Complete 90-Day NCLEX-RN Study Plan
This single page contains the full 90-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
Day 31
Day 31 • ComfortSleep and the 0200 noise we pretend is normal
Cluster care, caffeine, and delirium that starts as “a bad night.”
Learning objectives
- Cluster tasks so the client can sleep.
- Name a hospital factor that wrecks sleep.
- Treat new night confusion as data.
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.
Today’s practice focus: After each item, explain why one alternative would have been less safe.
Related: International nurse guide
Day 32
Day 32 • PharmRights, 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
- Stop a dose that is 10 times the usual range.
- Name drugs you never crush or never IV-push.
- Use a second nurse on high-alert meds.
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.
Today’s practice focus: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.
Related: International nurse guide
Day 33
Day 33 • PharmIV fluids that help — and fluids that drown
Isotonic rescue versus fluid you stop when the lungs fill.
Learning objectives
- Name a common isotonic fluid.
- Stop a bolus when crackles and JVD appear.
- Choose the first action for infiltration.
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.
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 • PharmAntibiotics and the bag you stop mid-drip
Allergies, peak and trough thinking, and C. diff after the third antibiotic.
Learning objectives
- Stop an infusion when a reaction starts.
- Know why a trough is drawn before the dose.
- Teach that diarrhea after antibiotics is not “just a stomach bug.”
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.
Today’s practice focus: Focus on recognizing when a chronic condition has a new acute change.
Related: International nurse guide
Day 35
Day 35 • PharmInsulin, 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
- Match a peak to a hypoglycemia time.
- Treat a symptomatic low now.
- Hold or adjust only with a parameter, not a vibe.
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.
Today’s practice focus: For communication questions, eliminate answers that give false reassurance.
Related: International nurse guide
Day 36
Day 36 • PharmAnticoagulants and the lab that belongs to each drug
Warfarin and INR, heparin and aPTT, and the antidote you must not mix up.
Learning objectives
- Match warfarin to INR and vitamin K.
- Match heparin to aPTT and protamine.
- Teach one bleeding precaution that a client will actually use.
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.
Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.
Related: International nurse guide
Day 37
Day 37 • PharmCardiac drugs you will hold at the doorway
Digoxin, ACE inhibitors, beta blockers, and nitroglycerin limits.
Learning objectives
- Hold digoxin for the pulse and potassium in the stem.
- Teach the ACE cough and the first-dose hypotensive sit.
- State when nitroglycerin is not given.
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.
Today’s practice focus: Review any question you answered correctly for the wrong reason.
Related: International nurse guide
Day 38
Day 38 • PharmPsychiatric medications that turn into emergencies
NMS, lithium and sodium, MAOI food, and serotonin excess.
Learning objectives
- Recognize lead-pipe rigidity and fever as NMS.
- Link lithium toxicity to dehydration or low sodium.
- Avoid the cheese-and-MAOI story becoming a real stroke.
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.
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 • PharmSteroids, thyroid, and the taper nobody wants to hear
Infection, glucose, bones, and why abrupt stops cause crisis.
Learning objectives
- Teach one steroid adverse effect that changes daily life.
- Do not stop a long-term steroid cold.
- Spot thyroid-hormone toxicity as a rate problem.
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.
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 • PharmOpioids, PCA, and the epidural that went wrong
Respiratory rate, who may press the button, and red flags in the back.
Learning objectives
- Act on a respiratory rate of 6 after morphine.
- Keep family off the PCA button.
- Name an epidural emergency cue.
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.
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 • RiskLabs you should be able to say in a stairwell
Electrolytes, blood counts, and the one number that makes you hold the drug.
Learning objectives
- Recite potassium, sodium, and glucose floors.
- Hold a drug based on a lab in the stem.
- Treat a critical value as a phone call, not a sticky note.
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.
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 • RiskPotassium, calcium, magnesium — the muscle labs
Cardiac rhythm, tetany, and the reflex that tells you magnesium is winning.
Learning objectives
- Connect potassium to rhythm.
- Connect calcium to tetany or stones.
- Connect magnesium to reflexes and breathing.
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.
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 • RiskSodium, water, SIADH, and diabetes insipidus
Seizures at 118, concentrated urine, and the free-water mistake.
Learning objectives
- Treat a sodium of 118 with a seizure as an airway and safety item.
- Contrast SIADH and DI in one sentence each.
- Avoid slamming free water into hypernatremia.
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.
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 • RiskGlucose emergencies that are not “give a sandwich later”
Hypoglycemia now, DKA after airway, HHS in the older silent client.
Learning objectives
- Treat a symptomatic low immediately.
