📖 Nursing glossary
316 nursing terms explained in one plain sentence each, with the lesson that teaches it.
The exam
Computer adaptive testing (CAT)
An exam that picks each next question based on your answers so far, hunting for the level where you start to miss.
📚 Learn it: Why Every Question Feels Hard (That's the Point)
Passing standard
The ability level set by NCSBN that a candidate must be shown to be above, with 95% confidence, to pass.
Clinical Judgment Measurement Model
NCSBN's six-step model (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes) that case-study items follow.
Select all that apply (SATA)
An item where any number of options can be correct, so each option is judged on its own as true or false.
📚 Learn it: SATA: Every Option Is Its Own True-or-False Question
Bowtie item
A stand-alone item with the client's condition in the center, two actions on the left and two parameters to monitor on the right.
📚 Learn it: The Bowtie: Condition in the Middle, Actions Left, Parameters Right
Matrix item
A grid that asks you to classify each row (a finding or order) into one of the columns, with each row scored on its own.
Authorization to Test (ATT)
The emailed permission to schedule the exam, valid for a limited window set by your nursing regulatory body.
Candidate Performance Report
The breakdown by content area that candidates who do not pass receive, used to plan the next attempt.
Priority & management
ABCs
The first prioritization rule: airway problems outrank breathing problems, which outrank circulation problems.
Maslow's hierarchy
A ranking of needs where physiological needs come before safety, and both come before emotional needs.
Nursing process (ADPIE)
Assessment, diagnosis, planning, implementation and evaluation, the cycle every plan of care follows.
📚 Learn it: ADPIE: Nursing Diagnoses Are Not Medical Diagnoses
Delegation
Assigning a task to another person while the registered nurse remains accountable for the outcome.
Five rights of delegation
Right task, right circumstance, right person, right direction and right supervision.
Unlicensed assistive personnel (UAP)
Staff such as nursing assistants who do routine, predictable tasks for stable clients under the nurse's direction.
START triage
A disaster sorting system that tags victims red (immediate), yellow (delayed), green (minor) or black (expectant).
📚 Learn it: Disaster Triage: Sickest First Is Sometimes Wrong
Informed consent
A competent client's voluntary agreement to a procedure after the provider explains its risks, benefits and alternatives.
Advance directive
A document stating a client's treatment wishes or naming a decision-maker for when the client cannot decide.
📚 Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'
Do-not-resuscitate order (DNR)
A provider's order to withhold CPR in cardiac or respiratory arrest; every other treatment continues.
📚 Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'
SBAR
Situation, background, assessment, recommendation: the structure for reporting a client problem to a provider.
📚 Learn it: SBAR, Handoffs and When to Climb the Chain of Command
Incident report
An internal quality document filed for any unusual event, kept out of the client's chart and never mentioned in it.
📚 Learn it: Incident Reports, Root Causes and Who to Refer To
Safety & infection
Standard precautions
The hand hygiene, protective equipment matched to the expected exposure, and safe sharps and injection practices used with every client, regardless of diagnosis.
Contact precautions
Gown and gloves for organisms spread by touch, such as MRSA, VRE, C. difficile and scabies.
Droplet precautions
A surgical mask worn on entering the room of a client with influenza, pertussis, mumps, rubella or meningococcal meningitis.
Airborne precautions
An N95 respirator and a negative-pressure room for tuberculosis, measles, varicella and disseminated zoster.
Negative-pressure room
A room that pulls air inward and vents it outside so airborne organisms cannot escape into the hallway.
Surgical asepsis
Technique that keeps an area completely free of microorganisms, used for catheters, central lines and invasive procedures.
📚 Learn it: Clean Versus Sterile, and the Chain You Are Breaking
Restraint
Any device or drug that restricts a client's movement, allowed only as a last resort with a time-limited, non-PRN order.
📚 Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots
Quick-release knot
A knot that frees a restraint with one pull, tied to the bed frame and never to the side rail.
📚 Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots
Morse Fall Scale
A fall-risk score built from fall history, diagnoses, mobility aids, IV lines, gait and mental status.
📚 Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach
High-alert medication
A drug such as insulin, heparin, opioids or concentrated electrolytes that causes serious harm if given wrong and needs an independent double check.
📚 Learn it: The Rights of Medication Administration and the Errors That Beat Them
RACE
Rescue, alarm, confine, extinguish or evacuate: the order of actions when a fire is discovered.
📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight
PASS
Pull, aim, squeeze, sweep: how to use a fire extinguisher.
📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight
Pharmacology & IV
Peak (insulin)
The time after a dose when a drug's effect is strongest; for insulin, the hour the client is most likely to go hypoglycemic.
