Complete 30-Day NCLEX-RN Study Plan
This single page contains the full 30-day schedule. Work through each day in order, or jump to a specific day using the anchors below.
30-Day intensive · 60-Day balanced
Day 1
Day 1 • FoundationHow the NCLEX actually works
CAT, item count, time, and what a short exam does — and does not — mean.
Learning objectives
- Explain computerized adaptive testing in one clear sentence.
- State the current 85–150 item range and 5-hour limit.
- Name the three ways the exam can stop.
Daily lesson
- The NCLEX-RN is a computerized adaptive test. After each item the computer updates its estimate of your ability and chooses the next item near that estimate.
- You will see 85 to 150 items in a maximum of 5 hours. About 15 of those items are pretest items that do not count; you will not know which ones they are.
- The exam can stop when the computer is 95% sure you are above or below the passing standard, when you reach 150 items, or when time runs out.
- A short exam is not a score. Stopping at 85 only means the estimate became stable — it can be a pass or a fail.
- You see one item at a time. After you select NEXT you cannot go back. Optional breaks around 2 hours and 3.5 hours count against the 5-hour clock.
- These rules come from the current NCSBN test plan and candidate bulletin. Practice items in this app are app-generated, not official exam items.
Reflect and review
Do not pace yourself by item number. Pace yourself by thinking once, then moving.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: How to prepare for NCLEX
Day 2
Day 2 • FoundationNGN and the six judgment steps
How Next Generation items score clinical judgment, not trivia.
Learning objectives
- Map a stem to the matching NCJMM step.
- Tell a case study apart from a bow-tie or a trend item.
- Use partial-credit formats without over-clicking.
Daily lesson
- Next Generation NCLEX items are built around the NCSBN Clinical Judgment Measurement Model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes.
- Unfolding case studies walk one client across six items. Stand-alone items such as bow-tie, matrix, highlight, and trend tables can appear anywhere in the exam.
- Many NGN formats use plus/minus scoring. Extra wrong clicks can lower the item score. Highlight only the words that change the plan — not every abnormal number.
- A case study is a handoff, not a reading-comprehension contest. Read the chart the way you would read a night-shift report: vitals, trends, what just changed.
- Name the judgment step before you touch an option. “What is the nurse recognizing?” is a different job from “What should the nurse do now?”
Reflect and review
Say the NCJMM step out loud before you click. It keeps you from treating every item like a first-action item.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: How to prepare for NCLEX
Day 3
Day 3 • FoundationWho is first: priority frameworks
ABC, safety, acute versus chronic, and when to act instead of assess.
Learning objectives
- Apply airway and circulation before teaching or comfort.
- Sort four clients into unstable versus expected.
- Decide when the first action is an intervention, not another assessment.
Daily lesson
- When the stem says first, priority, or most concerning, circle that word. The test is asking for a sort, not a complete care plan.
- Airway obstruction, new hemorrhage, and a sudden change in level of consciousness beat chronic pain, teaching, and discharge paperwork.
- A new unexpected finding beats a chronic expected finding. Day-of-surgery bright-red saturation beats the client with long-standing osteoarthritis who rates pain 6.
- If the stem already gives you a crashing cue — no pulse, not breathing, blood soaking the sheets — do not pick “assess further.” Act.
- If the data are incomplete and the client is still stable, assess first. Guessing a drug or a procedure without a current set of vitals is how new graduates miss easy items.
Reflect and review
Read the four names. Ask: who loses an airway or a circulation in the next five minutes?
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Write down any medication or lab value that changed your decision and review it tomorrow.
Related: How to prepare for NCLEX
Day 4
Day 4 • Safe CareDelegation and who may do the work
Five rights, RN-only work, and what a float nurse can safely take.
Learning objectives
- List the five rights of delegation.
- Name tasks that cannot leave the RN.
- Match stable work to LPN/VN and UAP.
Daily lesson
- The five rights are task, circumstance, person, direction, and supervision. Missing any one of them is not delegation — it is abandonment of judgment.
- The RN keeps initial assessment, initial teaching, evaluation of teaching, and unstable clients. Those four do not go to UAP, and they do not go to an LPN/VN as the sole responsible nurse.
- UAP can take vital signs on stable clients, feed a client who is not at high aspiration risk, bathe, ambulate if the client already walks safely, and collect intake and output.
