Comprehensive System-by-System NCLEX Review (High-Yield)

Cardiovascular

Myocardial Infarction (MI)

• S/S: Crushing chest pain radiating to arm/jaw/back, diaphoresis, SOB, N/V; atypical in women/older adults.

• Immediate steps (MONA): Morphine, Oxygen, Nitroglycerin, Aspirin.

• Also: 12-lead ECG ≤10 min, troponin/CK-MB, beta-blocker, ACE-I, prep for PCI.

Heart Failure

• Left-sided: Pulmonary crackles, dyspnea, orthopnea, PND, pink frothy sputum, S3.

• Right-sided: JVD, hepatomegaly, ascites, edema, rapid weight gain.

• Nursing: Daily weights (same scale/time), I&O, Na+ restriction (~2 g/day), fluid restriction, high-Fowler’s, med adherence.

Hypertension—Patient teaching
DASH diet (low Na+), exercise, weight control, limit alcohol, stop smoking, stress reduction, don’t stop meds abruptly.

Respiratory

COPD vs Asthma (high-yield comparison)

COPD care: Short/long-acting bronchodilators, low-flow O₂ (avoid CO₂ retention), vaccines, pulm rehab, smoking cessation (most important).

Asthma care: Peak-flow tracking, ICS controllers, SABA rescue, trigger control, written action plan.

Pneumonia—priorities
Airway clearance (C&DB, positioning), O₂/SpO₂ monitoring, hydration, culture then antibiotics, elder red flag: confusion.

Neurological

Stroke FAST: Face droop, Arm drift, Speech difficulty, Time to call 911 (note onset).

• Ischemic: tPA if eligible (3–4.5 h), then aspirin after 24 h if tPA given.

• Hemorrhagic: BP control, no tPA/anticoagulants, possible surgery.

Increased ICP

• Early: ↓LOC (most sensitive), pupil change, headache, vomiting.

• Late (Cushing triad): ↑BP with wide pulse pressure, bradycardia, irregular respirations.

• Nursing: HOB 30°, midline head, avoid Valsalva/hip flexion, hourly neuro checks, mannitol as ordered.

Seizure care

• During: Protect from injury, time it, side-lying, no restraints/objects in mouth.

• After: Airway, reorient, document features, med per order.

Endocrine

Diabetes—targets
Pre-meal 80–130 mg/dL; 2-hr post-meal <180 mg/dL; A1c <7%.

Emergencies

Hypoglycemia

• Mild (54–70): 15 g fast carb → recheck in 15 min.

• Severe (<54): Glucagon IM/SQ or D50 IV; monitor closely.

Thyroid

• Thyroid storm: Hyperthermia, tachy, HTN → antithyroid + beta-blocker + steroids; cool environment, cardiac monitor.

• Myxedema coma: Hypothermia, brady, ↓LOC → IV levothyroxine + steroids; warm, resp support.

GI & Hepatic

Peptic Ulcer Disease

• Risks: H. pylori, NSAIDs, steroids, smoking, alcohol.

• Complications: GI bleed, perforation (rigid abdomen), obstruction.

• Tx: Triple therapy for H. pylori; PPI; avoid NSAIDs/alcohol.

IBD comparison

Cirrhosis—watch for jaundice, ascites, varices, encephalopathy (asterixis).

• Encephalopathy: Lactulose (goal 2–3 soft stools/day), limit sedatives, monitor ammonia (<50 mcg/dL).

Renal & Urinary

AKI phases: Onset → Oliguric (<400 mL/24h) → Diuretic (↑UO) → Recovery.

• Causes: Pre-renal (dehydration, HF), intra-renal (nephrotoxins/contrast), post-renal (obstruction).

CKD stages (by GFR):
Stage 1 ≥90 → 2 (60–89) → 3 (30–59) → 4 (15–29) → 5 <15 (dialysis).

• Management: BP control (ACE-I), fluid/electrolyte balance, anemia/bone disease care.

Safety & Priorities (always testable)

• ABCs first; unstable > stable; acute > chronic; safety > comfort.

• Infection control: standard vs contact/droplet/airborne.

• Delegation: RN = assess/teach/evaluate; LPN = stable care/meds (no IV push in many states); UAP = ADLs/vitals (stable).

• Documentation (5 C’s): Clear, Concise, Complete, Correct, Current.

Smart Study Moves

• Daily mixed Med-Surg questions + full-length sims (CAT style).

• Review lab values tied to action decisions (K⁺, Na⁺, creatinine, troponin, INR).

• Case-based learning for clinical judgment.

Helpful internal reads 

• Top Med-Surg NCLEX Topics You Can’t Afford to Miss

• Pharmacology Made Easy for NCLEX

• How to Tackle Maternity NCLEX Questions with Confidence

• NCLEX Pathophysiology Exam Guide: Master Disease Processes