- Start DKA thinking with fluids after airway.
- Do not confuse HHS quietness with stability.
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.
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 • RiskABGs you can sort without a mnemonic tattoo
ROME, compensation, and treating ventilation instead of the antacid.
Learning objectives
- Name the primary disorder from pH, CO2, and HCO3.
- Decide whether compensation has started.
- Choose a ventilation action for respiratory acidosis.
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.
Today’s practice focus: For communication questions, eliminate answers that give false reassurance.
Related: Management of Care syllabus
Day 46
Day 46 • RiskPre-procedure prep that prevents a cancelled case
NPO, marks, consents, and the lab that stops the knife.
Learning objectives
- Name what must be done before a client leaves the floor.
- Hold the drug the stem says to hold.
- Report the lab that cancels the case.
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.
Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.
Related: Management of Care syllabus
Day 47
Day 47 • RiskAfter the procedure: PACU thinking on a regular floor
Airway, bleeding, urine, and the first walk.
Learning objectives
- Protect an airway while the client is still sleepy.
- Find a bleed under a dressing.
- Do not delay the first void problem.
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.
Today’s practice focus: Review any question you answered correctly for the wrong reason.
Related: Management of Care syllabus
Day 48
Day 48 • RiskImaging, contrast, and the metformin conversation
Allergies, kidneys, pregnancy questions, and after-care.
Learning objectives
- Ask the allergy and kidney questions before contrast.
- Hold metformin when the protocol says to.
- Teach fluids after a dye study when that is the plan.
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.
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 • RiskTubes, drains, and the chamber that should not bubble like that
Chest tubes, central lines, and the sudden quiet that is not peace.
Learning objectives
- Interpret continuous bubbling in the water seal.
- Know the first action when a chest tube disconnects.
- Prevent a central-line infection with boring sterile habits.
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.
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 • CheckpointWeek 7 mixed check: numbers that change the plan
Labs, ABGs, and tubes — use the value in the stem.
Learning objectives
- Let the lab pick the hold.
- Let the ABG pick the system.
- Let the chamber pick the leak.
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.
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 • AdaptationAirway, asthma, and the quiet chest
Position, oxygen, and the asthmatic who stops wheezing for the wrong reason.
Learning objectives
- Sit a dyspneic client up first when that is safe.
- Treat a quieter chest in a tiring asthmatic as worse, not better.
- Act on an SpO2 of 84% instead of charting it.
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.
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 • AdaptationChest pain, STEMI cues, and nitroglycerin limits
What you do in the first minutes and when you hold the nitro.
Learning objectives
- Recognize a STEMI cluster.
- Hold nitroglycerin when the pressure or the other drug says so.
- Give oxygen when the stem actually needs it.
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.
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 • AdaptationHeart failure, fluids, and the weight from yesterday
Daily weights, crackles, and when a drip is not kindness.
Learning objectives
- Use yesterday’s weight.
- Stop extra fluid when the lungs are wet.
- Choose sitting up and oxygen before a teaching pamphlet.
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.
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 • AdaptationShock that is not all the same color
Hypovolemic, septic, cardiogenic, and the fluid that helps one and harms another.
Learning objectives
- Name the first volume move in hypovolemic or septic shock.
- Avoid drowning a cardiogenic client.
- Watch lactate as a trend, not a trophy.
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.
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 • AdaptationDKA, HHS, and hormone crises that look like personality
Fluids first after airway, potassium planning, and thyroid or adrenal crash.
Learning objectives
- Start DKA with fluids after airway.
- Explain why potassium can look high and still be a risk.
- Treat an adrenal or thyroid crisis as a medical event.
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.
Today’s practice focus: For communication questions, eliminate answers that give false reassurance.
Related: Management of Care syllabus
Day 56
Day 56 • AdaptationNeuro: stroke, seizure, and the glucose check inside the pathway
Time last known well, nothing in the mouth, and hypoglycemia that mimics stroke.
Learning objectives
- Ask last known well.
- Protect a seizing client’s airway without putting objects in the mouth.
- Check glucose in a new stroke-like picture.
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.
Today’s practice focus: Note whether the priority was assessment, action, or notification — and why.
Related: Management of Care syllabus
Day 57
Day 57 • AdaptationGI bleed, pancreas, and the belly that should not be rigid
Airway in a vomiting blood picture, NPO, and peritonitis cues.
Learning objectives
- Protect the airway in hematemesis.
- Keep the pancreatitis client NPO when that is the plan.
- Treat a rigid abdomen as a surgical emergency cue.
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.