- LPN/VN can reinforce teaching, give most oral and some injectable medications per facility policy, and monitor stable clients with predictable outcomes.
- A float nurse gets familiar, stable work — not the fresh ICU transfer and not the first-hour PACU client. Competency, not goodwill, decides the assignment.
Reflect and review
If the task requires you to interpret a new finding, it is not a UAP task.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.
Related: How to prepare for NCLEX
Day 5
Day 5 • Safe CareConsent, privacy, and the law you will be tested on
Who discloses, what you witness, when you break confidentiality, and how a DNR still gets nursing care.
Learning objectives
- Describe the nurse’s role in informed consent.
- Name when confidentiality must be broken.
- Honor a DNR without withholding comfort.
Daily lesson
- The provider who performs the procedure discloses risks, benefits, and alternatives. You witness the signature and you stop the process if the client cannot teach back what is about to happen.
- A client who is confused, sedated, or only nodding is not giving informed consent. Call the provider. Do not “just get the form signed so we can go.”
- Protect PHI: lock the screen, no hallway details, no photos. You break confidentiality for suspected abuse, reportable disease, and a specific threat of harm.
- A valid DNR does not mean “do not nurse.” You still turn, medicate for pain, suction if that is comfort, and stay with the family.
- Against-medical-advice leaving by a competent adult is not false imprisonment if you have taught the risks and documented the refusal.
Reflect and review
If the client cannot explain the procedure in their own words, the consent is not done.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: For communication questions, eliminate answers that give false reassurance.
Related: How to prepare for NCLEX
Day 6
Day 6 • Safe CareHandoff that the next nurse can use
SBAR, transfer packets, and the referral that actually prevents a bounce-back.
Learning objectives
- Build an SBAR that names the current problem.
- List what must travel with a transfer.
- Choose the right referral for housing, language, or home oxygen.
Daily lesson
- SBAR is situation, background, assessment, recommendation. Lead with the current problem, not the entire hospital course.
- A usable handoff always includes code status, allergies, the one priority for the next shift, and results that are still pending.
- If the oncoming nurse would be surprised by a drain, a new anticoagulant, or a family conflict, the handoff failed — even if every box on the form is checked.
- Transfers fail on missing facesheets, missing last med times, and missing isolation status. Those three create harm faster than a missing care-plan narrative.
- Social work, interpreter services, and home-health are not “nice extras.” A client who cannot afford the inhaler will be back on your floor.
Reflect and review
If the next nurse would be surprised, the handoff failed.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.
Related: Prioritization strategy
Day 7
Day 7 • Safe CareIncidents, advocacy, and what never goes on social media
Factual incident reports, language access, and information security.
Learning objectives
- Write an incident note that is only facts.
- Protect screens, paper, and photos.
- Get a professional interpreter for consent.
Daily lesson
- Incident reports exist for quality improvement. Write what you saw, what you did, and who you notified. Do not write “nurse was careless.”
- The incident report is not a punishment form and it is not copied into the client’s chart as a confession. Chart the clinical facts in the record; send the report through the facility path.
- Unattended screens, hallway conversations, and a phone photo of a wound are HIPAA problems waiting for a screenshot.
- Family members who “speak a little English” are not interpreters for consent. Use the professional line.
- Advocacy on this exam looks like calling the provider when the client is still in pain, not posting a rant about staffing.
Reflect and review
If a neighbor could recognize the client from the photo, do not take the photo.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Review any question you answered correctly for the wrong reason.
Related: Prioritization strategy
Day 8
Day 8 • CheckpointWeek 1 mixed check: who is unstable
Spaced review of priority, first actions, and assignment — matching the items you will see today.
Learning objectives
- Pick the client who is changing now.
- Name one first action in an emergency stem.
- Keep RN-only work off the UAP list.
Daily lesson
- Today’s block recycles the highest-yield safe-care judgments: new bleed versus chronic pain, a med that should be held, anaphylaxis, early sepsis, and a STEMI cluster.
- That is intentional. Mixed days are not new content. They are the same four questions the exam will keep asking in new clothes.
- Fresh postoperative bleeding, a new pressor requirement, and a first-hour chest-pain change outrank teaching and comfort.
