Proven Mnemonics & Acronyms — fast to learn, hard to forget.
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Morphine Side Effects
MORPHINE
Myosis · Out of it · Respiratory depression · Pneumonia · Hypotension · Infrequency · Nausea · Emesis
Remember morphine's side effects using the drug name itself
One of the most elegant mnemonics in nursing — the drug name spells out its own side effects. Respiratory depression is the most dangerous and the priority nursing assessment after administration.
M
Myosis — pinpoint pupils
O
Out of it — sedation
R
Respiratory depression — hold if RR <12
P
Pneumonia — aspiration risk
H
Hypotension — monitor BP
I
Infrequency — urinary retention, constipation
N
Nausea
E
Emesis — vomiting
Beta Blockers
-olol = beta blocker. 'Block the BASH' — Bradycardia, AV block, Spasm (broncho), Hypotension.
Beta Blocker Side Effects
The most tested drug class on NCLEX — know the suffix and the side effects cold
All beta blockers end in -olol (metoprolol, atenolol, propranolol, carvedilol). Block beta-1 (heart) and beta-2 (lungs) receptors. Side effects — BASH: Bradycardia (hold if HR <60), AV block, Bronchospasm (avoid in asthma/COPD), Sexual dysfunction, Hypotension. Never stop abruptly — taper to avoid rebound hypertension and angina. Check apical pulse before giving. Used for: HTN, heart failure, angina, dysrhythmias, post-MI.
Side effects of anticholinergic medications — impossible to forget
Anticholinergic drugs block acetylcholine — the "rest and digest" neurotransmitter. ANTI means NOT, so these are all the things your patient CAN'T do. Classic drugs: atropine, diphenhydramine, scopolamine, oxybutynin, tricyclic antidepressants.
Can't See
Blurred vision — mydriasis (dilated pupils)
Can't Pee
Urinary retention — especially in older males
Can't Spit
Dry mouth — decreased salivation
Can't Defecate
Constipation — decreased GI motility
Hypothyroidism
MOM'S SO TIRED
Memory loss · Obesity · Malar flush/Menorrhagia · Slowness · Skin/hair dryness · Onset gradual · Tiredness · Intolerance to cold · Really low BP · Energy falls · Depression
Signs and symptoms of hypothyroidism — everything slows down
Hypothyroidism occurs when the thyroid doesn't produce enough hormones, slowing the entire metabolism. Think of MOM'S SO TIRED as the perfect picture of someone whose body has completely slowed down. Treatment: levothyroxine (synthetic T4).
M
Memory loss — cognitive slowing
O
Obesity — weight gain from slow metabolism
M
Malar flush/Menorrhagia — facial redness, heavy periods
Hyperkalemia is one of the most dangerous electrolyte imbalances — it can cause fatal cardiac arrhythmias. Normal K+ is 3.5–5.0 mEq/L. Causes: renal failure, acidosis, potassium-sparing diuretics, ACE inhibitors. Treatment: calcium gluconate (cardiac protection), insulin + glucose (shift K+ into cells), kayexalate, dialysis.
LEAN helps you remember the key emergency drugs nurses must know cold. Each targets a specific crisis situation and must be available for rapid administration.
Spot lidocaine toxicity before it becomes life-threatening
Lidocaine is generally safe but has a narrow therapeutic window. SAMS helps you recognize toxicity early — symptoms progress from mild neurological changes to seizures if not caught quickly.
S
Slurred speech — early warning sign
A
Altered CNS — confusion, dizziness
M
Muscle twitching — progressing toxicity
S
Seizures — severe toxicity, stop drug immediately
Medication Administration
TRAMP
Time · Route · Amount · Medication · Patient
Safe medication administration — the 5 rights in disguise
TRAMP is your checklist for safe and accurate medication administration. Each step must be verified before giving any medication to any patient, every single time.
T
Time — when was last dose given?
R
Route — verify method of administration
A
Amount — correct dose and interval?
