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.
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.
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.