- Anaphylaxis: airway and epinephrine first, then the rest of the cascade. Do not start with an H2 blocker.
- If a stem mixes two systems, treat the one that kills in minutes.
Reflect and review
New rhythm, new bleed, new airway. Those three beat everything else in this block.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Connect today’s topic to one Client Needs category and practice two related items.
Related: Prioritization strategy
Day 9
Day 9 • SafetyPPE you can put on in the doorway
Donning, doffing, and the soap-and-water exceptions.
Learning objectives
- State the donning order.
- State what comes off first.
- Choose soap and water versus alcohol gel.
Daily lesson
- Don in this order: gown, mask or respirator, goggles or face shield, gloves. You are covering your clothes before your airway before your eyes before your hands.
- Doff in this order: gloves, goggles, gown, mask. Gloves are the dirtiest surface. The mask comes off last, after you have left the room if it is a respirator.
- Alcohol gel is fine for most standard-precaution exits. It is not enough for C. difficile or when hands are visibly soiled — use soap and water.
- Standard precautions assume every body fluid can infect you. That is gloves for blood, a mask for splashes, and a gown when your uniform will get wet.
- If you contaminate a glove while doffing, stop, wash, and replace. Pride is not a barrier.
Reflect and review
Say the four-word donning list before you touch the dispenser.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: End the session by listing one thing you will watch for more carefully next time.
Related: Prioritization strategy
Day 10
Day 10 • SafetyIsolation that matches the organism
Contact, droplet, and airborne — and the one mask that is not optional.
Learning objectives
- Pair a common organism with its isolation category.
- Choose N95 plus negative pressure when it is required.
- Teach a visitor what they may not do.
Daily lesson
- Contact: C. difficile, MRSA, VRE, scabies. Gown and gloves. Soap and water for C. diff.
- Droplet: influenza, pertussis, meningococcal disease. Surgical mask within about three feet. The client wears a mask for transport.
- Airborne: pulmonary tuberculosis, measles, varicella. N95 or equivalent and a negative-pressure room. A surgical mask is the wrong answer.
- A client can require more than one category. Disseminated zoster is airborne plus contact.
- Visitors still follow the sign on the door. Family preference does not cancel an N95.
Reflect and review
N95 versus surgical mask is the detail that decides many safety items.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Prioritization strategy
Day 11
Day 11 • SafetyFalls, restraints, fire, and a hallway full of victims
Least-restrictive first, RACE then PASS, and mass-casualty triage colors.
Learning objectives
- Name a less-restrictive option before a restraint.
- Apply RACE then PASS.
- Sort expectant versus immediate in a disaster stem.
Daily lesson
- Restraints are last. Try a sitter, toileting, bed alarm, and treating the cause of agitation before you tie anyone down.
- If a restraint is used you need an order, circulation checks, toileting, nutrition, and documentation of why it is still required.
- Fire: RACE — rescue, alarm, contain, extinguish. PASS — pull, aim, squeeze, sweep. Know where the extinguisher is before the alarm.
- In mass casualty, expectant (black) is not “ignore the person.” It is the honest sort when resources cannot save them and someone else can still be saved.
- A fall-risk client who is climbing is a toileting and delirium problem first, a vest-restraint problem last.
Reflect and review
Treat the reason they are climbing before you reach for straps.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Prioritization strategy
Day 12
Day 12 • SafetySterile fields, sharps, and the spill you cannot mop casually
What breaks sterility, how needles move, and chemo or radiation caution.
Learning objectives
- Identify when a sterile field is ruined.
- Refuse two-handed recapping.
- Choose the spill kit instead of a towel.
Daily lesson
- Below the waist, wet, turned back to the field, or a 1-inch edge: treat it as contaminated. Do not “save the tray.”
- Never recap a used needle with two hands. Scoop if policy still allows recapping at all; the safer habit is a sharps box in reach before you stick.
- Chemotherapy spills need the spill kit, not a housekeeper’s regular mop. Protect yourself first.
- Radiation implants: time, distance, shielding. Cluster care. A pregnant nurse does not take that assignment.
- If you stick yourself, wash, report, and follow occupational health. Do not squeeze the site as folk wisdom.
Reflect and review
If the tray is wet, it is not sterile. Start over.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Prioritization strategy
Day 13
Day 13 • SafetyHome hazards and the allergy that was already on the chart
Oxygen plus flames, rugs, unlocked meds, and the band that must match the tray.