Today’s practice focus: Review any question you answered correctly for the wrong reason.
Related: Management of Care syllabus
Day 58
Day 58 • AdaptationBlood counts, neutropenia, and oncologic emergencies
No fresh flowers, a temperature that is an emergency, and SVC syndrome cues.
Learning objectives
- Apply neutropenic precautions.
- Treat a fever in neutropenia as urgent.
- Recognize superior vena cava and tumor-lysis clusters.
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.
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 • AdaptationKidneys, dialysis day, and the fistula you never use for labs
Fluid, potassium, and the bruit you are supposed to hear.
Learning objectives
- Protect the fistula.
- Watch potassium on the day they miss dialysis.
- Measure what went in and what came out.
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.
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 60
Day 60 • CheckpointAdult emergencies mixed check I
Spaced review of first actions across airway, bleed, anaphylaxis, sepsis, and ACS.
Learning objectives
- Pick the crashing client.
- Start the first action the stem already earned.
- Name what you will evaluate after the action.
Daily lesson
- This sitting repeats the emergency cluster on purpose: new bleed versus chronic pain, a hold, anaphylaxis, sepsis with a falling pressure, STEMI language.
- You are not learning a new disease today. You are proving you can still sort when you are tired of sorting.
- Evaluation language matters. After epinephrine you want air moving. After a bolus in sepsis you want a pressure and a mentation change, not a prettier chart.
- If you miss, write the rule in one sentence. “Epinephrine before antihistamine in anaphylaxis” is a rule. “I will try harder” is not.
Reflect and review
Who loses an airway or a circulation in 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: Complete the linked questions, then name the single most important cue in one sentence.
Related: Physiological Adaptation syllabus
Day 61
Day 61 • CheckpointAdult emergencies mixed check II
A second pass at the same lethal cluster so the rule sticks.
Learning objectives
- Switch frameworks without rereading the whole week.
- Hold the med the number tells you to hold.
- Do not pick teaching on a crash stem.
Daily lesson
- Same cluster, new names on the clients. The exam does this too.
- Teaching, documentation, and “notify the provider” lose when the client is not exchanging air.
- Notify the provider is correct after you have started the action you are allowed to start — not instead of that action.
- If two options both look right, the more lethal-if-skipped option usually wins.
Reflect and review
Notify is not a substitute for the first action you can already do.
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: After each item, explain why one alternative would have been less safe.
Related: Physiological Adaptation syllabus
Day 62
Day 62 • Maternal-ChildAntepartum warning signs you do not send home
Bleeding, pressure, a headache with lights, and a fetus that went quiet.
Learning objectives
- Send bleeding and leaking fluid in for care.
- Treat preeclampsia symptoms as now, not next week.
- Act on a change in fetal movement.
Daily lesson
- Bleeding in pregnancy is not “spotting we will mention on Thursday” when the stem gives you volume or pain.
- Preeclampsia language: headache, vision change, right-upper pain, swelling that is new, and a pressure that is no longer their baseline.
- A client who says the baby is quieter today needs a same-day plan, not a smile.
- Leaking fluid is rupture until the exam says it is urine. Infection and cord risk ride with that story.
- Ectopic pain plus shoulder tip plus a positive test is volume and surgery time, not an analgesic and a bus ride.
Reflect and review
Headache plus lights plus a pregnant client is not a computer-screen problem.
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: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.
Related: Physiological Adaptation syllabus
Day 63
Day 63 • Maternal-ChildIntrapartum emergencies you drill because seconds matter
Prolapsed cord, shoulder dystocia, and oxytocin that is too friendly.
Learning objectives
- Position for a prolapsed cord.
- Name a shoulder-dystocia maneuver the stem expects.
- Stop oxytocin when tachysystole is harming the tracing.
Daily lesson
- Prolapsed cord: lift the presenting part off the cord, knees to chest or Trendelenburg as you were taught, and do not push the cord back like a cable.
- Shoulder dystocia: call for help, McRoberts, suprapubic pressure — not fundal pressure.
- Oxytocin with tachysystole and a bad tracing is stop the pit, side-lying, oxygen per protocol, and the rest of the intrauterine resuscitation bundle.
- Late decelerations are a placenta problem. Variable decelerations often mean cord. The tracing is a conversation, not wallpaper.
- You cannot document your way out of a cord you can see.
Reflect and review
Fundal pressure is not the shoulder-dystocia answer.
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: Physiological Adaptation syllabus
Day 64
Day 64 • Maternal-ChildPostpartum hemorrhage and infection after the balloons come down
A boggy fundus, a soaked pad, and a fever on day 3.
