+RED NURSESNCLEX Learning Studio

Complete 60-Day NCLEX-RN Study Plan

Educational material by Red Nurses. These guides are independent study resources for NCLEX-RN practice. They are not written or reviewed by a named licensed clinician for this site, and they are not an official NCSBN product. Always verify clinical and eligibility details with authoritative sources. About this site · Editorial standards

This single page contains the full 60-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 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day 19 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day 33 Day 34 Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 49 Day 50 Day 51 Day 52 Day 53 Day 54 Day 55 Day 56 Day 57 Day 58 Day 59 Day 60 Day 61 Day 62 Day 63 Day 64 Day 65 Day 66 Day 67 Day 68 Day 69 Day 70 Day 71 Day 72 Day 73 Day 74 Day 75 Day 76 Day 77 Day 78 Day 79 Day 80 Day 81 Day 82 Day 83 Day 84 Day 85 Day 86 Day 87 Day 88 Day 89 Day 90

Day 1

Day 1 • Foundation

How the NCLEX actually works

CAT, item count, time, and what a short exam does — and does not — mean.

Learning objectives

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.

Practise questionsAll study days

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 • Foundation

NGN and the six judgment steps

How Next Generation items score clinical judgment, not trivia.

Learning objectives

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.

Practise questionsAll study days

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 • Foundation

Who is first: priority frameworks

ABC, safety, acute versus chronic, and when to act instead of assess.

Learning objectives

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.

Practise questionsAll study days

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 Care

Delegation and who may do the work

Five rights, RN-only work, and what a float nurse can safely take.

Learning objectives

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.

Practise questionsAll study days

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 Care

Consent, 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

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.

Practise questionsAll study days

Today’s practice focus: For communication questions, eliminate answers that give false reassurance.

Related: How to prepare for NCLEX

Day 6

Day 6 • Safe Care

Handoff that the next nurse can use

SBAR, transfer packets, and the referral that actually prevents a bounce-back.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.

Related: Prioritization strategy

Day 7

Day 7 • Safe Care

Incidents, advocacy, and what never goes on social media

Factual incident reports, language access, and information security.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: Review any question you answered correctly for the wrong reason.

Related: Prioritization strategy

Day 8

Day 8 • Checkpoint

Week 1 mixed check: who is unstable

Spaced review of priority, first actions, and assignment — matching the items you will see today.

Learning objectives

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.

Practise questionsAll study days

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 • Safety

PPE you can put on in the doorway

Donning, doffing, and the soap-and-water exceptions.

Learning objectives

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.

Practise questionsAll study days

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 • Safety

Isolation that matches the organism

Contact, droplet, and airborne — and the one mask that is not optional.

Learning objectives

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.

Practise questionsAll study days

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 • Safety

Falls, restraints, fire, and a hallway full of victims

Least-restrictive first, RACE then PASS, and mass-casualty triage colors.

Learning objectives

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.

Practise questionsAll study days

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 • Safety

Sterile fields, sharps, and the spill you cannot mop casually

What breaks sterility, how needles move, and chemo or radiation caution.

Learning objectives

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.

Practise questionsAll study days

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 • Safety

Home 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

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.

Practise questionsAll study days

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 • Checkpoint

Week 2 mixed check: isolation pairs

Closed-book pairing of organism, room, and mask.

Learning objectives

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.

Practise questionsAll study days

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 Promotion

Growth, milestones, and the toy that chokes

Fontanels, stranger anxiety, play, and injury prevention by age.

Learning objectives

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.

Practise questionsAll study days

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 Promotion

Prenatal teaching that belongs on a poster

Weight, vaccines, warning signs, and what not to tell a pregnant client to “tough out.”

Learning objectives

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.

Practise questionsAll study days

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 Promotion

Newborn and postpartum first looks

APGAR is not the whole shift. What you watch in the first hours for parent and infant.

Learning objectives

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.

Practise questionsAll study days

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 Promotion

Screening, vaccines, and the visit that is not optional

Age-based screens and immunization teaching without scolding.

Learning objectives

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.

Practise questionsAll study days

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 Promotion

Lifestyle teaching that a night-shift client can keep

Diet, activity, sleep, and substances without a sermon.