Rule of 15
For hypoglycemia, give 15 grams of fast carbohydrate and recheck the glucose in 15 minutes.
aPTT
The clotting test that monitors a heparin infusion, aiming for about 1.5 to 2.5 times the control.
INR
The clotting test that monitors warfarin, usually aiming for 2 to 3.
Antidote
A drug that reverses the effect of another, such as naloxone for opioids or vitamin K for warfarin.
Heparin-induced thrombocytopenia (HIT)
An immune reaction to heparin that drops the platelet count and paradoxically causes clots; heparin is stopped for good.
Trough level
The lowest drug level in the blood, drawn just before the next dose, used to monitor aminoglycosides, and vancomycin unless pharmacy uses AUC-guided dosing.
Extravasation
Leakage of a vesicant (tissue-damaging) IV drug, such as some chemotherapy, into the tissue around the vein; a non-vesicant leak is infiltration.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Transfusion reaction
Fever, chills, back pain, hives or hypotension during a blood transfusion; stop the blood and keep the line open with saline through new tubing.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Desired over have
The dose calculation formula: desired dose divided by the dose on hand, times the quantity it comes in.
Drop factor
The number of drops per milliliter a gravity IV set delivers, printed on the tubing package.
Parkland formula
Burn fluid resuscitation: 4 mL × kg × percent of body surface burned over 24 hours, half in the first 8 hours from the injury.
📚 Learn it: Burns: The Parkland Formula and Neutropenic Fever
Top drugs
ACE inhibitors (-pril)
Lower blood pressure and protect the heart and kidneys in heart failure and diabetes; the defining effects are a dry cough, high potassium and angioedema (stop the drug and protect the airway), and they are never given in pregnancy.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Angiotensin receptor blockers (-sartan)
The ACE inhibitor alternative for a client who developed the cough; they still raise potassium and can cause angioedema, so check potassium and creatinine, and they are contraindicated in pregnancy.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Beta blockers (-olol)
Slow the heart and lower blood pressure after a heart attack and in heart failure; hold for a heart rate under 60 or systolic pressure under 90 per order, never stop them abruptly, and warn clients with diabetes that they mask hypoglycemia.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Calcium channel blockers (-dipine, verapamil, diltiazem)
Relax vessels for hypertension and angina, and verapamil or diltiazem also slow the heart rate; expect ankle swelling and headache, hold for low pressure or a slow pulse per order, and avoid grapefruit juice.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Loop and thiazide diuretics
Furosemide and hydrochlorothiazide both waste potassium, so check the level, weigh the client daily and give the dose in the morning; push IV furosemide slowly to protect hearing, and expect thiazides to raise glucose, uric acid and calcium.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Potassium-sparing diuretics
Spironolactone and its relatives hold on to potassium, so the danger is hyperkalemia; teach the client to skip potassium supplements and salt substitutes, watch the level with ACE inhibitors or ARBs, and expect breast tenderness with spironolactone.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Digoxin
Strengthens and slows the heart in failure and atrial fibrillation; count an apical pulse for a full minute and hold under 60, watch for nausea, vomiting and yellow-green halos, remember low potassium raises toxicity, and the antidote is digoxin immune fab.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Nitroglycerin and nitrates
Dilate vessels to relieve angina: one sublingual tablet every 5 minutes up to three, calling emergency services if the first does not help; expect a headache, store tablets in the dark bottle, and never give within 24 to 48 hours of sildenafil or tadalafil.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Statins (-statin)
Lower cholesterol to prevent heart attack and stroke; teach the client to report unexplained muscle pain or dark urine (rhabdomyolysis), check liver enzymes, take simvastatin in the evening, avoid grapefruit juice, and stop them in pregnancy.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Amiodarone
Controls dangerous ventricular and atrial rhythms but damages the lungs, thyroid, liver and eyes; report new cough or dyspnea at once, check thyroid and liver labs, expect bradycardia and hypotension during IV loading, and teach sun protection for the blue-gray skin and photosensitivity.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Adenosine
Resets supraventricular tachycardia by briefly stopping the heart; push it fast over 1 to 2 seconds with an immediate saline flush into a large proximal vein, keep the client on a monitor, and warn that seconds of chest pressure, flushing and asystole are expected.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Atropine
The anticholinergic that speeds a symptomatic slow heart (1 mg IV, repeated every 3 to 5 minutes to 3 mg) and the antidote for cholinergic crisis and organophosphate poisoning; expect dry mouth, blurred vision, urinary retention and flushing.
Epinephrine
The first drug for anaphylaxis, 0.3 to 0.5 mg IM (1 mg/mL) into the outer thigh, and 1 mg IV every 3 to 5 minutes in cardiac arrest; expect tachycardia and hypertension, and check the concentration twice because the two strengths differ tenfold.