Learning objectives
- Name three home-safety finds that require teaching now.
- Match an allergy band to a meal or a med.
- Stop a known allergen before it reaches the client.
Daily lesson
- Home oxygen and cigarettes, candles, or a gas stove are a fire item. The teaching is not subtle.
- Throw rugs, missing smoke detectors, and unlocked bottles of pills drop older adults and toddlers in the same week.
- Allergy: band on, tray checked, pharmacy flagged. “They usually tolerate it” is not an order.
- Latex and iodine allergies change which gloves and which prep you reach for before the procedure starts.
- If the kitchen at home still has the warfarin next to the vitamins in an unmarked cup, the discharge was not done.
Reflect and review
The allergy band is part of the first look, not an afterthought when the tray is already open.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Prioritization strategy
Day 14
Day 14 • CheckpointWeek 2 mixed check: isolation pairs
Closed-book pairing of organism, room, and mask.
Learning objectives
- Name the category for TB, C. diff, influenza, measles, and varicella.
- Choose soap and water when gel is wrong.
- Correct a visitor in a surgical mask at an airborne door.
Daily lesson
- Today’s items are isolation pairs. Say the organism, then the room, then the mask, then the hand hygiene.
- Pulmonary TB and measles are airborne. Influenza is droplet. C. diff is contact plus soap and water.
- Varicella and disseminated zoster need more than a surgical mask.
- If two answers both look clean, the deciding detail is usually N95 versus surgical mask or gel versus soap.
- Do not invent a new category. Use the three the test plan expects.
Reflect and review
Organism first, then room, then mask. In that order.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Prioritization strategy
Day 15
Day 15 • Health PromotionGrowth, milestones, and the toy that chokes
Fontanels, stranger anxiety, play, and injury prevention by age.
Learning objectives
- Place a common milestone in the correct age window.
- Choose a toy that is safe for a toddler.
- Teach one injury-prevention point per age group.
Daily lesson
- The anterior fontanel usually closes between 12 and 18 months. A sunken fontanel is volume. A bulging fontanel in a quiet infant is not “a cute head shape.”
- Stranger anxiety commonly arrives around 6 to 8 months. Separation protest in a toddler is expected; a 9-month-old who cannot sit even with support is not something you reassure away.
- Toddlers play beside each other, put objects in their mouths, and drown in two inches of water. Preschoolers begin associative play. Adolescents need privacy and still need a parent in the building for safety.
- A milestone that is late by a wide margin is a referral, not a “wait and see” smile.
- Safe toddler toys have no button batteries, no small detachable eyes, and no cords.
Reflect and review
Age and milestone mismatch is a referral, not reassurance.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 16
Day 16 • Health PromotionPrenatal teaching that belongs on a poster
Weight, vaccines, warning signs, and what not to tell a pregnant client to “tough out.”
Learning objectives
- Name a prenatal warning sign that needs same-day care.
- Choose a vaccine that is expected in pregnancy.
- Teach a food or activity limit that actually matters.
Daily lesson
- Warning signs that leave the clinic today: vaginal bleeding, leaked fluid, severe headache with vision change, decreased fetal movement after the client knows movement, and a seizure.
- Inactivated influenza and Tdap in the third trimester are expected teaching. Live vaccines are not a prenatal gift.
- Listeria teaching is deli meat, unpasteurized cheese, and leftovers that sat out. It is not a lecture about every restaurant.
- Supine hypotension late in pregnancy is why you tilt the hip. The client is not being dramatic.
- If the partner is answering every question, get a moment alone. Intimate-partner violence screening is part of health promotion.
Reflect and review
Bleeding, fluid, a white-hot headache, or a quiet fetus does not wait for the next prenatal visit.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 17
Day 17 • Health PromotionNewborn and postpartum first looks
APGAR is not the whole shift. What you watch in the first hours for parent and infant.
Learning objectives
- Identify an expected versus concerning newborn finding.
- Teach one feeding safety point.
- Name a postpartum hemorrhage cue.
Daily lesson
- Expected: acrocyanosis, irregular breathing with pauses under 15 seconds, and a soft fontanel. Not expected: grunting, nasal flaring, a silent chest, or a floppy unexplained baby.
