Fundamentals of Nursing, Assessment, Vital Signs, and the Nursing Process
Everything in nursing starts with accurate assessment and the nursing process. These foundational terms and frameworks appear on every first-semester exam.
Core Assessment Frameworks
The nursing process (ADPIE) provides your systematic approach: Assessment, Diagnosis, Planning, Implementation, Evaluation. When prioritizing care, use Maslow's hierarchy (physiological needs first, then safety, love/belonging, esteem, self-actualization). In emergencies, always start with ABCs: Airway, Breathing, Circulation.
Vital Signs and Normal Ranges
Normal adult values are:
- Temperature: 97-99°F
- Heart rate: 60-100 bpm
- Respiratory rate: 12-20 breaths per minute
- Blood pressure: Less than 120/80 mmHg
- Oxygen saturation: 95% or higher
Assessment Structures You Must Know
Pain assessment (PQRST) structures your pain history: Provokes, Quality, Radiation, Severity, Time. Use SBAR for handoffs: Situation, Background, Assessment, Recommendation. For fall risk, assess age over 65, fall history, gait instability, and sedating medications using tools like the Morse scale.
Infection Control and Precautions
Break the infection chain at any link (agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host). Apply standard precautions to every patient: hand hygiene, gloves, masks, gowns, and proper sharps disposal. Use transmission-based precautions for specific diseases: contact (C. diff, MRSA), droplet (influenza, pertussis), airborne (TB, measles, varicella).
Medication Safety and Skin Assessment
Follow the five rights of medication administration: right patient, right drug, right dose, right route, right time. Some sources add right documentation and right reason. Know pressure injury stages: Stage 1 (non-blanchable redness), Stage 2 (partial-thickness loss), Stage 3 (full-thickness loss), Stage 4 (bone or muscle exposure), plus unstageable and deep tissue injury.
Clinical Communication and Consent
Use therapeutic communication: open-ended questions, active listening, reflection, and silence. Avoid "why" questions and false reassurance. Informed consent requires the physician to disclose risks, benefits, and alternatives while you witness the signature. Practice delegation using the five rights: right task, right circumstance, right person, right direction, right supervision.
Orthostatic Changes
Orthostatic hypotension is a drop of 20 mmHg or more systolic (or 10 mmHg or more diastolic) within 3 minutes of standing. This is a key safety flag for fall risk.
| Term | Meaning |
|---|---|
| Nursing process (ADPIE) | Assessment, Diagnosis, Planning, Implementation, Evaluation. The systematic framework for nursing care. |
| Normal adult vital signs | Temp 97-99°F, HR 60-100 bpm, RR 12-20, BP <120/80, SpO2 ≥95%. |
| Maslow's hierarchy | Priority framework: physiological needs first, then safety, love/belonging, esteem, self-actualization. |
| ABCs | Airway, Breathing, Circulation. Always the first priority in any emergency assessment. |
| Five rights of medication administration | Right patient, right drug, right dose, right route, right time. Some sources add right documentation and right reason. |
| Pain assessment (PQRST) | Provokes, Quality, Radiation, Severity, Time. Structure for a complete pain history. |
| Fall risk assessment | Identified with tools like the Morse scale. Key factors include age >65, history of falls, gait instability, and sedating medications. |
| Infection chain | Agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Breaking any link prevents infection. |
| Standard precautions | Hand hygiene, gloves, masks, gowns, and proper disposal of sharps used with every patient regardless of diagnosis. |
| Transmission-based precautions | Contact (C. diff, MRSA), droplet (influenza, pertussis), airborne (TB, measles, varicella). |
| Pressure injury stages | Stage 1: non-blanchable redness; Stage 2: partial-thickness loss; Stage 3: full-thickness loss; Stage 4: exposure of bone/muscle; unstageable and deep tissue injury. |
| Orthostatic hypotension | Drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing. |
| Therapeutic communication | Open-ended questions, active listening, reflection, and silence. Avoid 'why' questions and false reassurance. |
| Informed consent | Requires disclosure of risks, benefits, and alternatives. Physician obtains; nurse witnesses the signature. |
| SBAR | Situation, Background, Assessment, Recommendation. The structured handoff format. |
| Delegation (5 rights) | Right task, right circumstance, right person, right direction, right supervision. |
Essential Lab Values Every Nurse Must Memorize
NCLEX and every med-surg exam tests your ability to interpret lab values quickly. These ranges must be instantly recallable.