Learning objectives
- Massage a boggy fundus and call for help.
- Treat a soaked pad as volume.
- Do not ignore a day-3 uterine tenderness.
Daily lesson
- Four T’s you were taught — tone, trauma, tissue, thrombin — but the first hands-on move for uterine atony is a firm massage and help.
- A pad soaked in 15 to 20 minutes is not lochia. It is a hemorrhage clock.
- Affect can smile while volume falls. Believe the pad and the pulse.
- Day-3 fever, foul lochia, and uterine tenderness is endometritis until the provider says it is not.
- A rising fundal height after it had been down is clots that need to come out, not a new pillow.
Reflect and review
The pad and the fundus tell the truth before the smile does.
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: Physiological Adaptation syllabus
Day 65
Day 65 • Maternal-ChildNewborn distress you do not explain away
Work of breathing, glucose, jaundice timing, and a floppy unexpected baby.
Learning objectives
- Act on grunting and flaring.
- Treat a jittery newborn as a glucose item.
- Know when jaundice is too early to be casual.
Daily lesson
- Grunting, flaring, retracting, or a silent chest is respiratory support and a team, not a longer look from the doorway.
- Jittery plus a poor feed is glucose. Hypothermia makes everything worse. Warm and feed or treat per protocol.
- Jaundice in the first 24 hours is not “a little sunshine.” It is a lab.
- A baby who will not wake to feed after a long labor needs a second look, not a longer stretch so the parent can sleep.
- Safe sleep teaching still belongs here because the car ride home is how good inpatient work gets undone.
Reflect and review
Grunting is not a cute newborn sound.
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: Physiological Adaptation syllabus
Day 66
Day 66 • Maternal-ChildPediatrics: dehydration, fever, and the parent who knows the baseline
Wet diapers, fontanels, and a fever in an infant who is not acting right.
Learning objectives
- Use wet diapers and tears as data.
- Believe a parent who says this is not their child.
- Treat an infant who looks ill as urgent even if the number is modest.
Daily lesson
- Fewer wet diapers, no tears, a sunken fontanel, and a dry mouth are dehydration. Cap refill and mental status tell you if this is a hallway conversation or a team.
- Parents know the baseline. “He is not acting right” is an assessment cue.
- A young infant with fever and lethargy is not a wait-for-morning clinic speech.
- Medication doses are weight-based. Adult tablets cut in half are how we write incident reports.
- Keep the parent in the room when you can. Restraint by panic is not a pediatric skill.
Reflect and review
“Not acting right” from a parent is data. Do not talk them out of it.
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: Physiological Adaptation syllabus
Day 67
Day 67 • Maternal-ChildPediatrics: respiratory and the epiglottitis reflex you do not poke
Croup versus epiglottitis, bronchiolitis, and the throat you do not examine.
Learning objectives
- Keep a drooling tripoded child calm.
- Do not put a stick in that throat.
- Use position and oxygen before a long teaching talk.
Daily lesson
- A drooling, tripoded, anxious child is an airway team and a calm room. You do not inspect the throat with a tongue blade to satisfy curiosity.
- Croup is stridor and a bark. Cool air and the drugs the protocol names. Keep them upright.
- Bronchiolitis is suction, oxygen, hydration, and watching the work of breathing — not an antibiotic reflex.
- A child who was fighting and now slumps is worse.
- Let the parent hold them if that keeps the airway quieter. Fighting a mask can drop saturation faster than a gentle parent.
Reflect and review
No tongue blade in a suspected epiglottitis. Curiosity is not an indication.
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: Physiological Adaptation syllabus
Day 68
Day 68 • CheckpointWeek 10 mixed check: parent and child
Tie maternal-newborn and pediatric red flags to a first action.
Learning objectives
- Do not send a warning sign home.
- Treat a soaked pad or a grunting newborn as now.
- Keep adult emergency rules when the stem is actually an adult.
Daily lesson
- This week’s living clients are pregnant, postpartum, or small. The mixed items in the bank may still throw an adult emergency into the set — read the age.
- Postpartum hemorrhage and a grunting neonate are volume and air. Teaching about car seats waits.
- If the stem is a 62-year-old with chest pain, do not force a fundal massage.
- Write one rule after you miss: “No tongue blade in epiglottitis.” Rules travel. Shame does not.
Reflect and review
Read the age and the last sentence of the stem before you pick a maternal 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: Connect today’s topic to one Client Needs category and practice two related items.
Related: Physiological Adaptation syllabus
Day 69
Day 69 • NGN StudioNGN mechanics: what each format is asking
Recognize, analyze, act, evaluate — and the bow-tie center.