M
Medication — correct name, check for errors
P
Patient — verify name and check ID bracelet
Oral Contraceptives
SEA CASH
Severe leg pain · Eye issues · Abdominal pain · Chest pain · Acne · Swelling · Headaches
Danger signs of oral birth control pills — report these immediately
SEA CASH helps nurses and patients recognize the serious side effects that oral contraceptives can occasionally cause. These symptoms require immediate medical attention and may indicate clotting complications.
Medications used to treat bradycardia and hypotension
IDEA helps you recall the four drugs used when heart rate and blood pressure drop dangerously low. Each works through a different mechanism — knowing which to reach for first is critical in emergencies.
I
Isoproterenol — beta agonist, increases HR
D
Dopamine — increases BP and cardiac output
E
Epinephrine — powerful vasopressor and cardiac stimulant
A
Atropine Sulfate — first-line for symptomatic bradycardia
Thiazides are the most commonly prescribed oral diuretics. CHIC helps you remember the four conditions they are used to treat — a high-yield NCLEX topic especially for hypertension management.
PALS helps you remember the four antiarrhythmic drugs used to treat ventricular arrhythmias. Amiodarone is currently the most widely used, but all four may appear on NCLEX and in clinical practice.
P
Procainamide — Class IA antiarrhythmic
A
Amiodarone — most commonly used, monitor thyroid/liver
L
Lidocaine — Class IB, IV administration
S
Sotalol — beta blocker with antiarrhythmic properties
One of the highest-yield drug classes — the cough and angioedema are classic NCLEX traps
All ACE inhibitors end in -pril (lisinopril, enalapril, captopril, ramipril). Block conversion of angiotensin I → II → less vasoconstriction, less aldosterone → lower BP + less sodium/water retention. Key side effects: Dry hacking cough (most common reason stopped — switch to ARB). Angioedema: life-threatening swelling of airway — STOP immediately, epinephrine. Hyperkalemia (blocks aldosterone). Teratogenic (category D/X) — never in pregnancy. First-dose hypotension. Check K+ and creatinine.
Cough
Dry hacking — most common SE
Angioedema
Airway swelling — STOP, give epinephrine
Potassium ↑
Monitor K+ levels
hypOtension
Especially first dose
Pregnancy X
Teratogenic — never give
Renal
Can worsen renal failure
Digoxin Toxicity
Digoxin toxicity: early = GI (nausea, vomiting, anorexia) + visual (yellow-green halos). Hold if HR <60.
Digoxin
The classic narrow therapeutic index drug — toxicity is a NCLEX favorite
Digoxin: cardiac glycoside — slows HR (negative chronotrope), strengthens contraction (positive inotrope). Therapeutic level: 0.5–2 ng/mL. Toxicity signs — early GI: nausea, vomiting, anorexia. Visual: yellow-green halos around lights (classic). Cardiac: bradycardia, heart block, dysrhythmias. Hypokalemia potentiates toxicity (K+ competes at same receptor). Antidote: Digibind (digoxin immune fab). Hold if apical pulse <60. Assess K+ before giving. Toxicity treated with: hold drug, K+ replacement, Digibind for severe.
Early
Nausea, vomiting, anorexia
Visual
Yellow-green halos
Cardiac
Brady, blocks, dysrhythmias
Risk factor
Hypokalemia — K+ check first
Antidote
Digibind — digoxin immune fab
Warfarin (Coumadin)
Warfarin: monitor PT/INR (normal INR 2–3 for most, 2.5–3.5 for mechanical valves). Antidote: Vitamin K.
Warfarin Nursing
The original anticoagulant — full of interactions and monitoring requirements
Vitamin K antagonist — inhibits clotting factors II, VII, IX, X. Monitor INR (not PTT — that's heparin). Therapeutic INR: 2–3 (most indications), 2.5–3.5 (mechanical heart valves). Foods high in Vitamin K (green leafy vegetables) DECREASE warfarin effect — consistent intake, not elimination. Drug interactions: enormous — antibiotics, NSAIDs, many others. Antidote: Vitamin K (slow, oral/IV) or FFP (fast, emergency). Bleeding precautions: soft toothbrush, electric razor. Hold for procedures. Takes 3–5 days to reach therapeutic level.