📚 Learn it: Four Kinds of Shock and the First Hour of Sepsis
Vasopressors (norepinephrine, dopamine)
Squeeze vessels to raise blood pressure in shock after fluids are given, titrated by pump (dopamine in mcg/kg/min) to a mean arterial pressure of 65 or more through a central line; watch for tachycardia and arrhythmias, and infiltrate phentolamine if the drug extravasates.
Nitroprusside
A fast IV vasodilator for hypertensive emergency, titrated with continuous blood pressure monitoring (ideally an arterial line); wrap the bag to protect it from light, and watch for cyanide or thiocyanate toxicity (confusion, metabolic acidosis) with high doses, long infusions or kidney failure.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Hydralazine
A direct vasodilator for severe hypertension, including preeclampsia alongside labetalol; expect reflex tachycardia, headache and orthostatic drops, check blood pressure before and after each IV dose, and report joint pain or rash, which can signal a lupus-like reaction with long-term use.
📚 Learn it: Preeclampsia, Magnesium and the Reflexes You Check
Clonidine
A central alpha-2 agonist for hypertension (also ADHD and opioid withdrawal) that causes dry mouth and drowsiness; the defining danger is rebound hypertension when it is stopped suddenly, so taper it, never skip doses, and change the weekly patch on schedule.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Sacubitril-valsartan
A heart failure combination that cuts deaths and hospital stays; never give it within 36 hours of an ACE inhibitor or to anyone who had angioedema on an ACE inhibitor or ARB, watch blood pressure, potassium and creatinine, and stop it in pregnancy.
Antiplatelets (aspirin, clopidogrel)
Keep platelets from clumping after heart attack, stroke or a stent; both cause bleeding and are usually stopped 5 to 7 days before surgery per order, aspirin is never given to children with viral illness (Reye's syndrome), and omeprazole weakens clopidogrel.
Heparin
Prevents and treats clots within minutes, given IV by pump or subcutaneously; monitor the aPTT (goal 1.5 to 2.5 times control) and platelets, watch for bleeding and heparin-induced thrombocytopenia, and keep protamine sulfate available as the antidote.
Enoxaparin (low-molecular-weight heparin)
A low-molecular-weight heparin injected into the abdominal fat without expelling the air bubble, aspirating or rubbing the site; it needs no routine aPTT monitoring, is dose-reduced in kidney disease, and carries a boxed warning for spinal hematoma with epidural catheters.
Warfarin
An oral anticoagulant that takes 3 to 5 days to work and is monitored with the INR (usual goal 2 to 3); teach steady vitamin K intake, no aspirin or NSAIDs, and bleeding precautions, never give it in pregnancy, and reverse it with vitamin K.
Direct oral anticoagulants (DOACs)
Apixaban, rivaroxaban, dabigatran and edoxaban prevent stroke and treat clots without routine lab monitoring; missed doses sharply raise clot risk (boxed warning), bleeding is the main danger, kidney function guides the dose, and idarucizumab reverses dabigatran.
Thrombolytics (alteplase, tenecteplase)
Dissolve the clot in ischemic stroke (within 4.5 hours of last known well), heart attack and massive pulmonary embolism; rule out bleeding and recent surgery first, control blood pressure, avoid IM injections and needless punctures, and stop the infusion for any bleeding or neurologic change.
Protamine and vitamin K
The anticoagulant reversal pair: protamine neutralizes heparin within minutes but can cause hypotension and anaphylaxis if pushed fast, while vitamin K (phytonadione) reverses warfarin over hours and is given orally or subcutaneously when possible because IV doses carry a boxed warning for fatal reactions.
Albuterol and ipratropium
The rescue bronchodilators: albuterol opens airways within minutes but causes tachycardia, tremor and nervousness (report a racing heart), and ipratropium adds anticholinergic drying with a dry mouth; take the bronchodilator first, before any inhaled steroid.
Inhaled corticosteroids and montelukast
Daily controllers that never treat an acute attack: inhaled steroids (fluticasone, budesonide) cause thrush and hoarseness unless the mouth is rinsed after each dose, and montelukast carries a boxed warning for agitation, depression and suicidal thoughts, so report mood changes at once.
Theophylline
An older bronchodilator with a narrow therapeutic range (about 10 to 20 mcg/mL); toxicity shows as nausea, tachycardia, restlessness and seizures, so check levels, limit caffeine, and know that smoking lowers the level while ciprofloxacin and heart failure raise it.
Insulins by onset and peak
Rapid-acting (lispro, aspart) peaks 30 minutes to 3 hours after injection, regular in 2 to 4 hours, NPH in 4 to 12, and glargine or degludec has no peak; hypoglycemia is most likely at the peak, so a meal must be ready.