Learning objectives
- Match a verb in the stem to an NCJMM step.
- Put the problem, not a random drug, in the bow-tie center.
- Stop over-clicking highlight items.
Daily lesson
- Recognize-cues items want the findings that matter, not every abnormal number on the sheet.
- Take-action items reward the next safe move, not the complete pathophysiology essay.
- Evaluate-outcomes items want the change that means the action worked — air moving, pressure rising, urine appearing.
- A bow-tie center is the problem you are managing, such as fluid-volume overload, not a side-task like “call dietary.”
- Highlight items lose points when you paint the whole paragraph yellow. Mark the phrase that changes the plan.
Reflect and review
Extra clicks can cost points. Mark less than you think you should, then look once more.
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: Physiological Adaptation syllabus
Day 70
Day 70 • NGN StudioNGN studio: the tiring respiratory client
A four-hour trend of work of breathing, not a single sat.
Learning objectives
- Treat a falling rate after tachypnea as fatigue.
- Sit the client up and start oxygen when the number and the face agree.
- Evaluate after the action, not after a speech.
Daily lesson
- Read the time column. Respiratory items hide the story in the trend, not in the first set of vitals.
- A quieter chest and a falling rate in asthma or COPD is worse.
- Position and oxygen are often the first actions the case will reward before a long teaching option.
- Evaluation is a better saturation and less work of breathing — not a completed pamphlet.
- If the case adds a blood gas, use it. A rising CO2 in a tiring client is a ventilation conversation.
Reflect and review
The last column in the table is usually where the case turns.
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: Physiological Adaptation syllabus
Day 71
Day 71 • NGN StudioNGN studio: chest pain that changes after nitro
Pain-free can be good. New crackles after fluids are not.
Learning objectives
- Recognize the ACS cluster again in case form.
- Hold nitro when the pressure says so.
- Evaluate lungs after volume.
Daily lesson
- Cases recycle STEMI language because CAT will too. Crushing pain, sweat, and nausea still matter.
- Pain that eases after nitro is an evaluation cue that the action did something.
- Crackles that appear after a fluid bolus are an evaluation cue that the action did something you may not want.
- Put the problem in the center of the bow-tie: acute coronary syndrome or fluid overload — whichever the chart is actually doing.
- Do not add every protocol drug to a take-action row. Add the ones the current numbers allow.
Reflect and review
Pain-free after nitro is good. New crackles after fluids are not.
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: After each item, explain why one alternative would have been less safe.
Related: Physiological Adaptation syllabus
Day 72
Day 72 • NGN StudioNGN studio: stroke and the clock
Last known well, glucose, and what you do not put in the mouth.
Learning objectives
- Find last known well in the chart.
- Keep the glucose check.
- Hold oral anything until swallow is safe.
Daily lesson
- The case will bury last known well in a sentence from a spouse. Circle it.
- Glucose still belongs in the recognize-cues or take-action row even when the CT is the glamorous option.
- A take-action row that includes a meal is usually wrong before swallow screening.
- Evaluate: a stable airway, a repeat exam, and a blood pressure the protocol can live with — not a completed menu choice.
- If thrombolytics appear, look for contraindications the chart already handed you: recent surgery, a bleed, an INR.
Reflect and review
The spouse’s sentence about “when it started” is the 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: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.
Related: Physiological Adaptation syllabus
Day 73
Day 73 • NGN StudioNGN studio: DKA that is not only an insulin story
Fluids, potassium planning, and dextrose when the cutoff hits.
Learning objectives
- Put fluids near the first action after airway.
- Do not treat the first potassium as the whole story.
- Add dextrose when the protocol cutoff arrives.
Daily lesson
- Recognize: Kussmaul, fruity breath, a high glucose, and a sick teenager or adult who has been thirsty for days.
- Take action: fluids, the insulin the protocol names, and a monitor. Teaching about carbohydrate counting is later.
- Evaluate: closing the anion-gap story, a safer potassium, and a client who is no longer blowing off acid like a freight train.
- When glucose hits the cutoff, dextrose joins so ketones can finish clearing. That line is in this case on purpose.
- A falling potassium after insulin starts is expected work, not a surprise lab.
Reflect and review
When glucose hits the cutoff, dextrose joins. Remember that sentence.
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: Physiological Adaptation syllabus
Day 74
Day 74 • NGN StudioNGN studio: postpartum bleed while everyone is smiling
Tone, pad counts, and a pulse that does not match the affect.
Learning objectives
- Massage and help first for atony.
- Quantify the pad.
- Evaluate with a firm fundus and a slower pulse.