Fast-acting anticoagulant — the aPTT and antidote are high-yield NCLEX content
Heparin activates antithrombin III → inhibits thrombin and factor Xa. Monitor aPTT (activated partial thromboplastin time) — therapeutic: 60–100 seconds (1.5–2.5× normal of ~40 sec). NOT INR (that's warfarin). Antidote: protamine sulfate. HIT (Heparin-Induced Thrombocytopenia): paradoxical clotting — check platelets. If platelets drop >50% → STOP heparin, switch to argatroban. LMWH (enoxaparin/Lovenox): does NOT require monitoring, give SubQ, do not rub. Overdose signs: bleeding — gums, urine (hematuria), stools (melena).
The most NCLEX-tested pain medication — respiratory depression is priority
Opioids (morphine, oxycodone, hydromorphone, fentanyl): bind mu receptors. Side effects — COAT: Constipation (always give stool softener), Over-sedation, Aspiration risk (nausea/vomiting), respiratory depression (most dangerous). Respiratory depression: RR <12, O2 sat dropping → administer naloxone (Narcan). Tolerance: need more for same effect. Physical dependence: withdrawal if stopped abruptly. Assess pain BEFORE giving, reassess 30–60 min after. Naloxone: short-acting — may need repeat doses. Hold if RR <12.
Three classes of diuretics — knowing which loses and which spares potassium saves patients
Loop diuretics (furosemide/Lasix, bumetanide): most potent. Act in loop of Henle. Lose K+, Na+, Mg2+, Ca2+. Monitor K+ — hypokalemia potentiates digoxin toxicity. Ototoxicity (hearing loss) — avoid with other ototoxic drugs. Thiazides (HCTZ, chlorthalidone): act in DCT. Also lose K+. Used for HTN. Potassium-sparing (spironolactone, triamterene): act in collecting duct. KEEP K+ — monitor for hyperkalemia. Spironolactone: anti-aldosterone, used in heart failure. Osmotic (mannitol): draws fluid out of brain — used for cerebral edema. Monitor I&O and daily weights for all diuretics.
Loop
Furosemide — loses K+, ototoxic
Thiazide
HCTZ — loses K+, used for HTN
K-sparing
Spironolactone — keeps K+
Osmotic
Mannitol — cerebral edema
Antibiotics — Nursing Considerations
Before antibiotics: always get culture first. Check allergies. Monitor for superinfection (C. diff, thrush).
Antibiotic Nursing Care
Cross-class nursing considerations that apply to every antibiotic — high-yield for NCLEX
Culture before antibiotics — 'culture before cure.' Allergy history: penicillin allergy — 1–10% cross-reactivity with cephalosporins. Anaphylaxis kit at bedside after first dose. Aminoglycosides (gentamicin, tobramycin): nephrotoxic + ototoxic — monitor BUN/creatinine, peak/trough levels. Fluoroquinolones: tendon rupture risk, avoid in children. Tetracyclines: avoid in pregnancy, children <8 (discolors teeth), take with full glass of water, no dairy. Superinfection: C. diff (watery diarrhea after antibiotics — contact precautions), oral thrush. Complete the full course.
First
Culture before giving antibiotic
Aminoglycosides
Monitor renal function, peak/trough
Fluoroquinolones
Tendon rupture risk
Tetracyclines
No dairy, no pregnancy, no <8 yr
Superinfection
C. diff, oral thrush — monitor
Insulin
Insulin types: Rapid (Lispro), Short (Regular — only IV), Intermediate (NPH), Long (Glargine — no mixing). 'RINS'
Insulin Types and Nursing
The most dangerous medication nurses give — every detail matters
Rapid-acting (lispro/Humalog, aspart/NovoLog): onset 15 min, give WITH meal or right after. Short-acting (Regular/Humulin R): onset 30–60 min, only insulin given IV. Intermediate (NPH/Humulin N): onset 2–4 hr, cloudy — gently roll, never shake. Long-acting (glargine/Lantus, detemir/Levemir): no peak, 24 hr. NEVER mix glargine. Draw clear before cloudy (Regular before NPH). Hypoglycemia: BS <70, diaphoresis, tremor, confusion — give 15g fast carbs, recheck in 15 min (15-15 rule). Insulin sites: rotate — abdomen absorbs fastest.