JNCLEX-RN (Jordan) cheat sheet

Priority-setting frameworks: ABC (Airway, Breathing, Circulation) precedes Maslow-based needs; unstable client over stable client; acute over chronic; safety risk over routine care.

Five rights of delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation. Delegation to UAP never includes assessment, teaching, evaluation, or nursing judgment.

Chain of command escalation order in Jordanian hospitals: charge nurse → nursing supervisor → on-call physician → nursing director; document time, persons notified, and client status at each step.

Scope of practice: RN performs initial assessment, care planning, and evaluation; LPN/associate nurse performs stable, predictable interventions; UAP performs ADLs, vital signs on stable clients, and ambulation.

Informed consent elements: nature of procedure, risks, benefits, alternatives, right to refuse. The physician obtains consent; the nurse verifies comprehension, voluntariness, and signature, and witnesses.

Continuity tools: SBAR (Situation, Background, Assessment, Recommendation) for handoff; ISBAR adds Identification. Handoff must occur at every transfer of accountability.

Case management targets high-risk, high-cost clients; critical pathways define expected length of stay and variance documentation.

Incident reporting is non-punitive and factual; report is filed for risk management, not placed in the medical record, and never altered after the fact.

Resource allocation during surge: use triage tags and objective scoring, document rationing decisions, and follow institutional disaster policy rather than individual preference.

Standard precautions apply to all clients: hand hygiene, gloves for body-fluid contact, gown/mask/eye protection per anticipated splash, safe sharps handling, and respiratory hygiene.

Transmission-based additions: contact (MRSA, C. difficile, scabies) requires gown and gloves plus dedicated equipment; droplet (influenza, pertussis, meningococcus) requires a surgical mask within 1 m; airborne (TB, measles, varicella) requires an N95 respirator and negative-pressure room.

Hand hygiene: alcohol-based rub for visibly clean hands; soap and water when hands are visibly soiled or after caring for a client with C. difficile or norovirus.

Needlestick after exposure: wash with soap and water, report immediately, obtain source serology, and start post-exposure prophylaxis per protocol; time to HIV PEP is ideally under 2 hours.

Fall prevention bundle: Morse or Hendrich risk assessment on admission and shift, bed low and locked, call light within reach, nonskid footwear, hourly rounding, and toileting schedules.

Restraint use requires a physician order, time-limited renewal, face-to-face evaluation, monitoring of circulation, skin, and vitals, and the least restrictive alternative first.

Medication safety: two client identifiers before administration, independent double-check for high-alert drugs (insulin, heparin, chemotherapy, opioids), and no interruption during preparation.

Fire response: RACE (Rescue, Alarm, Contain, Extinguish/Evacuate); PASS for extinguisher use (Pull, Aim, Squeeze, Sweep).

Sterile field rules: 2.5 cm border is contaminated; never turn the back on the field; any moisture strike-through contaminates; items below waist level are contaminated.

Screening schedules: cervical cytology from age 21 (or 25 per local protocol) every 3 years; mammography from 40-50 every 1-2 years; colorectal screening from 45-50; blood pressure at every visit.

Antenatal visit schedule for uncomplicated pregnancy: every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, then weekly until birth.

Expected weight gain in pregnancy depends on pre-pregnancy BMI; normal-BMI singleton gain is roughly 11.5-16 kg, with most gain in the second and third trimesters.

Fetal heart rate baseline 110-160 beats/min; early decelerations mirror head compression and are benign; late decelerations indicate uteroplacental insufficiency and require repositioning and provider notification.

Growth milestones: birth weight doubles by 5 months and triples by 12 months; head circumference exceeds chest circumference until about 6 months.

Developmental stages: stranger anxiety around 6-8 months, object permanence around 9-12 months, parallel play in toddlers, cooperative play in school-age children.

Immunization principles: live vaccines are contraindicated in pregnancy and significant immunosuppression; mild illness with low-grade fever is not a reason to defer.

Health education models: the Health Belief Model addresses perceived susceptibility, severity, benefits, and barriers; the Transtheoretical Model stages are precontemplation, contemplation, preparation, action, maintenance.

Cultural and religious context in Jordan: Ramadan fasting exemptions for pregnancy, diabetes, and chronic illness; hydration and medication timing counseling are core nursing tasks.

Therapeutic communication techniques: open-ended questions, reflection, restatement, silence, clarification, and focusing. Nontherapeutic: false reassurance, giving advice, changing the subject, and why-questions.

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

Suicide risk assessment: direct asking does not increase risk; assess plan, means, intent, and history; a contract for safety alone is insufficient; maintain line-of-sight precautions per order.