Daily lesson
- Recognize: boggy fundus, a soaked pad, clots, and a pulse that climbed while the client joked with visitors.
- Take action: fundal massage, help, the uterotonic that is ordered, oxygen if they look empty, and a second IV if that is the protocol.
- Do not pick a teaching row about peri-care as the first action.
- Evaluate: fundus firm at the umbilicus, lochia slowing, mentation staying clear.
- Affect can smile while volume falls. The case is built to punish politeness.
Reflect and review
Believe the pad, not the smile.
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: Physiological Adaptation syllabus
Day 75
Day 75 • NGN StudioNGN formats drill: contraindicated is an answer
Matrix rows, highlight restraint, and the action that would harm.
Learning objectives
- Fill every matrix row — including contraindicated.
- Highlight only the turning phrase.
- Read a four-hour table before the first option.
Daily lesson
- Matrix items often want indicated, non-essential, and contraindicated. Leaving the contraindicated row blank is how you lose easy points.
- A contraindicated action is usually the one that ignores a number you already have: nitroglycerin at a systolic of 84, oral fluids before a swallow screen, a tongue blade in epiglottitis.
- Read the entire table. Hour 4 is frequently the reason hour 1 teaching is now wrong.
- If two highlights look pretty, keep the one that changes the priority.
- This sitting is mechanics plus judgment. Slow down for one extra breath before you click.
Reflect and review
Contraindicated is as important as indicated.
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: Final review tips
Day 76
Day 76 • Boards MixBoards mix: who is first on a four-client list
Fresh instability versus day-3 comfort.
Learning objectives
- Sort by newness and lethality.
- Keep UAP off interpretive work.
- Do not pick a teaching option on a bleed.
Daily lesson
- Today’s mix leans on assignment and first action: new postoperative bleed versus chronic pain, a hold, anaphylaxis, sepsis, ACS.
- Fresh post-op beats day-3 comfort. New confusion beats chronic stable dementia doing its usual evening shuffle — unless the stem says the dementia client just climbed the rails and is blue.
- Read every name. The exam hides the unstable client in the third line.
- After you pick, ask whether a UAP could have done it. If yes, it was probably not the RN priority item.
Reflect and review
Fresh post-op bleed beats day-3 comfort. Every time.
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: Final review tips
Day 77
Day 77 • Boards MixBoards mix: the lab that holds the drug
Digoxin, ACE, beta blocker, warfarin, heparin.
Learning objectives
- Hold digoxin when pulse, potassium, and vision line up.
- Match warfarin to INR and heparin to aPTT.
- Teach one ACE or beta-blocker landmine.
Daily lesson
- This set is hold parameters and antidotes. Say the triad out loud before you click.
- Digoxin, pulse 52, potassium 3.0, yellow halos: hold.
- ACE teaching includes cough, potassium, and sitting for the first dose. Beta blockers include the pulse parameter and not stopping cold.
- Warfarin/INR/vitamin K. Heparin/aPTT/protamine. Write it once on scratch paper if the site allows a board in practice — here, write it in your head.
- The cardiac or respiratory number usually drives the action more than a pretty teaching sentence.
Reflect and review
Drug, number, antidote. If you cannot say all three, you are guessing.
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: Final review tips
Day 78
Day 78 • Boards MixBoards mix: adult physiology under a clock
Anaphylaxis, sepsis, cardiogenic shock, and when to stop a bag.
Learning objectives
- Give epinephrine first in anaphylaxis.
- Do not bolus cardiogenic shock like hypovolemia.
- Stop the antibiotic when the reaction starts.
Daily lesson
- You already know these rules. Today you prove they still come out when the names change.
- Cardiogenic shock is not treated with a generous fluid challenge as the first idea.
- Stop the antibiotic bag when the rash, wheeze, or pressure drop starts.
- Lactate in sepsis is a trend to evaluate perfusion, not a trivia fact.
- Practice the evaluation sentence: “I will know this worked when…”
Reflect and review
Finish the sentence: I will know this worked when…
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: Final review tips
Day 79
Day 79 • Boards MixBoards mix: psych safety and a postpartum overlap
A plan with means, a sudden SSRI lift, and a pad that is not “blues.”
Learning objectives
- One-to-one when a plan and pills are in the room.
- Treat a new burst of energy on an SSRI as risk.
- Do not call hemorrhage baby blues.
Daily lesson
- A named plan and hidden pills is means plus intent. That is observation and removal, not a group-therapy flyer.
- Ask about suicide. Q15 checks are not enough when the client is actively trying to leave with the means.