Learning objectives

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.

Practise questionsAll study days

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 • Checkpoint

Week 3 mixed check: first actions

Spaced review of priority, holds, anaphylaxis, sepsis, and ACS — not a new prenatal lecture.

Learning objectives

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.

Practise questionsAll study days

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 • Psychosocial

Therapeutic communication that is not a slogan

Open questions, no false comfort, and when silence is the intervention.

Learning objectives

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.

Practise questionsAll study days

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 • Psychosocial

Anxiety, depression, and the sudden burst of energy

What you watch for besides mood: sleep, appetite, and a plan.

Learning objectives

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.

Practise questionsAll study days

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 • Psychosocial

Psychosis, mania, and a unit that has to stay intact

Reality, stimulation, and food that a manic client will actually eat.

Learning objectives

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.

Practise questionsAll study days

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 • Psychosocial

Abuse, neglect, and the story that does not match the injury

Mandatory reporting, interviewing alone, and injuries that do not fit.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.

Related: Pharmacology review

Day 25

Day 25 • Psychosocial

Grief, crisis, and the family in the hallway

Expected grief versus a crisis that needs a safety plan tonight.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: For communication questions, eliminate answers that give false reassurance.

Related: International nurse guide

Day 26

Day 26 • Checkpoint

Week 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

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.

Practise questionsAll study days

Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.

Related: International nurse guide

Day 27

Day 27 • Comfort

Hygiene, skin, and the turn that was skipped

Pressure injury prevention and the bath that is also an assessment.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: Review any question you answered correctly for the wrong reason.

Related: International nurse guide

Day 28

Day 28 • Comfort

Food, tubes, and TPN that cannot wait on a guess

Aspiration, tube placement, and what happens when TPN stops cold.

Learning objectives

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.

Practise questionsAll study days

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 • Comfort

Bowel, bladder, and the output that is a vital sign

Constipation after opioids, retention after catheters, and when anuria is an emergency.

Learning objectives

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.

Practise questionsAll study days

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 • Comfort

Pain, hearing, and care after death

Believe the number, face the client who cannot hear you, and give the family the room.

Learning objectives

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.

Practise questionsAll study days

Today’s practice focus: Complete the linked questions, then name the single most important cue in one sentence.

Related: International nurse guide

Day 31

Day 31 • Comfort

Sleep and the 0200 noise we pretend is normal

Cluster care, caffeine, and delirium that starts as “a bad night.”

Learning objectives

Daily lesson

  • Hospitals steal sleep with alarms, 0200 labs, and hallway laughs. Cluster what you can. The BMP can sometimes wait until 0500 if the client is stable.
  • New night confusion in an older adult is delirium until you look for infection, hypoxia, urine retention, and a new drug.
  • Sleeping pills are not the first answer when the room is loud and the catheter bag is tugging.
  • Caffeine at 1600 and a phone blazing at 2300 are still teaching points on the night before discharge.
  • A client who has not slept in three manic or pain-filled nights is a safety risk on the walk to the bathroom.

Reflect and review

Fix the room before you ask for a sedative.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: After each item, explain why one alternative would have been less safe.

Related: International nurse guide

Day 32

Day 32 • Pharm

Rights, math, and the dose that looks 10 times too big

The six rights, high-alert double checks, and when you do not give the dose you calculated.

Learning objectives

Daily lesson

  • Rights include client, drug, dose, route, time, and documentation. The seventh unofficial right is reason — if the dose makes no sense, you stop.
  • If your math produces a dose 10 times the usual range, you do not give it while you “think about it on the way to the room.” You recalculate and you call.
  • Potassium chloride does not get IV-pushed. Extended-release tablets and most capsules labeled XR or EC do not get crushed.
  • Insulin, heparin, chemotherapy, and PCA opioids are high-alert. Independent double-checks exist because nice people still kill with a decimal point.
  • A trailing zero (1.0 mg) and a naked decimal (.5 mg) are how 5 mg happens. Write it the way your facility banned those habits.

Reflect and review

A weird number is a stop, not a hurry-up.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.