Alcohol withdrawal: monitor CIWA scores; untreated severe withdrawal can progress to delirium tremens with seizures and cardiovascular collapse; benzodiazepines are first-line.

Eating disorders: refeeding syndrome risk with rapid caloric restoration; monitor phosphate, potassium, and magnesium; sit with the client during and after meals.

Psychiatric medication adherence: teach that therapeutic effect of SSRIs appears in 2-4 weeks and that discontinuation should be tapered to avoid withdrawal.

Anxiety hierarchy: mild anxiety improves learning; moderate narrows perception; severe and panic levels impair learning, so teaching is deferred until anxiety is reduced.

Delirium versus dementia: delirium has acute onset, fluctuating course, and altered attention; dementia has gradual, progressive cognitive decline with preserved attention early.

Mandatory reporting and duty to warn: confidentiality yields when a client poses a credible threat to an identifiable other or to self, per law and institutional policy.

Pressure injury staging: stage 1 nonblanchable erythema with intact skin; stage 2 partial-thickness loss; stage 3 full-thickness loss with visible fat; stage 4 extends to fascia, muscle, or bone.

Repositioning interval for at-risk clients is typically every 2 hours; use a 30-degree lateral tilt and keep the head of bed at or below 30 degrees when possible.

Pain assessment: use the numeric rating scale for adults, Wong-Baker FACES for children, and PAINAD or Abbey for clients with advanced dementia.

Opioid adverse effects: constipation is expected and requires a prophylactic bowel regimen; respiratory depression is the priority concern and is treated with naloxone.

Nutrition: clear liquids contain no dairy or pulp; full liquids add dairy; a post-pyloric feeding is indicated when aspiration risk is high, with head of bed at 30-45 degrees.

Fluid balance: 1 kg body weight change approximates 1 L of fluid; insensible loss is roughly 500-600 mL/day in adults, increased with fever and tachypnea.

Oxygen safety: no open flame or petroleum products near oxygen; humidify high-flow oxygen; monitor for oxygen-induced hypoventilation in chronic CO2 retainers.

Sleep hygiene: limit daytime naps, avoid caffeine after midday, promote dim lighting and quiet at night, and cluster nursing care to protect sleep cycles.

Mobility: dangling before ambulation, use gait belts, and apply antiembolism stockings with measurement-based sizing; remove and assess skin at least twice daily.

Dosage formula: desired dose / available dose x quantity. Pediatric dosing by weight: mg/kg/dose; verify against a safe-dose range before administration.

IV flow rate (mL/h) = total volume (mL) / total time (h). Drop rate (gtt/min) = (volume x drop factor) / time in minutes.

High-alert medications requiring independent double-check: insulin, heparin, warfarin, opioids, chemotherapy, and concentrated electrolytes such as potassium chloride.

IV push potassium chloride is never given; dilute and infuse via pump with a maximum peripheral concentration per policy.

Antidotes: naloxone for opioids, flumazenil for benzodiazepines, acetylcysteine for acetaminophen, protamine sulfate for heparin, vitamin K for warfarin, and digoxin immune Fab for digoxin toxicity.

Insulin onset: rapid-acting (lispro, aspart) 10-15 minutes; short-acting (regular) 30-60 minutes; intermediate (NPH) 1-2 hours; long-acting (glargine) has no peak. Only regular insulin may be given IV.

Vancomycin and aminoglycosides require peak and trough monitoring; draw troughs before the next dose, and monitor creatinine and hearing.

Blood transfusion: two-person verification, 0.9% sodium chloride only in the line, begin slowly and stay with the client for the first 15 minutes, and stop immediately for a reaction.

Parenteral nutrition: administer via a dedicated line, do not stop abruptly (risk of hypoglycemia), and monitor glucose, electrolytes, and triglycerides.

Postoperative complications: atelectasis is most common early; hypovolemic shock presents with tachycardia, hypotension, oliguria, and restlessness; malignant hyperthermia follows volatile anesthetics and succinylcholine.

Venous thromboembolism prevention: early ambulation, sequential compression devices, and anticoagulation; assess for unilateral calf pain, swelling, and warmth before ambulating a high-risk client.

Laboratory critical values: potassium below 2.5 or above 6.5 mmol/L, sodium below 120 or above 160 mmol/L, glucose below 2.8 mmol/L, and hemoglobin below 7 g/dL typically trigger immediate notification.

DKA versus HHS: DKA has ketosis, acidosis, and Kussmaul respirations in type 1; HHS has profound hyperglycemia, hyperosmolality, and minimal ketosis in type 2.