- Vitamin K, erythromycin, and hepatitis B are standard. Refusal gets documented teaching, not a fight in the hallway.
- Feed early, watch wet diapers, and do not microwave breast milk in a way that creates hot spots.
- Postpartum: a pad soaked in an hour, a boggy fundus, and a rising heart rate are volume until proven otherwise. A smiling parent can still be bleeding.
- Safe sleep is alone, on the back, in a crib. Not on a sofa with a grandparent who “always did it this way.”
Reflect and review
A soaked pad and a rising pulse beat a tidy fundal note.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 18
Day 18 • Health PromotionScreening, vaccines, and the visit that is not optional
Age-based screens and immunization teaching without scolding.
Learning objectives
- Match a common screen to an age or risk group.
- Correct a vaccine myth with one accurate sentence.
- Know when a screen is overdue, not optional.
Daily lesson
- Colon, cervical, breast, and lung-cancer screens have ages and intervals. The item will give you the age. Use it.
- A missed childhood vaccine is a catch-up schedule, not a reason to send the family out in shame.
- Live vaccines and pregnancy, severe immunosuppression, or a household member who is profoundly immunocompromised change the plan. Ask before you draw up.
- Depression and intimate-partner screens belong in well visits. A laugh does not cancel a PHQ score.
- If the client cannot afford the follow-up mammogram, the screening program failed. That is a referral, not a lecture.
Reflect and review
The age in the stem is a gift. Use it before you reach for a rare disease.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 19
Day 19 • Health PromotionLifestyle teaching that a night-shift client can keep
Diet, activity, sleep, and substances without a sermon.
Learning objectives
- Choose one change the client can do this week.
- Avoid all-or-nothing teaching.
- Link a habit to a specific risk the stem already named.
Daily lesson
- Teaching that requires a perfect kitchen and a gym membership fails at 0700 after a 12-hour shift. Offer the next smaller step.
- Sodium, walking, and sleep beat a 14-page diet packet the client will not open.
- If the stem already named heart failure, the teaching is daily weights and salt — not a generic “eat healthy.”
- Alcohol, nicotine, and unused opioids in the medicine cabinet are safety items as much as lifestyle items.
- Ask what they already tried. Repeating a pamphlet they ignored last admission is not education.
Reflect and review
Tie the habit to the diagnosis in the stem. Generic wellness talk is usually the distractor.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 20
Day 20 • CheckpointWeek 3 mixed check: first actions
Spaced review of priority, holds, anaphylaxis, sepsis, and ACS — not a new prenatal lecture.
Learning objectives
- Identify the unstable client in a four-name stem.
- Hold a med that the numbers say to hold.
- Start epinephrine when the airway is closing.
Daily lesson
- The item set on this day is a first-action drill, not a growth-and-development quiz. Treat it that way.
- You will see new postoperative bleeding versus chronic pain, a hold parameter, anaphylaxis, a sepsis bundle cue, and a STEMI cluster.
- That mix is how CAT feels after a health-promotion week: the exam will not stay in one Client Needs bucket.
- Anaphylaxis is epinephrine. Sepsis with hypotension is fluids and source control thinking, not a warm blanket as the first action.
- STEMI language is crushing pain, diaphoresis, and an ECG that cannot wait for breakfast.
Reflect and review
Do not look for a prenatal answer on a bleed-versus-pain item. Read the stem that is actually on the screen.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 21
Day 21 • PsychosocialTherapeutic communication that is not a slogan
Open questions, no false comfort, and when silence is the intervention.
Learning objectives
- Replace a cliché with an open prompt.
- Avoid “why” that sounds like blame.
- Stay with a client who is crying instead of changing the subject.
Daily lesson
- “Everything happens for a reason” is not therapeutic. “This sounds like a lot. I can sit here.” is.
- Ask what the feeling is. Do not ask why they feel it until they have named it.
- Advice, personal stories, and “at least” statements shut people down. Reflection and observation open the next sentence.
- If the client is silent after bad news, sit. Filling the air with tasks is how nurses hide.
- A client who jokes through a new cancer diagnosis is using a defense. You can name the joke without ripping it away on hour one.
