OBA NCLEX-RN (Part 1) cheat sheet

Scope of practice: RN tasks include assessment, care planning, and evaluation; delegation to UAP is limited to stable, predictable tasks with known outcomes.

Five rights of delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation.

SBAR handoff: Situation, Background, Assessment, Recommendation; state the current problem first, then supporting data.

Standard precautions apply to all clients: gloves for blood/body fluids, gown if splashing likely; hand hygiene before and after every client contact.

Airborne precautions: N95 respirator, negative-pressure room with door closed for tuberculosis, measles, and varicella.

Droplet precautions: surgical mask within 3 feet for influenza, pertussis, and meningococcal disease; client wears mask during transport.

Contact precautions: gown and gloves, dedicated equipment for MRSA, C. difficile, and scabies; C. difficile requires soap-and-water handwashing, not alcohol rub.

Fire response: RACE (Rescue, Alarm, Contain, Extinguish); use a Class C extinguisher for electrical fires.

Error prevention: verify the six rights of medication administration and require an independent double-check for high-alert drugs such as insulin and heparin.

Infant feeding: breast milk or iron-fortified formula through 12 months; no cow's milk before 12 months; introduce solids around 6 months.

Growth milestones: birth weight doubles by 5-6 months and triples by 12 months; head circumference equals chest circumference around 1-2 years.

Developmental screening: Denver-style milestones check gross motor, fine motor, language, and social skills at every well-child visit.

Adolescent screening: recommend HPV vaccine at 11-12 years; screen for depression and substance use annually.

Adult screening: colorectal cancer screening begins at 45 years; mammography typically starts at 40-50 years per guideline; cervical screening from 21 years.

Prenatal care: folic acid 400 mcg daily before conception reduces neural tube defects; first prenatal visit includes blood type, Rh, and rubella titer.

Older adult screening: bone density at 65 years for women; annual influenza vaccine and pneumococcal vaccination per schedule.

Health behavior counseling: use the 5 A's (Ask, Advise, Assess, Assist, Arrange) for tobacco cessation.

Therapeutic communication: use open-ended questions, reflection, and silence; avoid false reassurance, advice-giving, and why-questions.

Anxiety levels: mild widens perception and learning; severe narrows focus; panic causes loss of rational thought and requires short, simple directions.

Grief stages (Kubler-Ross): denial, anger, bargaining, depression, acceptance; stages are not linear and may recur.

Delirium versus dementia: delirium has acute onset, fluctuating consciousness, and reversible causes; dementia is chronic and progressive with clear consciousness.

Alcohol withdrawal: monitor for tremor, tachycardia, and hypertension; severe withdrawal causes seizures and delirium tremens, treated with benzodiazepines.

Suicide risk: direct questioning does not increase risk; assess plan, means, and intent, and maintain line-of-sight precautions for high risk.

Eating disorders: refeeding syndrome risk includes hypophosphatemia and cardiac dysrhythmia; monitor electrolytes during nutritional rehabilitation.

Abuse assessment: use private interview, document objective findings, and follow mandatory reporting laws for suspected abuse.

Acid-base: pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L; respiratory disorders change CO2, metabolic disorders change HCO3.

Compensation rule: if pH and CO2 move in opposite directions, the primary problem is respiratory; if pH and HCO3 move in the same direction, it is metabolic.

Potassium: normal 3.5-5.0 mEq/L; hyperkalemia causes peaked T waves and dysrhythmia; treat with calcium, insulin plus glucose, and kayexalate.

Sodium: normal 135-145 mEq/L; correct hyponatremia slowly (no more than 8-10 mEq/L in 24 hours) to avoid osmotic demyelination.

Heart failure: monitor daily weight, report a gain of 2-3 pounds in a day or 5 pounds in a week; elevate head of bed for orthopnea.

Insulin onset: rapid-acting (lispro) 15 minutes, short-acting (regular) 30 minutes, intermediate (NPH) 1-2 hours; give regular insulin before meals.

Digoxin: therapeutic level 0.5-2 ng/mL; hold and notify provider if apical pulse is below 60 beats/min in an adult.

Postoperative care: encourage incentive spirometry and early ambulation to prevent atelectasis and venous thromboembolism.

Stroke: time of symptom onset determines thrombolytic eligibility; administer alteplase within 3-4.5 hours and monitor for bleeding.