Related: International nurse guide

Day 33

Day 33 • Pharm

IV fluids that help — and fluids that drown

Isotonic rescue versus fluid you stop when the lungs fill.

Learning objectives

Daily lesson

  • Normal saline and lactated Ringer’s replace volume. They are not harmless water. Lungs keep the score.
  • New crackles, jugular venous distention, and a climbing respiratory rate during a bolus mean stop the fluid and sit the client up. Then call.
  • Infiltration: stop the infusion, take the device out per policy, elevate, and do not keep “trying that site.”
  • Vesicants need a working line you trust. Pain at the site is data, not weakness.
  • Hypotonic fluid into a client with a low sodium and a fresh head injury is how you make brain swelling worse.

Reflect and review

Crackles during a bolus are a stop, not a charting note for later.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Write down any medication or lab value that changed your decision and review it tomorrow.

Related: International nurse guide

Day 34

Day 34 • Pharm

Antibiotics and the bag you stop mid-drip

Allergies, peak and trough thinking, and C. diff after the third antibiotic.

Learning objectives

Daily lesson

  • A new rash, wheeze, or sudden drop in blood pressure on an antibiotic is stop the bag, then the rest of the emergency steps.
  • Vancomycin and aminoglycoside troughs exist because the kidneys and the ears keep receipts.
  • Culture first when the stem lets you. Do not wait on a crashing septic client to start the first dose the protocol already ordered.
  • Three loose stools and a recent antibiotic is C. diff until the lab says otherwise. Gel is not enough on the way out of that room.
  • “I take this at home when I feel sick” is how resistance and leftover-pill harm happen. Teach the course they were actually prescribed.

Reflect and review

Wheeze on an antibiotic is a stop-the-bag item.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.

Related: International nurse guide

Day 35

Day 35 • Pharm

Insulin, when to hold it, and the snack that is part of the order

Peaks, hypoglycemia treatment, and sick-day rules that do not say “skip everything.”

Learning objectives

Daily lesson

  • Know onset and peak well enough to know when the client will shake. Rapid-acting peaks while the tray is still in the hallway if the kitchen is late.
  • A symptomatic low is glucose now — juice or dextrose per protocol — not a lecture about carbohydrate counting.
  • Hold parameters exist. A glucose of 62 and a full dose of rapid insulin is a reportable miss waiting to happen.
  • Sick-day teaching is not “skip all insulin.” Illness raises needs. They check more often and they call when they cannot keep fluids down.
  • Never mix every insulin with every other insulin. If you are unsure about mixing, you do not invent a combination at 0610.

Reflect and review

The tray in the hallway is part of the insulin order.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: For communication questions, eliminate answers that give false reassurance.

Related: International nurse guide

Day 36

Day 36 • Pharm

Anticoagulants and the lab that belongs to each drug

Warfarin and INR, heparin and aPTT, and the antidote you must not mix up.

Learning objectives

Daily lesson

  • Warfarin is followed with INR. The usual teaching range for many indications sits near 2 to 3 — use the number in the stem if it gives you one.
  • Heparin is followed with aPTT. Protamine reverses heparin. Vitamin K reverses warfarin. Do not swap them under stress.
  • A sudden headache on an anticoagulant is intracranial bleeding until the exam tells you it is not.
  • Electric razors, soft toothbrushes, and no backyard football are boring and correct.
  • Antibiotics, NSAIDs, and leafy-green swings change warfarin more than clients expect. Teach the consistency, not a vegetable ban.

Reflect and review

Name the drug, the lab, and the antidote as a single sentence.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.

Related: International nurse guide

Day 37

Day 37 • Pharm

Cardiac drugs you will hold at the doorway

Digoxin, ACE inhibitors, beta blockers, and nitroglycerin limits.

Learning objectives

Daily lesson

  • Digoxin, a pulse of 52, potassium of 3.0, and yellow halos is hold and call — not “give it so the morning med pass stays on time.”
  • ACE inhibitors: sit for the first dose, report a nagging cough, and watch potassium. Pregnancy is a stop.
  • Beta blockers: hold when the pulse or blood pressure is below the parameter. Teaching includes not stopping cold.
  • Nitroglycerin is held when the systolic pressure is already low or when a phosphodiesterase inhibitor was recently taken. Three doses and ongoing pain is not a home experiment — it is emergency care.
  • The point of these items is the hold parameter. If you cannot find a number in the stem, look again before you pick “give as scheduled.”

