Memory tricks for nursing fundamentals

I PREPARE guides you through a complete environmental health assessment — identifying exposures at work, home, and during daily activities. Environmental factors are often overlooked but can be the root cause of many chronic conditions.

Use the 5 P's for every neurovascular check — especially when a patient has a cast, or has had an orthopedic or vascular procedure. Any abnormality signals compromised circulation and requires immediate intervention.

Always begin with ABC and patient safety. Once those are secured move through the framework systematically. Rapid assessment is essential to trauma patient survival — this framework keeps you focused under pressure.

AMPLE is your rapid medical history tool for trauma patients — especially before they go to surgery. Gathering this information quickly can prevent life-threatening complications during and after the procedure.

Altered mental status has many causes beyond neurological injury. AEIOU TIPS ensures you systematically explore every possibility before concluding the cause. Missing a treatable cause like hypoglycemia or infection can be fatal.

ADPIE describes the complete nursing process from start to finish. Every patient encounter follows these five steps in order. Mastering ADPIE is essential for NCLEX and clinical practice.

ROME interprets arterial blood gases. Check the pH first: below 7.35 is acidosis, above 7.45 is alkalosis. Then find the value that explains it. CO₂ (lungs, respiratory) moves OPPOSITE the pH. HCO₃⁻ (kidneys, metabolic) moves the SAME way as the pH. If the other value is abnormal too, the body is compensating.

SAMPLE is your guide for collecting a thorough patient health history during assessment. Each letter ensures you don't miss a critical area that could affect diagnosis or treatment decisions. It's AMPLE with one extra letter up front: S for signs and symptoms, so it works for any patient, not just trauma.

AVPU is a quick tool to assess a patient's level of consciousness based on their eye, vocal, and motor responses. It's faster than the full Glasgow Coma Scale and used in rapid assessments and emergencies. Any drop from the patient's baseline needs immediate assessment and provider notification, and a patient at P or U may not be able to protect their airway.

RICE is the standard first-line treatment for musculoskeletal injuries like sprains and strains. Simple, effective, and always testable on NCLEX — every nurse needs to know this cold.

PISO helps you remember the normal location of the two most important electrolytes. This is foundational knowledge for understanding fluid balance, cardiac function, and IV therapy.

BEEP helps you remember the four signs of minor bleeding that indicate a patient needs bleeding precautions. These are especially important when caring for patients on anticoagulants or with low platelet counts.

When multiple patients or problems: always prioritize in order. Airway: most critical — no airway = dead in minutes. Breathing: respiratory rate, effort, SpO2. Circulation: pulse, blood pressure, perfusion. Safety: falls, restraints, environment. Then Maslow's hierarchy: physiological → safety → love/belonging → esteem → self-actualization. NCLEX tip: physiological needs always come before psychosocial. Exception: if patient says 'I want to kill myself' — safety overrides physical needs. Actual problems before potential problems. Acute before chronic.

SATA questions on the Next Gen NCLEX are scored +/−: each correct pick earns a point and each wrong pick cancels one. Strategy: cover other options, read each one independently as True/False. Avoid: looking for patterns (2 and 4, all of the above thinking). Each option is its own T/F question. If unsure about one option — ask 'would a safe nurse do this?' Common trap: including an intervention that's appropriate but NOT the priority or NOT related to the specific scenario. Always re-read the stem after selecting to make sure your answers make clinical sense together.

Physiological: oxygen, food, water, shelter, sleep, elimination — ALWAYS first priority. Safety: security, protection from harm, falls prevention. Love/Belonging: relationships, family, social connection. Esteem: self-confidence, achievement, respect. Self-Actualization: reaching full potential. NCLEX application: patient with breathing problem AND anxiety → treat breathing first. Patient with pain AND loneliness → treat pain first. Exception: immediate safety threat (suicidal ideation) → safety before some physiological needs.

Standard precautions: for ALL patients — hand hygiene, gloves for body fluids. Contact precautions (gloves + gown): MRSA, VRE, C. diff, scabies, RSV. Private room preferred. Droplet precautions (surgical mask on entering room): influenza, pertussis, meningitis (meningococcal), mumps, rubella, strep pharyngitis. Airborne precautions (N95 + negative pressure room): TB, measles (rubeola), varicella (chickenpox), disseminated zoster (both also need contact). Mnemonic for airborne: MTV — Measles, TB, Varicella. N95 must be fit-tested. Patient wears surgical mask when transported.