Electrolytes and Their Clinical Significance
- Sodium (Na): 135-145 mEq/L. Low causes confusion and seizures. High causes thirst and neurological changes.
- Potassium (K): 3.5-5.0 mEq/L. Narrow therapeutic range. Both extremes cause dangerous arrhythmias.
- Calcium: 9.0-10.5 mg/dL. Low causes tetany and Chvostek/Trousseau signs. High causes bone pain and kidney stones.
- Magnesium: 1.3-2.1 mEq/L. Low causes tremors and torsades de pointes. High causes hyporeflexia and respiratory depression.
Kidney Function Markers
BUN (10-20 mg/dL) rises with dehydration, renal failure, GI bleeding, and high-protein diets. Creatinine (0.6-1.2 mg/dL) is more specific to kidney function than BUN and changes less with diet.
Blood Cell Counts
- Hemoglobin: Males 13.5-17.5 g/dL; females 12-16 g/dL. Low indicates anemia.
- Hematocrit: Males 41-53%; females 36-46%. Roughly three times the hemoglobin value.
- WBC: 5,000-10,000 per mm^3. Elevated in infection, inflammation, and leukemia. Low after chemotherapy.
- Platelets: 150,000-400,000 per mm^3. Bleeding risk rises sharply below 50,000.
Glucose and Diabetes Diagnosis
Fasting glucose is 70-110 mg/dL. Diabetes is diagnosed when fasting glucose is 126 mg/dL or higher on two occasions, or A1C is 6.5% or higher.
Clotting Studies
INR (International Normalized Ratio): 0.8-1.2 is normal; 2.0-3.0 is therapeutic for most warfarin uses. aPTT (activated partial thromboplastin time): 25-35 seconds is normal; 1.5-2.5 times control is therapeutic for heparin.
Acid-Base Balance
pH: 7.35-7.45. Below 7.35 is acidosis; above 7.45 is alkalosis. PaCO2: 35-45 mmHg (respiratory component). HCO3: 22-26 mEq/L (metabolic component).
Drug Levels
Digoxin level: Therapeutic 0.5-2.0 ng/mL. Toxicity causes visual changes, nausea, and arrhythmias.
| Term | Meaning |
|---|---|
| Sodium (Na) | 135-145 mEq/L. Low causes confusion, seizures; high causes thirst, neuro changes. |
| Potassium (K) | 3.5-5.0 mEq/L. Narrow therapeutic range, both extremes cause arrhythmias. |
| Calcium | 9.0-10.5 mg/dL. Low causes tetany and Chvostek/Trousseau signs; high causes bone pain and kidney stones. |
| Magnesium | 1.3-2.1 mEq/L. Low causes tremors, torsades; high causes hyporeflexia and respiratory depression. |
| Glucose (fasting) | 70-110 mg/dL. Diabetes diagnosed at fasting ≥126 mg/dL on two occasions or A1C ≥6.5%. |
| BUN | 10-20 mg/dL. Elevated with dehydration, renal failure, GI bleed, and high-protein diets. |
| Creatinine | 0.6-1.2 mg/dL. More specific to kidney function than BUN. |
| Hemoglobin | Males 13.5-17.5 g/dL; females 12-16 g/dL. Low indicates anemia. |
| Hematocrit | Males 41-53%; females 36-46%. Roughly three times the hemoglobin value. |
| WBC | 5,000-10,000/mm^3. Elevated in infection, inflammation, leukemia; low after chemotherapy. |
| Platelets | 150,000-400,000/mm^3. Bleeding risk rises sharply below 50,000. |
| INR | 0.8-1.2 normal; 2.0-3.0 therapeutic for most warfarin indications. |
| aPTT | 25-35 seconds normal; 1.5-2.5× control for therapeutic heparin. |
| ABG pH | 7.35-7.45. Below is acidosis, above is alkalosis. |
| ABG PaCO2 | 35-45 mmHg. Respiratory component of acid-base balance. |
| ABG HCO3 | 22-26 mEq/L. Metabolic component of acid-base balance. |
| Digoxin level | Therapeutic 0.5-2.0 ng/mL. Toxicity causes visual changes, nausea, and arrhythmias. |
High-Yield Medications for NCLEX and Med-Surg
These drug classes and prototypes appear in almost every NCLEX question bank. Learn medications at the class level with one or two key examples for each.