- Baby blues do not soak a pad in 20 minutes and do not produce a rigid abdomen. Hemorrhage is hemorrhage.
- Newly energetic after 10 days of an SSRI is a classic boards cue. Use it.
- If the stem is maternity and psych together, treat the lethal one first.
Reflect and review
Blues do not soak a pad in 20 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: End the session by listing one thing you will watch for more carefully next time.
Related: Final review tips
Day 80
Day 80 • Boards MixBoards mix: the assignment you would defend to a charge nurse
Float nurses, LPN/VN, UAP, and the client who just became interesting.
Learning objectives
- Give the float familiar stable work.
- Keep initial teaching and unstable clients with the RN.
- Reassign when a client turns unstable.
Daily lesson
- Float nurses get familiar, stable work. Curiosity is not a competency.
- The items may again include the emergency cluster. If the stem is anaphylaxis, you are not doing a staffing puzzle — you are giving epinephrine.
- When a client on an LPN/VN assignment becomes unstable, the assignment changes. Licenses do not stretch because the board is full.
- UAP cannot “just watch” a new chest-pain client and interpret the pain.
- If you would not defend the assignment to a charge nurse you respect, it is the wrong option.
Reflect and review
Float nurses get familiar stable work. That sentence ends a lot of 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 name the single most important cue in one sentence.
Related: Final review tips
Day 81
Day 81 • ReadyMixed review: why you missed — misread versus did not know
Task words, extra facts you added, and NGN format habits.
Learning objectives
- Classify each miss as knowledge, misread, or format.
- Circle except, first, and most.
- Stop adding a story the stem did not tell.
Daily lesson
- Most late-prep misses are misreads of the task, not empty brains. Except, first, most, and “which action is contraindicated” change the whole item.
- The item set here leans on NGN mechanics: recognize versus act versus evaluate, bow-tie centers, highlight restraint.
- If you added a fact from your last clinical day that the stem did not give, you invented a different client.
- Write the task word at the top of the scratch space. Then read the options.
- One review of misses beats three rereads of a chapter you already know.
Reflect and review
Read the stem twice today. The second read is for the task word.
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: After each item, explain why one alternative would have been less safe.
Related: Final review tips
Day 82
Day 82 • ReadyTimed endurance without abandoning safety
About two minutes an item, elimination, and a body that still has glucose.
Learning objectives
- Eliminate two options and move.
- Do not leave a blank item.
- Eat and drink on the schedule you already use.
Daily lesson
- On a long sitting you will feel the wish to rummage. Elimination is the clinical skill. Two options gone is enough to choose.
- A blank item is a zero. A thoughtful guess after elimination is still a chance.
- You cannot return after NEXT. That means the thought has to finish now — not after you “see if the next one is easier.”
- Low glucose looks like panic and missed stems. Pack the same breakfast you have already practiced.
- Optional breaks count against the 5-hour clock. Plan them so you are not negotiating with your bladder at item 80.
Reflect and review
A blank item is a zero. Elimination, then click.
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: Practice ranking actions by immediate threat to airway, breathing, circulation, or safety.
Related: Final review tips
Day 83
Day 83 • ReadyMixed review: when every item feels hard
CAT near the cut score, two-concept stems, and incomplete data.
Learning objectives
- Hold two ideas in one stem.
- Choose the least lethal error when you must guess.
- Accept that hard can mean you are near the standard.
Daily lesson
- If you are near the passing standard the computer will keep feeding items that feel too close to call. That is the design, not a verdict.
- Two-concept stems (a pregnant client with asthma, a dialysis client with chest pain) want the more lethal system first.
- Incomplete data on a still-stable client means assess. Incomplete data on a crashing client means act.
- The least lethal error is the guess strategy when two options remain and you are out of knowledge.
- Do not change a first careful answer because the item felt insulting.
Reflect and review
Hard is not a verdict. It is often the neighborhood of the cut score.
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: Final review tips
Day 84
Day 84 • ReadyMixed sitting A: switch frameworks on purpose
All Client Needs in one block, the way a real sitting feels.
Learning objectives
- Name the framework before you name the disease.
- Keep NCJMM language in your mouth.
- Stand up before you review.
Daily lesson
- This is a stamina sitting. You will jump from isolation to a hold parameter to a psych safety stem.
- Say the framework first: safety, ABC, rights, or NCJMM step. Disease names come second.
- When you finish, walk. Review is the learning. The sitting was only the sample.
- If a cluster of misses shares a Client Need, that is tomorrow’s one-hour repair — not a new textbook.
Reflect and review
Stand up before you review. Blood flow is part of judgment.