Blood pressure: normal <120/80, hypertension ≥130/80, hypotension <90/60. Heart rate: 60–100 bpm. Tachycardia >100 (pain, fever, hypovolemia, anxiety). Bradycardia <60 (athletes normal, beta blockers, increased ICP). Respiratory rate: 12–20 breaths/min. Tachypnea >20 (fever, pain, anxiety, respiratory distress). Bradypnea <12 (opioids — hold medication). Temperature: 36.1–37.2°C. Fever >38°C (100.4°F). SpO2: ≥95% normal, <90% hypoxemia needing prompt action. Pulse pressure: systolic - diastolic = 40 mmHg normal. Widening pulse pressure = increased ICP.

OLDCART: Onset (when did it start?), Location (where? does it radiate?), Duration (constant or intermittent?), Character (sharp, dull, burning, crushing?), Aggravating factors (what makes it worse?), Relieving factors (what helps?), Treatment (what have you tried?). Pain scales: NRS 0–10 (adults), FACES (children 3+), FLACC (infants/non-verbal — Face, Legs, Activity, Cry, Consolability). Reassess: 30–60 min after oral meds, 15–30 min after IV. Document: location, quality, severity, response to treatment. Pain is subjective — believe the patient.

Safe body mechanics protect the nurse from injury during patient care: maintain a wide base of support (feet shoulder-width apart), bend at the knees and hips rather than the waist/back when lifting, keep the load as close to the body's center of gravity as possible, and pivot with the feet instead of twisting the spine when changing direction. Use assistive devices — gait belts, mechanical lifts, slide sheets — for any patient who cannot fully bear weight or assist with movement, and get help from a second person for anything heavy or unpredictable rather than attempting it alone. Raising the bed to a comfortable working height before performing care also reduces strain. Musculoskeletal injury is one of the most common occupational injuries among nurses, and it is largely preventable with consistent use of these principles.

Preoperative nursing priorities: verify that informed consent is signed and the patient demonstrates understanding of the procedure — the nurse witnesses the signature but does not obtain consent, which is the surgeon's responsibility. Confirm NPO status per facility policy. Teach deep breathing, coughing, and incentive spirometer technique before surgery, while the patient is pain-free and able to learn — these skills prevent postoperative atelectasis and pneumonia. Remove jewelry, dentures, nail polish, and makeup (nail polish and dark polish interfere with pulse oximetry readings), and have the patient void before transport to the OR. Obtain baseline vital signs, and confirm the surgical site is marked per the Universal Protocol (correct patient, correct procedure, correct site) — a Joint Commission safety requirement. Address patient anxiety and answer remaining questions throughout.

MORSE Fall Scale risk factors: history of falls, secondary diagnosis, ambulatory aid (cane/walker), IV access, gait (weak/impaired), mental status (forgets limitations). High score = high risk. Interventions: bed lowest position and locked, call light within reach, non-slip footwear (socks with grips), keep personal items close, hourly rounding (4 Ps: Pain, Position, Potty, Personal items), bed alarm, yellow armband/door sign. High-risk medications: sedatives, opioids, antihypertensives, diuretics, antidiabetics. Do NOT restrain to prevent falls.

Restraints: physical or chemical limitation of movement. Must have: physician/LIP order (time-limited; violent: 4 h adults, 2 h ages 9–17, 1 h under 9), documented clinical justification, less restrictive alternatives tried first. Nursing responsibilities: restraint as LAST resort (try redirection, call family, sitter first). Check every 30 minutes: neurovascular status (circulation, sensation, movement). Release every 2 hours: reposition, ROM, toileting, skin care. Tie to bed frame (NOT side rail) with quick-release knot. Document every hour. Wrist restraints: keep 2 fingers under. Never restrain in prone position. Reassess need at every check; remove at the earliest possible time.

Infiltration: IV fluid leaks into surrounding tissue (non-vesicant). Signs: swelling, cool, pale, pain at site. Stop infusion, remove IV, elevate extremity, warm compress. Phlebitis: vein inflammation. Signs: redness, warmth, pain along vein, palpable cord. Stop infusion, remove IV, warm compress, document. Extravasation: vesicant (tissue-damaging drug) leaks — most serious. Signs: burning, blistering, tissue necrosis. STOP immediately, leave IV in place, aspirate, give antidote per protocol. Examples of vesicants: chemotherapy, calcium chloride, potassium (concentrated), dopamine, vancomycin. Document site every 1–2 hours.

Therapeutic techniques: Open-ended questions ('Tell me more about...'), Reflection (repeat back feelings), Clarification ('I'm not sure I understand...'), Active listening, Silence (powerful — allows patient to process), Focusing, Summarizing. Non-therapeutic (AVOID): False reassurance ('Everything will be fine'), Why questions ('Why did you...?' — puts patient on defensive), Giving personal opinions/advice, Changing the subject, Closed questions (yes/no only). For mental health: never argue with delusions, set limits on behavior (not feelings), don't agree with hallucinations but don't argue.