Pain Management
Acetaminophen is a non-opioid analgesic and antipyretic. Maximum dose is 4 g per day in healthy adults. Overdose causes hepatotoxicity, treated with N-acetylcysteine. Opioids (morphine example) require monitoring for respiratory depression, sedation, and constipation. Reverse opioid toxicity with naloxone.
Anticoagulation
Heparin is monitored with aPTT levels. Reverse with protamine sulfate. Watch for HIT (heparin-induced thrombocytopenia). Warfarin is an oral anticoagulant monitored with INR. Reverse with vitamin K. Avoid diets high in green leafy vegetables, as they contain vitamin K and reduce warfarin effectiveness.
Cardiovascular Drugs
Beta blockers (metoprolol example) lower heart rate and blood pressure. Hold for HR less than 60. Never stop abruptly. ACE inhibitors (lisinopril example) lower blood pressure. Side effects include dry cough, hyperkalemia, and angioedema. Monitor potassium and creatinine. Calcium channel blockers (amlodipine example) treat hypertension and angina. Common side effects are peripheral edema, constipation, and reflex tachycardia.
Diuretics and Heart Failure
Loop diuretics (furosemide example) waste potassium significantly. Monitor potassium closely. Watch for ototoxicity with rapid IV infusion. Digoxin is a positive inotrope for heart failure and atrial fibrillation. Hold for apical pulse less than 60. Hypokalemia worsens digoxin toxicity.
Endocrine Drugs
Insulin has two main types: Regular peaks in 2-3 hours; NPH peaks in 4-12 hours. Monitor for hypoglycemia at peak times. Metformin is first-line oral diabetes therapy. Risk of lactic acidosis exists. Hold for 48 hours around contrast imaging. Levothyroxine (thyroid hormone) must be taken on an empty stomach. Overdose signs include tachycardia, weight loss, and tremors.
Anti-Inflammatory and Psychiatric Drugs
Corticosteroids (prednisone example) require slow tapering. Side effects include hyperglycemia, immunosuppression, osteoporosis, and mood changes. SSRIs (sertraline example) take 4-6 weeks for full effect. Watch for serotonin syndrome when combined with other serotonergic drugs. Benzodiazepines (lorazepam example) are anxiolytics and sedatives. Risk respiratory depression. Reverse with flumazenil.
Antibiotics
Vancomycin requires trough level monitoring (10-20 mcg/mL). Red man syndrome occurs with rapid infusion. This drug is nephrotoxic and ototoxic.