Early warning scores: rising respiratory rate, falling oxygen saturation, altered mentation, and decreasing urine output precede cardiac arrest and mandate escalation.

Tuberculosis screening: a positive Mantoux is induration of 10 mm or more in most adults, 5 mm or more in immunocompromised clients, and 15 mm or more in low-risk clients without risk factors.

Falls and aspiration risk screening on admission and after any change in condition; place the call light, bed alarm, and suction equipment for seizure precautions.

Radiation and contrast safety: verify renal function and allergy history before iodinated contrast, and encourage hydration afterward.

Shock progression: compensatory (tachycardia, vasoconstriction, normal blood pressure), progressive (hypotension, oliguria, metabolic acidosis), and irreversible (cellular death, multi-organ failure).

Heart failure: left-sided failure causes dyspnea, orthopnea, crackles, and pink frothy sputum; right-sided failure causes jugular venous distension, hepatomegaly, and peripheral edema.

Acid-base interpretation: check pH first, then PaCO2 (respiratory) and HCO3 (metabolic); use the mnemonic ROME (Respiratory Opposite, Metabolic Equal) for direction of change.

Acute kidney injury: prerenal from hypoperfusion, intrarenal from tubular damage, postrenal from obstruction; oliguria is urine output below 0.5 mL/kg/h for 6 hours.

Stroke: thrombolysis window is up to 4.5 hours from symptom onset for selected clients; permissive hypertension is preferred unless thrombolysis is planned.

Increased intracranial pressure: earliest sign is a change in level of consciousness; Cushing triad (hypertension, bradycardia, irregular respirations) is a late, ominous sign.

Burns: use the Rule of Nines for extent; Parkland formula is 4 mL x body weight (kg) x %TBSA of lactated Ringer's in the first 24 hours, half in the first 8 hours.

Sepsis bundle: measure lactate, obtain cultures before antibiotics, give broad-spectrum antibiotics within 1 hour, and give 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more.

Hyperkalemia ECG progression: peaked T waves, prolonged PR interval, widened QRS, then sine wave; treat with calcium gluconate first for cardiac protection.

Jordanian nursing regulation: the Jordanian Nursing Council sets licensure, scope of practice, and continuing education standards; the Ministry of Health and the Jordanian Nurses and Midwives Council oversee registration and disciplinary action.

Licensure: practice requires a current registration; practicing without it is a legal offense regardless of clinical competence.

Four ethical principles: autonomy (right to decide), beneficence (do good), nonmaleficence (do no harm), and justice (fair distribution). Veracity and fidelity are supporting duties.

Informed refusal: a competent adult may refuse any treatment, including life-sustaining treatment; document the refusal, notify the provider, and continue supportive care.

Confidentiality exceptions: client consent, legal requirement (reportable communicable disease, gunshot or abuse injuries), and credible threat of harm to an identifiable person.

Advance directives and durable power of attorney for healthcare: the appointed surrogate decides only when the client lacks capacity; the nurse advocates for the client's documented wishes.

Documentation standards: objective, timely, factual entries; late entries are labeled as such; never alter or destroy a record; use only approved abbreviations.

Malpractice elements that must all be proven: duty, breach of duty, causation, and damages.

Cultural and legal context: Islamic bioethics emphasizes preservation of life, dignity, and family involvement in decision-making; nursing advocacy respects both client autonomy and family consultation.

Jordanian nursing regulation: the Jordanian Nursing Council sets licensure, scope of practice, and continuing education standards; the Ministry of Health oversees registration and disciplinary action.

Licensure: practice requires a current registration; practicing without it is a legal offense regardless of clinical competence.

Four ethical principles: autonomy (right to decide), beneficence (do good), nonmaleficence (do no harm), and justice (fair distribution). Veracity and fidelity are supporting duties.

Informed refusal: a competent adult may refuse any treatment, including life-sustaining treatment; document the refusal, notify the provider, and continue supportive care.

Confidentiality exceptions: client consent, legal requirement (reportable communicable disease, gunshot or abuse injuries), and credible threat of harm to an identifiable person.

Advance directives and durable power of attorney for healthcare: the appointed surrogate decides only when the client lacks capacity; the nurse advocates for the client's documented wishes.

Documentation standards: objective, timely, factual entries; late entries are labeled as such; never alter or destroy a record; use only approved abbreviations.

Malpractice elements that must all be proven: duty, breach of duty, causation, and damages.

Cultural and legal context: Islamic bioethics emphasizes preservation of life, dignity, and family involvement in decision-making; nursing advocacy respects both client autonomy and family consultation.