Reflect and review
If the sentence could go on a greeting card, it is probably the wrong option.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 22
Day 22 • PsychosocialAnxiety, depression, and the sudden burst of energy
What you watch for besides mood: sleep, appetite, and a plan.
Learning objectives
- Recognize a vegetative cluster.
- Treat a sudden lift on an SSRI as a risk cue.
- Ask directly about suicide.
Daily lesson
- Depression on this exam is sleep change, appetite change, anhedonia, and hopelessness — not only tears.
- A newly energetic client 7 to 14 days after starting an SSRI may finally have the energy to act on a plan. That is a safety item, not a success story.
- Ask about suicide directly. You do not plant the idea. You find the plan, the means, and whether they can contract for safety.
- Panic is staying with the client, short sentences, and reducing stimulation. Teaching about coping skills comes after the attack, not during it.
- Hidden pills and a named plan beat a vague “I wish I could sleep.” One-to-one is not optional when the means are in the room.
Reflect and review
Ask the question. “Have you thought about killing yourself?” is a nursing assessment.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then write one sentence naming the most important cue you used. Review it tomorrow before starting the next day.
Related: Pharmacology review
Day 23
Day 23 • PsychosocialPsychosis, mania, and a unit that has to stay intact
Reality, stimulation, and food that a manic client will actually eat.
Learning objectives
- Respond to a hallucination without arguing with the voice.
- Lower stimulation in mania.
- Offer high-calorie portable food.
Daily lesson
- You do not argue with a delusion. You acknowledge the fear and you present reality once: “I do not hear the voice, and you are safe here.”
- Command hallucinations that say to harm someone move the client to a higher observation level now.
- Mania: private room if you can, fewer visitors, no competitive games, finger foods because they will not sit for a tray.
- Sleep is treatment. A manic client who has not slept is a medical risk, not a colorful personality.
- If two clients are escalating each other, separate them. The milieu is an intervention.
Reflect and review
Do not debate the delusion. Protect the room and offer reality once.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Write down any medication or lab value that changed your decision and review it tomorrow.
Related: Pharmacology review
Day 24
Day 24 • PsychosocialAbuse, neglect, and the story that does not match the injury
Mandatory reporting, interviewing alone, and injuries that do not fit.
Learning objectives
- Name when you must report.
- Get the client alone.
- Document exact quotes and the appearance of the injury.
Daily lesson
- Nurses report suspected child, elder, and vulnerable-adult abuse. You do not need courtroom proof.
- Interview without the partner in the room. A partner who answers every question is data.
- Spiral fractures in a non-walking child, bruises in several stages, and a delay in seeking care are pattern cues.
- Chart what you see and what they said. Do not chart “abusive husband.” Chart the bruise, the time, and the quote.
- Intimate-partner violence in pregnancy is common and under-asked. A broken appointment pattern is not flakiness.
Reflect and review
Suspicion plus a pattern is enough to report. You are not the court.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.
Related: Pharmacology review
Day 25
Day 25 • PsychosocialGrief, crisis, and the family in the hallway
Expected grief versus a crisis that needs a safety plan tonight.
Learning objectives
- Name an expected grief behavior.
- Spot a crisis that needs more than a pamphlet.
- Include the family without letting them run the room.
Daily lesson
- Grief can look like anger, bargaining, or a clean house. It does not have to look like tears on your timetable.
- A crisis is when their usual coping is gone and safety is in doubt. That is stay-with-them care plus a concrete plan, not “call if you need anything.”
- Do not rush a viewing. Do not hide the body from a family that wants to see.
- Cultural and spiritual practice belongs in the plan if the family names it. Do not invent a ritual for them.
- A family shouting in the hallway is often fear. Move them to a room, one spokesperson, and a time you will be back.
Reflect and review
Stay. A pamphlet is not a presence.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: For communication questions, eliminate answers that give false reassurance.
Related: International nurse guide
Day 26
Day 26 • CheckpointWeek 4 mixed check: safety inside psych stems
Today’s items mix priority and first action — use psych knowledge only when the stem is actually psych.
Learning objectives
- Read the task word before you pick a feeling-focused option.
- Choose safety when a plan and means are present.
- Do not force a therapeutic-communication answer onto a bleed stem.
Daily lesson
- Today’s sitting mixes psychosocial safety with first-action stems. Read the screen in front of you. If the stem is chest pain, do not pick “sit and explore feelings.”