| Term | Meaning |
|---|---|
| Acetaminophen | Non-opioid analgesic and antipyretic. Max 4 g/day in healthy adults. Hepatotoxic in overdose; treat with N-acetylcysteine. |
| Opioids (morphine) | Monitor for respiratory depression, sedation, and constipation. Reverse with naloxone. |
| Heparin | Anticoagulant monitored with aPTT. Reverse with protamine sulfate. Watch for HIT (heparin-induced thrombocytopenia). |
| Warfarin | Oral anticoagulant monitored with INR. Reverse with vitamin K. Avoid diets high in green leafy vegetables. |
| Beta blockers (metoprolol) | Lower HR and BP; used for HTN, CAD, heart failure. Hold for HR <60. Avoid abrupt withdrawal. |
| ACE inhibitors (lisinopril) | Lower BP. Side effects: dry cough, hyperkalemia, angioedema. Monitor K+ and creatinine. |
| Calcium channel blockers (amlodipine) | Used for HTN and angina. Side effects: peripheral edema, constipation, reflex tachycardia. |
| Diuretics (furosemide) | Loop diuretic that wastes potassium. Monitor K+, watch for ototoxicity with rapid IV push. |
| Insulin (regular vs NPH) | Regular peaks 2-3 hr; NPH peaks 4-12 hr. Monitor for hypoglycemia at peak times. |
| Metformin | First-line oral antidiabetic. Risk of lactic acidosis. Hold for 48 hours around contrast imaging. |
| Levothyroxine | Thyroid hormone replacement. Take on empty stomach. Signs of overdose: tachycardia, weight loss, tremors. |
| Corticosteroids (prednisone) | Anti-inflammatory. Taper off slowly. Side effects: hyperglycemia, immunosuppression, osteoporosis, mood changes. |
| SSRIs (sertraline) | Take 4-6 weeks for full effect. Watch for serotonin syndrome when combined with other serotonergic drugs. |
| Benzodiazepines (lorazepam) | Anxiolytic, sedative, anticonvulsant. Risk of respiratory depression. Reverse with flumazenil. |
| Antibiotics, vancomycin | Monitor trough levels (10-20 mcg/mL). Red man syndrome occurs with rapid infusion. Nephrotoxic and ototoxic. |
| Digoxin | Positive inotrope for heart failure and atrial fibrillation. Hold for apical pulse <60. Toxicity worsened by hypokalemia. |
How to Study nursing Effectively
Mastering nursing requires the right approach, not just more hours. Three techniques produce the best learning outcomes: active recall (testing yourself rather than re-reading), spaced repetition (reviewing at scientifically-optimized intervals), and interleaving (mixing related topics instead of isolating them). FluentFlash is built around all three methods.
When you study with our FSRS algorithm, every term is scheduled at exactly the moment you're about to forget it. This maximizes retention while minimizing study time.
Why Passive Review Fails
The most common mistake is relying on passive methods. Re-reading notes, highlighting textbook passages, or watching lectures feels productive but produces only 10-20% of the retention that active recall achieves. Flashcards force your brain to retrieve information, strengthening memory pathways far more than recognition alone.
Pair flashcards with spaced repetition scheduling, and you learn in 20 minutes what would take hours of passive review.
A Practical Study Plan
- Create 15-25 flashcards covering the highest-priority concepts
- Review them daily for the first week using FSRS scheduling
- As cards become easier, intervals expand automatically from minutes to days to weeks
- Stay focused on material at the edge of your knowledge
- After 2-3 weeks of consistent practice, concepts become automatic rather than effortful
- 1
Generate flashcards using FluentFlash AI or create them manually from your notes
- 2
Study 15-20 new cards per day, plus scheduled reviews
- 3
Use multiple study modes (flip, multiple choice, written) to strengthen recall
- 4
Track your progress and identify weak topics for focused review
- 5
Review consistently, daily practice beats marathon sessions
Why Flashcards Work Better Than Other Study Methods for nursing
Flashcards aren't just for vocabulary. They're one of the most research-backed study tools for any subject, including nursing. Memory works through retrieval practice. When you read a textbook passage, your brain stores it in short-term memory, but without retrieval practice, it fades within hours. Flashcards force retrieval, transferring information from short-term to long-term memory.
The Testing Effect
The "testing effect," documented in hundreds of peer-reviewed studies, shows that flashcard students consistently outperform re-readers by 30-60% on delayed tests. This isn't because flashcards contain more information. It's because retrieval strengthens neural pathways in ways passive exposure cannot. Every successful recall makes that concept easier to recall next time.
FSRS Amplifies Results
FluentFlash amplifies this effect with the FSRS algorithm, a modern spaced repetition system that schedules reviews at mathematically-optimal intervals based on your actual performance. Cards you find easy move further into the future. Cards you struggle with return sooner.
Over time, this builds remarkable retention with minimal time investment. Students using FSRS systems typically retain 85-95% of material after 30 days, compared to roughly 20% retention from passive review alone.