Regular insulin
The standard IV insulin, so it runs the DKA infusion with hourly glucose and potassium checks (potassium falls as insulin pushes it into cells); when mixed with NPH, the clear regular is drawn up before the cloudy NPH.
📚 Learn it: DKA Versus HHS: Ketones, Fluids and the Potassium Trap
Glucagon
The rescue hormone for severe hypoglycemia when the client cannot swallow safely: 1 mg IM or subcutaneously (3 mg intranasally), then turn the client on the side because vomiting is common and feed carbohydrate once awake; it also treats beta blocker overdose.
Metformin
First-line type 2 diabetes drug that does not cause hypoglycemia on its own; the boxed warning is lactic acidosis, so it is held for kidney failure, serious illness and iodinated contrast per order (restart about 48 hours later if kidney function is stable).
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Sulfonylureas (glipizide, glyburide, glimepiride)
Squeeze insulin out of the pancreas, so hypoglycemia is the defining risk, worst in older adults, with skipped meals, alcohol or kidney disease; take them before breakfast, teach the signs and the rule of 15, and expect some weight gain.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
SGLT2 inhibitors (-gliflozin)
Make the kidneys dump glucose into the urine, which also helps heart failure and kidney disease; expect genital yeast infections, urinary infections and dehydration, watch for ketoacidosis even with normal glucose, and hold them at least 3 days before surgery per order.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
GLP-1 receptor agonists (-glutide, -tide)
Injections (semaglutide, liraglutide, tirzepatide) that lower glucose and weight by slowing the stomach; nausea is expected, severe abdominal pain may mean pancreatitis, they carry a boxed warning for thyroid C-cell tumors, and anesthesia teams need to know because the full stomach risks aspiration.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Levothyroxine
Lifelong replacement for hypothyroidism, taken on an empty stomach in the morning, 30 to 60 minutes before food, calcium or iron; too much looks like hyperthyroidism (racing heart, insomnia, weight loss), the dose is set by TSH, and it is never used for weight loss.
Methimazole and propylthiouracil (PTU)
Antithyroid drugs for hyperthyroidism that take weeks to work; both can wipe out white cells, so a sore throat or fever is reported immediately, PTU carries a boxed warning for liver failure but is preferred in the first trimester, and methimazole otherwise.
Corticosteroids (prednisone, hydrocortisone, dexamethasone)
Suppress inflammation and replace adrenal hormone; expect high glucose, masked infection, fluid retention, bone loss and GI bleeding, give them with food in the morning, never stop abruptly, and give IV hydrocortisone at once for adrenal crisis or when a steroid-dependent client is stressed.
Proton pump inhibitors (-prazole) and H2 blockers
Cut stomach acid for reflux and ulcers; PPIs are taken 30 to 60 minutes before breakfast and with long use raise the risk of fractures, Clostridioides difficile and low magnesium or B12, while famotidine is the milder H2 blocker that can confuse older adults.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Antiemetics (ondansetron, metoclopramide)
Ondansetron blocks serotonin to prevent chemotherapy and surgical nausea and can prolong the QT interval; metoclopramide empties the stomach but carries a boxed warning for irreversible tardive dyskinesia, so it is limited to 12 weeks and stopped for abnormal movements.
📚 Learn it: Burns: The Parkland Formula and Neutropenic Fever
Lactulose
A sugar laxative that traps ammonia in the gut for hepatic encephalopathy and treats constipation; titrate to two or three soft stools a day, watch for dehydration and low potassium from diarrhea, and judge success by a clearer mind and falling ammonia.