Reflect and review

Say the triad: drug, hold number, teaching landmine.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Review any question you answered correctly for the wrong reason.

Related: International nurse guide

Day 38

Day 38 • Pharm

Psychiatric medications that turn into emergencies

NMS, lithium and sodium, MAOI food, and serotonin excess.

Learning objectives

Daily lesson

  • Fever and lead-pipe rigidity on an antipsychotic is neuroleptic malignant syndrome. It is a stop-the-drug and emergency item, not a warm-blanket item.
  • Lithium lives next to sodium and fluid. Vomiting, diarrhea, and a low-salt crash raise levels.
  • MAOIs plus aged cheese, cured meats, or some tap beers are a hypertensive-crisis story the exam still uses because people still eat them.
  • SSRI plus St. John’s wort or another serotonergic drug is serotonin syndrome: agitation, hyperreflexia, fever, diarrhea.
  • EPS are often treated with an anticholinergic such as benztropine. Know the name your lecture used.

Reflect and review

Fever plus rigidity on an antipsychotic is not “extra-pyramidal discomfort.”

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Connect today’s topic to one Client Needs category and practice two related items.

Related: International nurse guide

Day 39

Day 39 • Pharm

Steroids, thyroid, and the taper nobody wants to hear

Infection, glucose, bones, and why abrupt stops cause crisis.

Learning objectives

Daily lesson

  • Steroids raise glucose, hide infection, thin skin, and steal bone. The client who feels wonderful on day 3 still needs the infection teaching.
  • A long course gets a taper. Adrenal glands that went to sleep do not wake on command.
  • Levothyroxine is a morning empty-stomach drug for many clients. A new tremor, heat intolerance, and a racing pulse is too much hormone.
  • Antithyroid drugs and iodine teaching belong with the hyperthyroid cluster — watch for agranulocytosis when the stem names a fever and a sore throat on those agents.
  • Take the steroid with food if that is the teaching your facility uses. A bleeding stomach is not a badge of compliance.

Reflect and review

If they have been on prednisone for weeks, “stop today” is almost never the answer.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: End the session by listing one thing you will watch for more carefully next time.

Related: International nurse guide

Day 40

Day 40 • Pharm

Opioids, PCA, and the epidural that went wrong

Respiratory rate, who may press the button, and red flags in the back.

Learning objectives

Daily lesson

  • Respiratory rate of 6 after morphine is airway, stimulation, oxygen as needed, and naloxone per protocol. Charting “seems sleepy” is not the first action.
  • Only the client presses the PCA button. A helpful spouse is how a carbon dioxide number climbs at 0300.
  • Epidural red flags: new numbness that climbs, severe back pain, headache after a wet tap, and a wet dressing that might be CSF.
  • Constipation and urinary retention are expected opioid problems you prevent, not surprises on day 4.
  • Naloxone wears off sooner than many opioids. You stay. A second drop can follow the first save.

Reflect and review

Family on the PCA button is a safety miss, not a kindness.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Complete the linked questions, then name the single most important cue in one sentence.

Related: Management of Care syllabus

Day 41

Day 41 • Risk

Labs you should be able to say in a stairwell

Electrolytes, blood counts, and the one number that makes you hold the drug.

Learning objectives

Daily lesson

  • Potassium 3.5 to 5.0 mEq/L. Sodium 135 to 145. Fasting glucose often taught near 70 to 110. You will live in these three.
  • A potassium of 2.8 with a new loop diuretic is a rhythm item. A potassium of 6.4 with peaked T waves is a crash-cart item.
  • Hemoglobin, platelets, INR, and creatinine change whether you give the next dose or send the client to a procedure.
  • Critical values are read-back phone calls. They are not left on a clipboard until after lunch.
  • Know the study ranges in this app’s Labs page. They are exam-prep ranges, not an order set for a named patient in your hospital.