Charting rules: factual and objective (what you see, hear, smell — not interpretations). Accurate: exact times, measurements, quotes. Timely: document as soon as possible after care. Complete: assessments, interventions, patient response, teaching, referrals. Correct errors: single line through error, write 'error,' date, initials — NEVER white-out or delete. Late entries: clearly label as 'late entry' with date/time of actual occurrence. Legal: medical record is a legal document. Patient quotes: use exact words in quotation marks. Avoid vague terms: 'seems better' → use objective data.

5 Rights of Delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision. RN scope: assessment, care planning, teaching, evaluation, complex interventions, unstable patients. LPN scope: stable patients, routine medications (some states IV), wound care, data collection, reinforcing teaching. UAP (CNA) scope: ADLs (bathing, feeding, ambulation), vital signs (stable patients), I&O, specimen collection, positioning. NEVER delegate to UAP: assessment, teaching, evaluation, care planning, unstable patients, complex procedures. RN remains accountable for all delegated tasks.

Assess every wound: Location, Size (length x width x depth in cm), Edges (well-defined, undermining, tunneling), Color of wound bed (red = granulating/healing, yellow = slough (devitalized, not infection by itself), black = necrotic/eschar), Exudate (color, amount, odor — purulent = infection), Surrounding skin (erythema, warmth, induration, maceration). Dressing principles: wet-to-dry (debrides — change q8h), hydrocolloid (moist healing, non-infected), alginate (heavy exudate), foam (moderate), transparent film (superficial/low exudate). Sterile technique for surgical/acute wounds; clean technique for chronic wounds per facility policy. Irrigate with normal saline — never hydrogen peroxide (destroys granulation tissue). Document before and after every dressing change. Report: increasing pain, spreading erythema, fever, foul odor, new dehiscence.

Surgical asepsis = complete absence of microorganisms. Used for: sterile dressing changes, catheter insertion, central line insertion, surgical procedures, LP, thoracentesis. Rules of a sterile field: Only sterile touches sterile — if unsure, it's contaminated. One-inch border around sterile field is considered contaminated. Sterile field must be kept in sight at all times — turn your back = contaminated. Moisture = contamination (wet = pathway for microorganisms). Sterile items below waist level = contaminated. Open sterile packages away from you (flap away first). Pour liquids from a distance — splashing contaminates. Never reach across a sterile field. NCLEX classic: glove tears, items fall below waist, field gets wet — always start over.

Know the FiO2 each device delivers: Nasal Cannula (NC): 1–6 L/min = 24–44% FiO2 (each liter adds ~4%). Simple Mask (SM): 5–10 L/min = 35–50% FiO2 (minimum 5 L to prevent CO2 rebreathing). Partial Rebreather Mask: 6–10 L/min = 40–70% FiO2. Non-Rebreather Mask (NRM): 10–15 L/min = 60–100% FiO2 — highest non-invasive O2 delivery. Venturi Mask: precise FiO2 (24–50%) — best for COPD (prevents suppression of hypoxic drive). High-Flow Nasal Cannula (HFNC): up to 60 L/min, heated/humidified, up to 100% FiO2. NCLEX: COPD patient with hypoxia → Venturi mask (controlled FiO2). SpO2 target: 94–98% most patients; 88–92% for COPD. Humidify O2 at flows >4 L/min.

CAUTI (Catheter-Associated Urinary Tract Infection) is one of the most common healthcare-associated infections. Insertion technique: sterile technique, smallest appropriate catheter size (14–16 Fr adults), cleanse urinary meatus with antiseptic (front to back in females), insert until urine flows then advance 1–2 inches more before inflating balloon. Maintenance: closed drainage system — never open. Catheter secured to inner thigh (female) or upper thigh (male) to prevent traction. Drainage bag always below bladder level — never on floor. Empty when 2/3 full or every 8 hours. Perineal care every shift with soap and water. NEVER disconnect tubing to obtain specimen — use needleless port. NCLEX: question the order — question any catheter order and advocate for removal ASAP. Straight catheter (in/out) preferred over indwelling when possible.

NG tubes are used for: gastric decompression, feeding (small bore), medication administration, lavage. Insertion: measure NEX (Nose-Earlobe-Xiphoid) for placement estimate, per facility protocol. Lubricate tip, insert through naris, ask patient to swallow sips of water as tube advances. NEVER force — if coughing/cyanosis, tube is in lungs — withdraw immediately. Verification (NCLEX critical): Gold standard = X-ray confirmation before first use. pH of aspirate: <5 = gastric (safe), 6+ = intestinal or respiratory (do not use). Auscultation of air insufflation is NOT reliable — do not use alone. Mark tube at nostril and check mark each shift. Secure to nose, never forehead. HOB ≥30° during feeding. Check residual if facility policy requires — ASPEN: don't hold feeds for GRV <500 mL without other signs of intolerance.