Sucralfate
Forms a paste that coats an ulcer so it can heal; give it on an empty stomach 1 hour before meals and at bedtime, separate it from other medicines by about 2 hours because it binds them, and expect constipation.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Penicillins and cephalosporins
The most common antibiotic families and the most common cause of drug allergy, with some cross-reactivity between them; ask what the past reaction was, not just whether there is one, culture before the first dose, and report severe diarrhea as possible Clostridioides difficile.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Vancomycin
The IV drug for MRSA and the oral drug for Clostridioides difficile; infuse each dose over at least 60 minutes to prevent vancomycin infusion reaction (flushing, itching and hypotension), and protect the kidneys and ears by following trough or AUC levels and creatinine.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Aminoglycosides (gentamicin, tobramycin, amikacin)
Potent IV antibiotics for serious gram-negative infections whose boxed warnings are kidney damage, hearing loss and neuromuscular weakness; draw peak and trough levels on time, follow creatinine and urine output, and report ringing in the ears or dizziness immediately.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Fluoroquinolones (-floxacin)
Broad antibiotics whose boxed warnings are tendon rupture (worst with steroids and in older adults), permanent nerve damage, confusion and worsened myasthenia gravis; stop for tendon pain, separate doses from antacids, dairy and iron by 2 hours, and watch glucose in diabetes.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Tetracyclines (doxycycline, minocycline)
Antibiotics for acne, Lyme disease and atypical pneumonia that stain developing teeth, so they are avoided in pregnancy and children under 8; take with a full glass of water while upright, away from dairy, antacids and iron, and use sun protection.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Macrolides (azithromycin, erythromycin, clarithromycin)
Antibiotics for respiratory and sexually transmitted infections and the usual choice in penicillin allergy; they upset the stomach, prolong the QT interval (check for other QT drugs), and erythromycin and clarithromycin raise levels of warfarin, statins and other drugs cleared by the liver.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Metronidazole
Treats anaerobic infections, trichomoniasis, bacterial vaginosis and Clostridioides difficile; no alcohol during treatment and for 3 days after (flushing, vomiting and pounding headache), expect a metallic taste and dark urine, and report numbness or tingling in the hands and feet.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Trimethoprim-sulfamethoxazole (TMP-SMX)
The sulfa antibiotic for urinary infections and Pneumocystis pneumonia; stop for any rash because it can become Stevens-Johnson syndrome, push fluids to keep crystals out of the kidneys, watch potassium and blood counts, use sun protection, and expect it to raise the INR on warfarin.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Tuberculosis drugs (isoniazid, rifampin)
Months of combined therapy in which isoniazid damages the liver and nerves (give pyridoxine, avoid alcohol, report dark urine or numbness) and rifampin turns urine, sweat and tears orange and makes oral contraceptives fail; a client is no longer infectious after three negative sputum smears.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Acyclovir and valacyclovir
Antivirals that shorten herpes simplex and shingles outbreaks when started within 72 hours of the rash but cure nothing; infuse IV doses over at least an hour with plenty of fluids because the drug crystallizes in the kidneys, and check creatinine.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Opioids (morphine, hydromorphone, fentanyl, oxycodone)
Relieve severe pain but depress breathing and consciousness; assess sedation and respiratory rate before each dose and hold for a rate under 12 or a client who is hard to rouse, treat the constipation that never goes away, and keep naloxone available.
Naloxone
The opioid antidote, given IV, IM or intranasally and repeated every 2 to 3 minutes until the client breathes; it wears off before most opioids do, so keep monitoring for returning sedation, and expect sudden pain and withdrawal symptoms.
Acetaminophen
The pain and fever reliever that destroys the liver in overdose while looking harmless for the first day; keep the total under 4 grams daily (less with liver disease or regular alcohol), count combination products, and give acetylcysteine, best within 8 hours.
NSAIDs (ibuprofen, naproxen, ketorolac)
Relieve pain and inflammation at the cost of stomach bleeding, kidney injury and heart attack or stroke risk; take them with food, avoid them with anticoagulants, in kidney disease and late pregnancy, and limit ketorolac to 5 days total by any route.
Phenytoin
A seizure drug with a narrow range (10 to 20 mcg/mL) whose toxicity shows as nystagmus, ataxia and slurred speech; push IV doses slowly in saline only with cardiac monitoring, expect gum overgrowth with long use, and hold tube feedings around oral doses.
Levetiracetam
A widely used seizure drug with few interactions and no routine blood levels; the defining side effects are drowsiness and behavior changes (irritability, aggression, depression), the dose drops in kidney disease, and it must never be stopped suddenly.
Carbamazepine
A seizure, trigeminal neuralgia and bipolar drug (range 4 to 12 mcg/mL) with boxed warnings for aplastic anemia and Stevens-Johnson syndrome (worst in people of Asian ancestry with the HLA-B*1502 gene); report fever, sore throat, bruising or rash, watch sodium, and avoid grapefruit.
Valproate (valproic acid, divalproex)
A seizure and bipolar drug (range 50 to 100 mcg/mL) with boxed warnings for liver failure, pancreatitis and birth defects; check liver enzymes, platelets and ammonia, report abdominal pain, jaundice or easy bruising, and expect weight gain and tremor.
Carbidopa-levodopa
The main Parkinson disease drug, which replaces dopamine; give it on time (doses can wear off between them), rise slowly for orthostatic hypotension, expect harmless dark urine and sweat, report new jerky movements or compulsive behaviors, and separate high-protein meals from the dose.
Donepezil
A cholinesterase inhibitor that slows the memory loss of Alzheimer disease without curing it; expect nausea, diarrhea and weight loss, give it at bedtime, and report a slow pulse, fainting or vivid dreams, because the extra acetylcholine slows the heart.