Reflect and review

If the stem gave you a number, the number is doing work. Use it.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: After each item, explain why one alternative would have been less safe.

Related: Management of Care syllabus

Day 42

Day 42 • Risk

Potassium, calcium, magnesium — the muscle labs

Cardiac rhythm, tetany, and the reflex that tells you magnesium is winning.

Learning objectives

Daily lesson

  • Low potassium: weakness, U waves, digoxin toxicity risk. High potassium: peaked T waves, a wide QRS, a rising sense that this shift just changed.
  • Never IV-push potassium. Dilute, pump, monitor. The vein and the heart both complain when you rush.
  • Low calcium: tetany, Chvostek, laryngospasm risk. High calcium: stones, groans, psychiatric overtones, and too much sitting.
  • Low magnesium loves alcohol withdrawal and loop diuretics. High magnesium from treatment for preeclampsia first drops reflexes, then drops respirations.
  • Replace the cluster. Isolated calcium teaching that ignores magnesium is how the number bounces back.

Reflect and review

Reflexes disappearing during a magnesium infusion is a stop-and-call moment.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.

Related: Management of Care syllabus

Day 43

Day 43 • Risk

Sodium, water, SIADH, and diabetes insipidus

Seizures at 118, concentrated urine, and the free-water mistake.

Learning objectives

Daily lesson

  • Sodium 118 and a new seizure is safety, airway, and a slow, planned correction — not a pitcher of water at the bedside.
  • SIADH: too much ADH, concentrated urine, low sodium, fluid restriction is often in the plan.
  • Diabetes insipidus: not enough ADH effect, huge dilute urine, rising sodium, thirst. Replace what they are losing and give the hormone analog when ordered.
  • Hypernatremia with dry membranes is water deficit. You correct it in a controlled way. A sudden free-water dump can swell the brain.
  • Head-injury clients live in this lecture for a reason. Watch urine like a vital sign.

Reflect and review

A seizing client with a sodium of 118 is not a “encourage fluids” item.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Write down any medication or lab value that changed your decision and review it tomorrow.

Related: Management of Care syllabus

Day 44

Day 44 • Risk

Glucose emergencies that are not “give a sandwich later”

Hypoglycemia now, DKA after airway, HHS in the older silent client.

Learning objectives

Daily lesson

  • Sweaty, shaky, confused: glucose now. If they cannot swallow, use the route the protocol names — glucagon or IV dextrose — not a peanut-butter lecture.
  • DKA after airway is fluids, then insulin per protocol, with potassium planned because the number in the bag is not the number in the cell.
  • When glucose reaches the protocol cutoff, dextrose joins the bag so you can keep clearing ketones without crashing the sugar.
  • HHS is often an older client with a very high glucose, profound dehydration, and little ketone drama. They look “quietly late.”
  • Kussmaul breathing is the body blowing off acid. Do not tell that client to “calm down and breathe slower” as the first action.

Reflect and review

If they can drink and they are low, they drink now. Teaching waits.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.

Related: Management of Care syllabus

Day 45

Day 45 • Risk

ABGs you can sort without a mnemonic tattoo

ROME, compensation, and treating ventilation instead of the antacid.

Learning objectives

Daily lesson

  • pH tells acid or base. Then ask which partner moved the same direction as the story: CO2 for lungs, HCO3 for kidneys.
  • ROME: respiratory opposite, metabolic equal. pH 7.28 with PaCO2 62 and a normal HCO3 is respiratory acidosis.
  • pH 7.50 with HCO3 32 and a normal CO2 is metabolic alkalosis. Do not treat it with a random respiratory intervention.
  • Compensation means the other system has started to move. A normal pH with two abnormal partners is often fully compensated.
  • Respiratory acidosis in a tiring COPD or overdose client is a ventilation item. An antacid will not blow off carbon dioxide.

Reflect and review

pH 7.28 and CO2 60 is a ventilation problem until you prove it is not.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: For communication questions, eliminate answers that give false reassurance.

Related: Management of Care syllabus

Day 46

Day 46 • Risk

Pre-procedure prep that prevents a cancelled case

NPO, marks, consents, and the lab that stops the knife.