The provider explains the procedure, risks, benefits, and alternatives. The nurse's job is the 3 W's: Witness the signature, Watch for understanding/competence/voluntariness, Write it down. Consent must happen BEFORE any sedating pre-op medication — a classic timing trap.

Treatment, Payment, and Operations disclosures don't need separate authorization — refusing a legitimate handoff or consult "because nothing's signed" is a common wrong answer. Outside TPO, use the minimum necessary standard. Accessing a chart out of curiosity is a violation on its own, even if you tell no one.

Order of draw for blood: blood culture (yellow) first, then light blue, red, gold/SST, light green, green, lavender, gray — "Stop Light Red, Stay Put, Green Light Go." Clean-catch urine: discard the first portion, keep the midstream. Sputum needs a deep cough, not saliva. Wound cultures come from the wound base after cleansing, not surface drainage. Never pre-label a container before collecting.

Ventrogluteal is the preferred adult IM site (no major nerves/vessels, thickest muscle); vastus lateralis is preferred for infants. CDC/WHO no longer recommend routine aspiration for standard vaccine sites. Z-track prevents irritating/staining medications from leaking back — never massage a Z-track site. Heparin SubQ is never aspirated, never massaged. Rotate insulin/heparin sites to prevent lipohypertrophy.

Screen for barriers (health literacy, finances, transportation, social support) early, not at discharge, when there's no time left to solve them. Confirm understanding with teach-back — have the patient explain instructions in their own words — not by asking "any questions?" About 1 in 5 Medicare patients is readmitted within 30 days, and many of those readmissions are preventable.

Ice for new injury/swelling; heat for chronic stiffness. Distraction and guided imagery shift attention and activate the parasympathetic nervous system. Most of these interventions can be nurse-initiated without an order — but they complement medication for moderate-severe pain, they don't replace it. Delaying an ordered analgesic in favor of guided imagery alone is undertreatment.

Autonomy: patient's right to make informed decisions about their own care — even bad ones. Informed consent, right to refuse treatment, advance directives. Beneficence: do good — act in the patient's best interest. Advocate, promote health, prevent harm. Non-maleficence: do no harm — avoid actions that cause harm. Weighing risks vs benefits. Justice: fair, equal treatment — equitable distribution of resources, treating all patients fairly regardless of background. Fidelity: keep promises — follow through on commitments, maintain trust. Veracity: tell the truth — honest communication even when difficult. NCLEX applications: patient refuses blood transfusion (autonomy — respect it), family demands treatment patient declined (autonomy wins over beneficence), resource allocation (justice). Advance directives override family wishes when patient is incapacitated.

Kübler-Ross five stages: Denial ("This can't be happening") — allow denial as coping, do not force acceptance. Anger ("Why me?") — do not take personally, set limits on harmful behavior, therapeutic presence. Bargaining ("If I recover, I'll...") — listen without judgment, allow expression. Depression (grief, withdrawal) — sit with patient, avoid false reassurance, assess for clinical depression. Acceptance (peace, readiness) — facilitate meaningful time, support family. Stages are NOT linear — patients move back and forth. NCLEX nursing priorities at end of life: comfort (pain/dyspnea/anxiety management), dignity, family support, communication. Signs of imminent death: Cheyne-Stokes respirations, mottling, cooling extremities, decreased urine output, loss of reflexes, inability to swallow. Hospice: comfort-focused, curative treatment stopped, family included in care.

Cultural competence = providing care that meets social, cultural, and linguistic needs of patients. Key concepts: Cultural awareness (recognizing your own biases), Cultural knowledge (learning about other cultures), Cultural sensitivity (respecting differences), Cultural humility (ongoing learning — not assuming you "know" a culture). NCLEX applications: Always use a professional interpreter for non-English speakers — never use family members or children (privacy, accuracy). Respect religious practices: Jehovah's Witnesses refuse blood products (autonomy), some cultures require same-sex providers, dietary laws (halal/kosher/vegetarian), prayer and healing rituals. Pain expression varies by culture — do not make assumptions. Eye contact, personal space, and touch norms differ. Avoid stereotyping — individual assessment always. Acknowledge and incorporate beliefs into the care plan when safe.

SBAR is the universal communication framework used during handoffs, phone calls to physicians, and critical situation reporting. Joint Commission endorses it as a patient safety tool. In real practice: state the Situation first ("My patient's BP just dropped to 80/50"), then Background, then your Assessment, then what you Recommend.

Two mnemonics, one fire emergency. RACE is the response priority order — Rescue patients in immediate danger FIRST before anything else. PASS is how to use the extinguisher. Always aim at the BASE of the fire, not the flames. Critical NCLEX rule: patient safety before property, always.