📚 Learn it: Normal Aging Versus the Thing You Must Not Call Normal
Pyridostigmine
The myasthenia gravis drug that keeps acetylcholine at the muscle; give it 30 to 60 minutes before meals to power chewing and swallowing, and tell too little (myasthenic crisis) from too much (cholinergic crisis with SLUDGE), since both cause weakness, and atropine is the antidote.
Benzodiazepines (-azepam, -azolam)
Calm anxiety, stop seizures and treat alcohol withdrawal, but they depress breathing (boxed warning with opioids), cause falls in older adults and create dependence; never stop them abruptly because withdrawal can cause seizures, and flumazenil reverses overdose but can itself trigger seizures.
📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt
SSRIs and SNRIs
First-line antidepressants that take 4 to 6 weeks to work; watch for increased suicidal thinking in clients under 25 (boxed warning), serotonin syndrome when combined with other serotonergic drugs, sexual side effects and hyponatremia in older adults, and taper them to avoid discontinuation symptoms.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Tricyclic antidepressants
Older antidepressants, also used for nerve pain and bedwetting, that are lethal in overdose from cardiac arrhythmias, so prescriptions are kept small for anyone at risk of suicide; expect anticholinergic effects (dry mouth, constipation, urinary retention), sedation and orthostatic hypotension.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
MAOIs (phenelzine, tranylcypromine, selegiline)
Last-resort antidepressants that cause a hypertensive crisis (pounding headache, stiff neck, very high pressure) with tyramine foods such as aged cheese, cured meats and red wine, or with decongestants and other antidepressants; allow a 2-week washout before starting an SSRI (5 weeks after fluoxetine).
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Bupropion
An antidepressant that also helps people quit smoking and spares sexual function; it lowers the seizure threshold, so it is contraindicated in seizure disorders, eating disorders and abrupt alcohol or benzodiazepine withdrawal, and it can cause insomnia and agitation.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Lithium
The bipolar mood stabilizer with a narrow range (0.6 to 1.2 mEq/L); toxicity above about 1.5 brings coarse tremor, vomiting, diarrhea and ataxia, so keep salt and fluid intake steady, avoid NSAIDs, thiazides and ACE inhibitors, and check kidney and thyroid function.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Typical antipsychotics (haloperidol, chlorpromazine, fluphenazine)
First-generation antipsychotics that calm psychosis but cause movement side effects: acute dystonia and akathisia early, parkinsonism, and tardive dyskinesia late; treat acute reactions with benztropine or diphenhydramine, watch for neuroleptic malignant syndrome (fever, rigidity), and report lip smacking and tongue movements.
📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis
Atypical antipsychotics (-apine, -idone, aripiprazole)
Second-generation antipsychotics with fewer movement effects but a metabolic price: weight gain, high glucose and high lipids, so weight, glucose and lipids are tracked; they carry a boxed warning for higher death rates in older adults with dementia and can still cause neuroleptic malignant syndrome.
📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis
Clozapine
The antipsychotic for schizophrenia that resists other drugs and can wipe out neutrophils; the absolute neutrophil count is checked regularly, the drug is held for a low count, fever or sore throat is reported at once, and it also causes seizures, myocarditis and severe constipation.
📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis
Buspirone
A non-sedating anxiety drug with no dependence or abuse potential but no use as a rescue dose for panic; it takes 2 to 4 weeks to work, must be taken every day, causes dizziness, and should not be combined with MAOIs or grapefruit juice.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Methylphenidate and amphetamine stimulants
First-line ADHD drugs and controlled substances with abuse potential; expect appetite loss, insomnia and weight loss, so give the last dose early in the day and track height and weight in children, check heart rate and blood pressure, and watch for tics and mood changes.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Disulfiram and naltrexone
Disulfiram makes any alcohol, including mouthwash, cough syrup and aftershave, cause flushing, vomiting and hypotension for up to 2 weeks after the last dose; naltrexone blocks the reward from alcohol and opioids, so the client must be opioid-free for 7 to 10 days first.
📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt
Oxytocin
The IV hormone that induces or strengthens labor and contracts the uterus after birth; titrate by pump with continuous fetal monitoring, and stop it, turn the client, give oxygen and notify the provider for more than five contractions in 10 minutes or late decelerations.
Magnesium sulfate
The IV drug that prevents eclamptic seizures in preeclampsia; check deep tendon reflexes, respirations and urine output every hour, hold for lost reflexes, respirations under 12 or output under 30 mL an hour, and keep calcium gluconate at the bedside as the antidote.