Learning objectives

Daily lesson

  • Consent, site mark, allergies, last food, last anticoagulant, and a working IV are how a 0730 case actually starts.
  • A potassium of 2.9 or an INR that is still 3.8 on a client heading for a spinal is a phone call, not a stretcher ride.
  • Dentures, jewelry, and the hearing aid policy differ by case. The hearing aid often stays until the last possible moment because teaching happens in holding.
  • If the client still cannot teach back the procedure, you do not roll. You call the provider back to the bedside.
  • A full bladder is not “the OR’s problem” when the client has been holding urine since 0400 for a pelvic case. Solve what you can on the floor.

Reflect and review

The lab that cancels the case belongs on your tongue before the transporter arrives.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.

Related: Management of Care syllabus

Day 47

Day 47 • Risk

After the procedure: PACU thinking on a regular floor

Airway, bleeding, urine, and the first walk.

Learning objectives

Daily lesson

  • The first PACU hour is airway and ventilation. A loud snore after extubation is not “cute.” Reposition, stimulate, and get help if the saturation drops.
  • Look under the client. Blood pools toward the bed, not toward the pretty dressing sticker.
  • Urine after anesthesia is a clock. Retention plus bladder pain is a scan and a plan, not more ice chips.
  • The first ambulation is a fall and an orthostatic item. Dangle first. Do not become the second person on the floor.
  • Report a new unequal grip, a spinal headache that is classic, or a dressing that was dry and is now saturated.

Reflect and review

Look behind and under the client before you trust a dry front dressing.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Review any question you answered correctly for the wrong reason.

Related: Management of Care syllabus

Day 48

Day 48 • Risk

Imaging, contrast, and the metformin conversation

Allergies, kidneys, pregnancy questions, and after-care.

Learning objectives

Daily lesson

  • Contrast stories fail on “are you allergic to iodine or shellfish” as a sloppy shortcut. Ask about prior contrast reactions and current kidney function.
  • Metformin and certain contrast studies are a protocol pair because of lactic-acidosis risk in injured kidneys. Follow the hold the stem describes.
  • Pregnancy screening before radiation is not optional in the age group that can be pregnant.
  • After a dye study, fluids that the protocol allows help the kidneys if the client can have volume.
  • A client climbing off a table dizzy after a long fast is a fall. Stay.

Reflect and review

Kidney number and prior reaction before the injector runs.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Connect today’s topic to one Client Needs category and practice two related items.

Related: Management of Care syllabus

Day 49

Day 49 • Risk

Tubes, drains, and the chamber that should not bubble like that

Chest tubes, central lines, and the sudden quiet that is not peace.

Learning objectives

Daily lesson

  • Tidaling in the water seal is often expected. Continuous bubbling in the water seal suggests an air leak.
  • A disconnected chest tube: a sterile water seal in a bottle if that is what you were taught, gloves, and help — not a long debate in the doorway.
  • Sudden stop in drainage plus distress can mean a clot or a tension story. Stay and get help. Do not milk a tube unless policy still says to.
  • Central-line infection prevention is sterile hubs, clean dressing changes, and taking the line out when it is no longer needed.
  • Never strip a chest tube out because the client wants to shower right now.

Reflect and review

Continuous bubbling in the water seal is an air leak until you prove it is not.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: End the session by listing one thing you will watch for more carefully next time.

Related: Management of Care syllabus

Day 50

Day 50 • Checkpoint

Week 7 mixed check: numbers that change the plan

Labs, ABGs, and tubes — use the value in the stem.

Learning objectives

Daily lesson

  • This week is Reduction of Risk Potential: the computer will keep handing you a number and asking what it means for the next action.
  • Potassium, INR, glucose, and pH do more work than a long narrative. Circle them.
  • If two options both treat the diagnosis, pick the one that matches the number you were given.
  • A beautiful teaching option is still wrong when the potassium is 6.5.

Reflect and review

Circle every number before you read the options.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Complete the linked questions, then name the single most important cue in one sentence.

Related: Management of Care syllabus

Day 51

Day 51 • Adaptation

Airway, asthma, and the quiet chest

Position, oxygen, and the asthmatic who stops wheezing for the wrong reason.