- When the stem is psychiatric, safety still leads: a plan, a method, command hallucinations, and a client who just regained energy on an SSRI.
- A mixed week trains you to switch frameworks. The adaptive exam will do the same thing around item 40.
- Match the framework to the stem, not to yesterday’s lesson title.
Reflect and review
Match the framework to the stem, not to the day title on the syllabus card.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.
Related: International nurse guide
Day 27
Day 27 • ComfortHygiene, skin, and the turn that was skipped
Pressure injury prevention and the bath that is also an assessment.
Learning objectives
- Stage a pressure injury from a description.
- Name a prevention bundle.
- Use the bath to look at skin you do not see at the desk.
Daily lesson
- A stage 1 injury does not blanch. Stage 2 is partial thickness. Staging an unstageable wound through slough is guessing.
- Turn, float heels, keep the skin dry, and feed the client. A fancy mattress does not cancel a missed turn.
- The bath is when you find the reddened coccyx, the old dressing, and the bruise nobody charted.
- Do not massage a reddened bony area. You are not rubbing circulation into dying tissue.
- Incontinence care is skin care. A wet brief left “until after lunch” is how stage 2 starts.
Reflect and review
If you have not seen the sacrum this shift, you have not finished the assessment.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Review any question you answered correctly for the wrong reason.
Related: International nurse guide
Day 28
Day 28 • ComfortFood, tubes, and TPN that cannot wait on a guess
Aspiration, tube placement, and what happens when TPN stops cold.
Learning objectives
- Place aspiration precautions in the right client.
- State how placement is confirmed before the first feed.
- Anticipate hypoglycemia when TPN interrupts.
Daily lesson
- Sit the client up. Stroke, decreased LOC, and a wet voice after sips are aspiration items.
- A new feeding tube is not used for formula until placement is confirmed the way the facility requires — usually an x-ray for a small-bore tube, not an air whoosh alone.
- TPN goes through a central line. It is not a peripheral “until we get a PICC” cocktail.
- If TPN stops suddenly, expect a glucose drop. Hang the dextrose the protocol names while pharmacy catches up.
- Never speed TPN to “catch up” the bag. The pancreas is not a pump you can bully.
Reflect and review
Whoosh is not a placement confirmation on a new small-bore tube.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Connect today’s topic to one Client Needs category and practice two related items.
Related: International nurse guide
Day 29
Day 29 • ComfortBowel, bladder, and the output that is a vital sign
Constipation after opioids, retention after catheters, and when anuria is an emergency.
Learning objectives
- Prevent opioid constipation before day 3.
- Recognize retention versus oliguria.
- Treat output like data, not housekeeping.
Daily lesson
- Opioids plus iron plus not walking is a bowel obstruction in slow motion. Start the bowel regimen when you start the opioid.
- A bladder that holds 600 mL after a “successful” void is retention. Scan, then catheterize if that is the order — do not keep encouraging tea.
- New anuria after a contrast study or a shock night is perfusion and kidney until proven otherwise.
- Black tarry stool and coffee-ground emesis are bleed items, not GI-comfort items.
- Document the last bowel movement as if it were a lab. Families remember. Computers forget.
Reflect and review
Last bowel movement is part of the morning vital signs on an opioid client.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: End the session by listing one thing you will watch for more carefully next time.
Related: International nurse guide
Day 30
Day 30 • ComfortPain, hearing, and care after death
Believe the number, face the client who cannot hear you, and give the family the room.
Learning objectives
- Reassess after an opioid.
- Stand where a hard-of-hearing client can see your mouth.
- Allow time with the body.
Daily lesson
- Pain is what the client says it is. A stoic 2 after a thoracotomy is not a contest you are winning.
- Reassessment is part of the pain item. If you gave morphine, you come back. That return visit is the evaluation step.
- Face the client, drop the mask if you can do it safely, and do not shout from the doorway at a person who reads lips.
- Fear of addiction is not a reason to withhold comfort at the end of life.
- After death: clean, position, allow family time, follow organ-donation policy. Do not rush the room for the next admission until you must.
Reflect and review
Reassessment is part of the pain item. If it is missing, the item is incomplete.
Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.
Today’s practice focus: Complete the linked questions, then name the single most important cue in one sentence.
Related: International nurse guide