NCLEX-RN Cheat Sheet: High-Yield Facts for Test Day

✓ Correct: A 0.9% Normal Saline 1,000 mL bolus

Why. In Hyperosmolar Hyperglycemic State (HHS), the primary physiological threat is profound dehydration and hypovolemic shock. For an older client with a history of heart failure and a current blood pressure of 82/50 mmHg, the immediate priority is restoring intravascular volume with an isotonic solution like 0.9% Normal Saline. Option A is correct because isotonic fluids are necessary to stabilize hemodynamics despite the risk of fluid overload in heart failure patients; volume resuscitation takes precedence over potential congestion. Option B is incorrect because 0.45% Normal Saline is hypotonic and will not stay in the intravascular space effectively enough to treat acute shock. Option C is incorrect because D5W would worsen the hyperglycemic state and provide no volume expansion. Option D is incorrect because 3% NaCl is a hypertonic solution used for severe hyponatremia, not volume resuscitation, and would exacerbate the client’s hyperosmolar state.

✓ Correct: C One slice of whole-wheat toast with a poached egg and half a grapefruit.

Why. This selection aligns with the 30-gram limit, as one slice of toast is approximately 15 grams and half a grapefruit is about 15 grams, while the egg provides protein without carbohydrates. Option A is incorrect because a standard bagel alone often exceeds 50 grams of carbohydrates, and juice adds significant simple sugars. Option B is incorrect because pancakes and bananas are both high-carbohydrate items that would likely exceed 45 to 60 grams. Option D is incorrect as sweetened cereal, milk, and granola bars represent a high-glycemic load that would significantly exceed the 30-gram threshold. Managing breakfast carbohydrates is critical in gestational diabetes due to the dawn phenomenon and increased cortisol levels, which heighten morning glucose sensitivity and require strict portion control.

✓ Correct: A 150 minutes of moderate-intensity aerobic activity weekly.

Why. The correct choice is A as it reflects the current American Heart Association and CDC recommendations for adults to achieve substantial health benefits and reduce cardiovascular risk. For a client with a sedentary job and a high-risk family history, meeting this threshold is essential for primary prevention. Option B is incorrect because 60 minutes per month is significantly below the recommended frequency and duration for heart health. Option C is also insufficient, as high-intensity training should be more frequent to provide lasting metabolic benefits. Option D provides the correct timeframe (weekly) but specifies “light-intensity,” which does not meet the “moderate” threshold required to effectively lower the risk of coronary artery disease in an overweight individual. Providing the specific 150-minute target gives the client a clear, evidence-based goal to improve their long-term health trajectory.

✓ Correct: B Implement the high-risk fall interventions.

Why. The correct answer is B because a Morse Fall Scale score of 65 is significantly above the high-risk threshold of 45. The cues of new diuretics, which increase urinary urgency, and nocturnal confusion indicate a high physiological risk. Option A is a highly restrictive and resource-intensive intervention usually reserved for clients who fail other measures or are at risk for self-harm. Option C is a collaborative referral that addresses long-term mobility but does not provide the immediate safety required at the bedside. Option D is a helpful strategy but is only one component of the comprehensive high-risk interventions required for a score of 65. The high-risk bundle addresses the physiological and environmental risks identified by the high Morse score, ensuring a multi-faceted approach to preventing injury in a confused, high-risk client.

✓ Correct: A Direct the flow from the inner canthus toward the outer canthus.

Why. Irrigation must flow from the inner canthus to the outer canthus to prevent the chemical and contaminated fluid from entering the lacrimal duct or crossing over to the unaffected eye. Option B is incorrect because directing flow toward the inner canthus risks flushing contaminants into the tear duct and the other eye. Option C is suboptimal because a direct stream on the cornea can cause mechanical trauma to the already damaged epithelial layer. Option D is incorrect because chemical burns, especially alkaline ones, require prolonged irrigation, often thirty to sixty minutes, until the pH neutralizes, rather than a brief five-minute cycle. The nurse must prioritize protecting the unaffected structures while ensuring thorough removal of the caustic substance from the conjunctival sac. It is often necessary to check the pH repeatedly during this process.