Learning objectives

Daily lesson

  • Most clients who cannot breathe want to sit up. Let them. Flat is how we do procedures, not how we treat air hunger.
  • A loud wheeze that becomes a quiet chest in a tiring asthmatic is closing airways, not improvement.
  • SpO2 84% is oxygen and a look at the client, not a note that “sat is low.” Confirm the probe only after you start support if they look like the number.
  • Status asthmaticus needs more than a home inhaler speech. It needs the emergency drugs and the team.
  • Falling respiratory rate after hours of tachypnea is fatigue. That client is heading toward a bag, not toward discharge.

Reflect and review

A quieter chest in a tiring asthmatic is an emergency cue.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: After each item, explain why one alternative would have been less safe.

Related: Management of Care syllabus

Day 52

Day 52 • Adaptation

Chest pain, STEMI cues, and nitroglycerin limits

What you do in the first minutes and when you hold the nitro.

Learning objectives

Daily lesson

  • Crushing pain, diaphoresis, nausea, and a sense of doom with a 12-lead that cannot wait is the cluster. Aspirin per protocol, monitor, IV, and the team.
  • Nitroglycerin is held if the systolic pressure is already low or if a phosphodiesterase inhibitor for erectile dysfunction was recently taken.
  • Oxygen in ACS is for hypoxemia, not a reflex on every chest-pain client with an SpO2 of 98%.
  • Unrelieved pain after the protocol doses is not “give them a sandwich.” It is a call and a bigger pathway.
  • Right-ventricular infarct teaching in many courses says be careful with nitro and fluids — if the stem hands you that diagnosis, do not ignore it.

Reflect and review

Low pressure plus nitroglycerin is a hold. The pain does not outrank perfusion.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.

Related: Management of Care syllabus

Day 53

Day 53 • Adaptation

Heart failure, fluids, and the weight from yesterday

Daily weights, crackles, and when a drip is not kindness.

Learning objectives

Daily lesson

  • Two extra kilos since yesterday is fluid, not “a big dinner.” Daily weights are the cheapest hemodynamic monitor you have.
  • Wet lungs, a climbing need for pillows, and a tight ring are the same story. Sit up, oxygen if they need it, and the drugs the protocol already named.
  • A bolus that made sense in the ED may be wrong on day 2 of wet failure. Question the fluid.
  • Low-sodium teaching and a scale at home prevent the next admission. Do that after they can breathe.
  • Inotropic or vasodilator drips are not UAP work and they are not a good first assignment for a float who has never seen the pump.

Reflect and review

The weight from yesterday is part of this morning’s assessment.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Write down any medication or lab value that changed your decision and review it tomorrow.

Related: Management of Care syllabus

Day 54

Day 54 • Adaptation

Shock that is not all the same color

Hypovolemic, septic, cardiogenic, and the fluid that helps one and harms another.

Learning objectives

Daily lesson

  • Hypovolemic shock wants volume and source control of the bleed. Keep the client warm and find the hole.
  • Septic shock: cultures when you can, antibiotics, fluids, and a blood pressure that still needs a pressor after fluids. Lactate is a trend.
  • Cardiogenic shock is a pump that cannot take a generous bolus. More fluid is not kindness.
  • Anaphylactic shock is epinephrine first. You already practiced that on mixed days — it still wins.
  • A MAP that is sliding while the client becomes confused is a brain-perfusion item. Stay and call.

Reflect and review

Name the shock before you pick the fluid.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.

Related: Management of Care syllabus

Day 55

Day 55 • Adaptation

DKA, HHS, and hormone crises that look like personality

Fluids first after airway, potassium planning, and thyroid or adrenal crash.

Learning objectives

Daily lesson

  • After airway, DKA starts with fluids. Insulin follows the protocol. Potassium is a planned problem because insulin drives it back into cells.
  • A potassium of 5.4 at the start of DKA does not mean you will ignore replacement later.
  • Add dextrose when the glucose hits the cutoff so you can finish the ketone work without a hypoglycemic second emergency.
  • Myxedema and thyroid storm are temperature, rate, and airway stories. Adrenal crisis is fluids, sugar, and steroids the provider orders — not a pep talk.
  • These clients look “difficult” when they are actually empty or overloaded with hormone. Believe the vitals.