📚 Learn it: Preeclampsia, Magnesium and the Reflexes You Check
Methylergonovine, carboprost and misoprostol
The drugs given when massage and oxytocin fail to stop postpartum bleeding: methylergonovine is withheld for hypertension or preeclampsia, carboprost for asthma, and misoprostol is expected to cause fever, chills and diarrhea; recheck the fundus and bleeding after each.
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
Terbutaline
A beta agonist that relaxes the uterus to delay preterm labor briefly; injectable use beyond 48 to 72 hours (and any oral use) carries a boxed warning for maternal heart deaths, so hold it for a maternal pulse over 120 and report chest pain.
Betamethasone (antenatal steroids)
Two IM doses of 12 mg given 24 hours apart to a woman expected to deliver between 24 and 34 weeks, to mature the fetal lungs and cut respiratory distress, brain bleeding and bowel injury; watch the mother's glucose and for signs of infection.
Rho(D) immune globulin
A blood product given IM to an Rh-negative mother with a negative antibody screen at 28 weeks, within 72 hours of delivering an Rh-positive baby, and after miscarriage, abortion, amniocentesis or abdominal trauma; it is useless once the mother has already formed antibodies.
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
Filgrastim and epoetin alfa
Filgrastim raises neutrophils after chemotherapy, causes bone pain and is not given within 24 hours of a dose, while epoetin alfa raises hemoglobin in kidney disease but raises blood pressure and clot risk, so it is held when hemoglobin passes 10 to 11 g/dL.
📚 Learn it: Burns: The Parkland Formula and Neutropenic Fever
Methotrexate
A folate blocker for cancer, rheumatoid arthritis and psoriasis that suppresses the marrow and damages the liver, lungs and mouth lining; weekly doses taken daily by mistake are fatal, so confirm the schedule, give folic acid or leucovorin rescue as ordered, and prevent pregnancy.
📚 Learn it: Burns: The Parkland Formula and Neutropenic Fever
Tacrolimus and cyclosporine
Transplant anti-rejection drugs taken for life with trough levels to guide the dose; both damage the kidneys and raise blood pressure, potassium and infection risk, tacrolimus adds tremor and diabetes, cyclosporine adds gum overgrowth and hair growth, and grapefruit raises the levels.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Potassium chloride
Replaces low potassium but stops the heart if it goes in too fast: never IV push, always diluted and run by pump (about 10 mEq an hour through a peripheral line), with urine output confirmed first; oral doses are taken with food and water.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Sodium bicarbonate
An IV base for severe metabolic acidosis, hyperkalemia and tricyclic overdose; it is incompatible with calcium (precipitate), so flush the line before and after, watch the blood gas for overshoot into alkalosis and the potassium for a fall, and expect sodium and fluid load.
Hypertonic saline (3%)
A concentrated salt infusion for severe symptomatic hyponatremia that pulls water out of swollen brain cells; run it slowly by pump, check sodium every few hours, and never correct faster than about 8 to 10 mEq/L in 24 hours, or the brain demyelinates.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Albumin (IV colloid)
A colloid made from pooled human plasma that pulls fluid back into the vessels in shock, burns, large-volume paracentesis and low protein states; it needs no cross-match, but watch for circulatory overload (crackles, dyspnea, rising pressure) and allergic reactions during the infusion.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Mannitol
An osmotic diuretic that pulls water out of a swollen brain to lower intracranial pressure; inspect the bag for crystals and infuse through a filter, follow serum osmolality, sodium and urine output, and watch for fluid overload, pulmonary edema or dehydration.
Gout drugs (allopurinol, colchicine)
Allopurinol prevents gout attacks but cannot treat one and is stopped at the first rash (Stevens-Johnson risk); colchicine treats the acute flare and is stopped for diarrhea or vomiting, its first signs of toxicity; both call for 2 to 3 liters of fluid a day.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Alendronate (bisphosphonates)
Builds bone in osteoporosis but burns the esophagus; take it first thing in the morning with a full glass of plain water, stay upright and eat nothing for 30 minutes, report jaw pain or new thigh pain, and keep calcium and vitamin D intake up.
📚 Learn it: Normal Aging Versus the Thing You Must Not Call Normal
Tamsulosin and finasteride
The two prostate drugs: tamsulosin relaxes the bladder outlet but causes orthostatic dizziness (take it 30 minutes after the same meal and tell the eye surgeon before cataract surgery), while finasteride shrinks the prostate over 6 months and must not be handled by pregnant women.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Combined oral contraceptives
Estrogen-progestin pills that prevent pregnancy but raise clot risk, so smokers over 35 and anyone with a clot history cannot take them; teach ACHES (abdominal pain, chest pain, headache, eye changes, severe leg pain) as reasons to call, and that rifampin makes them fail.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Iron supplements
Oral iron is taken on an empty stomach with vitamin C and away from antacids, turns stools dark, constipates, stains teeth unless sipped through a straw, and is locked away because a child's overdose is deadly (antidote deferoxamine); IM iron goes in by Z-track.
