicants: chemotherapy, calcium chloride, potassium (concentrated), dopamine, vancomycin. Document site every 1–2 hours.
Infiltration
Non-vesicant leak — swelling, cool, pale
Phlebitis
Vein inflammation — red, warm, cord
Extravasation
Vesicant leak — STOP, aspirate, antidote
Therapeutic Communication
Therapeutic communication: open-ended questions, reflection, clarification. AVOID: false reassurance, why questions, giving advice.
Therapeutic Communication
The communication techniques NCLEX tests — and the common mistakes to avoid
Therapeutic techniques: Open-ended questions ('Tell me more about...'), Reflection (repeat back feelings), Clarification ('I'm not sure I understand...'), Active listening, Silence (powerful — allows patient to process), Focusing, Summarizing. Non-therapeutic (AVOID): False reassurance ('Everything will be fine'), Why questions ('Why did you...?' — puts patient on defensive), Giving personal opinions/advice, Changing the subject, Closed questions (yes/no only). For mental health: never argue with delusions, set limits on behavior (not feelings), don't agree with hallucinations but don't argue.
Use
Open-ended, reflection, silence, clarification
Avoid
False reassurance, 'why?' questions
Avoid
Giving advice, changing subject
Documentation Principles
Documentation: if it's not written, it wasn't done. Objective, accurate, timely, complete. Use military time. Never falsify.
Nursing Documentation
The legal and professional rules of nursing documentation — what NCLEX always includes
Charting rules: factual and objective (what you see, hear, smell — not interpretations). Accurate: exact times, measurements, quotes. Timely: document as soon as possible after care. Complete: assessments, interventions, patient response, teaching, referrals. Correct errors: single line through error, write 'error,' date, initials — NEVER white-out or delete. Late entries: clearly label as 'late entry' with date/time of actual occurrence. Legal: medical record is a legal document. Patient quotes: use exact words in quotation marks. Avoid vague terms: 'seems better' → use objective data.
Delegation — RN, LPN, UAP
RN delegates to LPN/UAP based on: stability, complexity, predictability. RN cannot delegate assessment, teaching, evaluation, or care planning.
Delegation Framework
What the RN can and cannot delegate — a perennial NCLEX topic
5 Rights of Delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision. RN scope: assessment, care planning, teaching, evaluation, complex interventions, unstable patients. LPN scope: stable patients, routine medications (some states IV), wound care, data collection, reinforcing teaching. UAP (CNA) scope: ADLs (bathing, feeding, ambulation), vital signs (stable patients), I&O, specimen collection, positioning. NEVER delegate to UAP: assessment, teaching, evaluation, care planning, unstable patients, complex procedures. RN remains accountable for all delegated tasks.
RN
Assessment, planning, teaching, evaluation
LPN
Stable patients, routine meds, wound care
UAP
ADLs, vital signs, I&O, specimens
Never delegate
Assessment, teaching, unstable patients
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