Reflect and review

Personality change plus a wild temperature or glucose is medical until proven otherwise.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: For communication questions, eliminate answers that give false reassurance.

Related: Management of Care syllabus

Day 56

Day 56 • Adaptation

Neuro: stroke, seizure, and the glucose check inside the pathway

Time last known well, nothing in the mouth, and hypoglycemia that mimics stroke.

Learning objectives

Daily lesson

  • Last known well starts the clock. A wake-up stroke is a different clock, but you still need the time story.
  • Glucose lives inside the stroke pathway because a low sugar mimics a brain attack. Check it.
  • NPO until swallow is cleared. A proud family feeding soup is how aspiration happens in the CT hallway.
  • Seizure: turn, protect the head, time it, nothing in the mouth, oxygen when you can, benzos per protocol when it does not stop.
  • A sudden “worst headache” with a stiff neck is not a migraine you treat with the lights off and a shrug.

Reflect and review

Glucose check lives inside the stroke pathway. Do not skip it to look efficient.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.

Related: Management of Care syllabus

Day 57

Day 57 • Adaptation

GI bleed, pancreas, and the belly that should not be rigid

Airway in a vomiting blood picture, NPO, and peritonitis cues.

Learning objectives

Daily lesson

  • Vomiting blood is an airway item before it is a proton-pump item. Sit them, suction if needed, get the team.
  • Black tarry stool plus a climbing heart rate is volume. Orthostatics are not a sport — if they are already dizzy sitting, do not stand them for fun.
  • Pancreatitis: pain, NPO, fluids, and watching the lungs. Food is not comfort here.
  • A rigid, silent abdomen and a client who does not want to move is peritonitis until the surgeon says it is not.
  • Liver-failure clients bleed and get confused. A rising ammonia story is safety plus the lactulose plan already ordered.

Reflect and review

Hematemesis is airway first. The PPI can wait thirty seconds.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Review any question you answered correctly for the wrong reason.

Related: Management of Care syllabus

Day 58

Day 58 • Adaptation

Blood counts, neutropenia, and oncologic emergencies

No fresh flowers, a temperature that is an emergency, and SVC syndrome cues.

Learning objectives

Daily lesson

  • Neutropenia: hand hygiene, no fresh flowers or raw food per protocol, private room when policy says so, and a temperature that is a phone call, not a blanket.
  • The client may look “fine” with a fever of 38.3. They do not have the white cells to look sick until they look terrible.
  • SVC syndrome: facial swelling, plethora, and dyspnea when the arms are raised. Sit up and get help. This is not a new-pillow problem.
  • Tumor lysis: high potassium, high phosphate, high uric acid, low calcium. Fluids and the drugs the protocol already named.
  • Platelets at 8,000 change whether you place a nasogastric tube for fun. You do not.

Reflect and review

A neutropenic fever is an emergency even when the client is sitting up watching television.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: Connect today’s topic to one Client Needs category and practice two related items.

Related: Management of Care syllabus

Day 59

Day 59 • Adaptation

Kidneys, dialysis day, and the fistula you never use for labs

Fluid, potassium, and the bruit you are supposed to hear.

Learning objectives

Daily lesson

  • No blood pressures, no IVs, no lab sticks in the fistula arm. Teach that like a fire exit.
  • You want a bruit and a thrill. Silence is a call, not a charting delay.
  • A missed dialysis day plus a potassium of 6.2 is a monitor and a team, not a banana joke.
  • Weights before and after, and a dry-weight number the client can say out loud, prevent the next flash pulmonary edema.
  • Disequilibrium after a first dialysis can look like headache and restlessness. Report it. Do not assume they are “just tired.”

Reflect and review

No sticks in the fistula arm. Say it every time you walk in.

Review this lesson in context of your current exam candidate bulletin and local clinical guidance. The daily plan is independent educational material.

Practise questionsAll study days

Today’s practice focus: End the session by listing one thing you will watch for more carefully next time.

Related: Management of Care syllabus