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: Final review tips
Day 85
Day 85 • ReadyMixed sitting B: patch the rule, not the trivia
Second mixed block. Look-alike misses mean a system hole.
Learning objectives
- Find the hole that made two similar misses.
- Rewrite one rule in a full sentence.
- Stop collecting new facts the night before the test.
Daily lesson
- If you missed two isolation items, you do not need a microbiology textbook. You need a four-line isolation table you can recite walking.
- Look-alike misses are a system hole. Patch the rule: “Airborne is TB, measles, varicella — N95 and negative pressure.”
- Do not add a new resource today. Tighten the floor you already have.
- Write the rule in a complete sentence. Fragments do not survive adrenaline.
Reflect and review
Patch the rule, not just the fact.
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: Final review tips
Day 86
Day 86 • TaperLock-in: labs and isolation only
Closed-book recitation. No new chapters.
Learning objectives
- Recite isolation pairs out loud.
- Recite critical labs and the hold they trigger.
- Recite PPE order once without looking.
Daily lesson
- No new textbooks. The floor is isolation pairs, critical labs, and PPE order.
- Walk and recite. Sitting and highlighting is how we pretend we are studying on day 86.
- If a pair will not stick, write only that pair on one card. Not a new deck of 80.
- Then stop. Sleep is a clinical intervention this week.
Reflect and review
Walk and recite. Do not open a new book.
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: Final review tips
Day 87
Day 87 • TaperLock-in: delegation and the four-client sort
Highest-frequency management items only.
Learning objectives
- Sort four clients in thirty seconds.
- Recite the five rights.
- Decide assess versus act on two crash stems.
Daily lesson
- Name the unstable client first: new rhythm, new bleed, new airway.
- Recite RN-only work: initial assessment, initial teaching, evaluation, unstable clients.
- Recite UAP work: stable ADLs, vitals on stable clients, feeding low-risk clients.
- That is enough management content for a taper day. Do not rewrite a leadership textbook.
Reflect and review
New rhythm, new bleed, new airway.
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: Final review tips
Day 88
Day 88 • TaperLock-in: high-alert drugs
Insulin, anticoagulants, opioids, potassium, digoxin.
Learning objectives
- Say the antidote.
- Say the hold parameter.
- Say the teaching landmine.
Daily lesson
- Five drugs. Three facts each. That is the whole sitting.
- Opioid overdose: naloxone and an airway. Antidote without airway is still wrong.
- Potassium: never IV push. Heparin: protamine. Warfarin: vitamin K. Digoxin: hold for the pulse, the potassium, and the halos.
- Insulin: peak, tray, and the number that means you do not give it.
- Say the triad out loud. If you cannot hear it, you do not have it.
Reflect and review
Antidote without airway is still wrong in an opioid overdose.
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: Final review tips
Day 89
Day 89 • TaperTest-day rules, then one mixed sitting
Pearson rules, a breakfast you already know, and a first case that is a handoff.
Learning objectives
- Match the name on the authorization to the ID in your pocket.
- Plan two optional breaks that count against the clock.
- Treat the first case study as a handoff, not a trivia hour.
Daily lesson
- The name on your authorization to test has to match the ID you will hand over. Check it tonight, not in the parking lot.
- The clock does not stop for breaks. Optional breaks near 2 hours and 3.5 hours are still on the 5-hour meter.
- No new nootropics, no new energy drink, no new supplement a classmate swore by in the group chat.
- The first unfolding case is a handoff. Read it the way you read night report. Trends first, then the question.
- You need to stay above the cut score. You do not need to ace every item. That sentence is how you leave an item behind.
Reflect and review
You need to stay above the cut score, not ace every 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: End the session by listing one thing you will watch for more carefully next time.
Related: Final review tips
Day 90
Day 90 • CapstoneCapstone mixed sitting, then you close the book
Last full daily test. Then rest on purpose.
Learning objectives
- Take the sitting once.
- Review misses one time.
- Stop studying after the review.
Daily lesson
- No 400-item binge tonight. Closing the book is a clinical skill. Fatigue creates fails that knowledge would have saved.
- Trust the process you already built: task word, framework, scope, click, next.
- Review misses once. Write one sentence rules. Then do something that is not a question bank — food, a walk, a person who does not quiz you.
- Sleep. A rested nurse beats a heroic one on CAT items that all feel hard.
- This app is practice. It is not the NCLEX, not an official score, and not a promise. You already know how to take care of people. Tomorrow you show a computer that judgment.
Reflect and review
Fatigue creates fails that knowledge would have saved. Close the book.
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: Final review tips