Antihistamines (diphenhydramine, loratadine, cetirizine)
Block histamine for allergies, itching and sleep; first-generation diphenhydramine sedates and dries (urinary retention, constipation, confusion and falls in older adults, paradoxical excitement in children), so it is avoided in glaucoma and prostate enlargement, while loratadine and cetirizine barely cross into the brain.
📚 Learn it: Normal Aging Versus the Thing You Must Not Call Normal
Fluids & acid-base
Hyperkalemia
Potassium above 5.0 mEq/L, which shows as peaked T waves and can stop the heart.
Hypokalemia
Potassium below 3.5 mEq/L, which shows as flat T waves and U waves and raises digoxin toxicity risk.
Hyponatremia
Sodium below 135 mEq/L, causing confusion and seizures; corrected slowly to protect the brain.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Chvostek's sign
A facial twitch when the cheek is tapped, a sign of low calcium.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Trousseau's sign
A hand spasm when a blood pressure cuff is inflated, a sign of low calcium.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Isotonic solution
An IV fluid such as 0.9% saline or lactated Ringer's that expands the blood volume without shifting water into or out of cells.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Hypotonic solution
An IV fluid such as 0.45% saline that moves water into cells, never used with increased intracranial pressure.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
ROME
Respiratory opposite, metabolic equal: the shortcut for telling whether an acid-base problem is respiratory or metabolic.
Kussmaul respirations
Deep, rapid breathing that blows off carbon dioxide to compensate for metabolic acidosis, classic in DKA.
Cardiac & shock
Troponin
The most specific blood marker of heart muscle injury, drawn in series because it rises over hours.
BNP
A hormone released when the ventricles stretch; above about 100 pg/mL supports heart failure.
Left-sided heart failure
Failure that backs blood up into the lungs, causing crackles, dyspnea, orthopnea and frothy sputum.
Right-sided heart failure
Failure that backs blood up into the body, causing jugular venous distention, edema and liver enlargement.
Pulse pressure
Systolic minus diastolic pressure, normally about 40; it narrows in shock and widens with raised intracranial pressure.
Mean arterial pressure (MAP)
The average pressure driving blood to the organs, which must stay at or above 65 mmHg.
Beck's triad
Hypotension, distended neck veins and muffled heart sounds: the signs of cardiac tamponade.
📚 Learn it: Tamponade, Tension Pneumothorax and Autonomic Dysreflexia
Cardiogenic shock
Shock caused by a failing heart pump, treated with inotropes rather than large fluid boluses.
📚 Learn it: Four Kinds of Shock and the First Hour of Sepsis
Septic shock
Sepsis with low blood pressure that persists after fluids; the first hour brings lactate, cultures, antibiotics, 30 mL/kg of fluid and vasopressors if needed.
📚 Learn it: Four Kinds of Shock and the First Hour of Sepsis
Respiratory
Tidaling
The normal rise and fall of fluid in a chest tube's water-seal chamber with breathing.
Air leak (chest tube)
Continuous bubbling in the water-seal chamber, meaning air is entering the system or still escaping the lung.
Tension pneumothorax
Air trapped under pressure in the chest that shifts the trachea away and collapses circulation; needle decompression relieves it.
📚 Learn it: Tamponade, Tension Pneumothorax and Autonomic Dysreflexia
Silent chest
The disappearance of wheezing in a severe asthma attack because air is no longer moving, a respiratory emergency.
Pursed-lip breathing
Breathing out slowly through pursed lips to keep the airways open longer, taught to clients with COPD.
Non-rebreather mask
A mask with a reservoir bag that delivers up to about 90% oxygen at 10 to 15 L/min, as long as the bag stays inflated.
Venturi mask
A mask with color-coded adapters that deliver exact oxygen percentages, preferred for COPD.
Pulmonary embolism
A clot lodged in the lung, causing sudden dyspnea, pleuritic chest pain, tachycardia and hypoxemia.
📚 Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss
Neuro & ortho
Cushing's triad
Hypertension with a widened pulse pressure, bradycardia and irregular breathing: a late sign of rising intracranial pressure.
Last known well
The last time a stroke client was seen normal, which starts the clock for thrombolytic eligibility.
Autonomic dysreflexia
A sudden dangerous hypertension with headache in spinal cord injuries at T6 or above, usually triggered by a full bladder.
📚 Learn it: Tamponade, Tension Pneumothorax and Autonomic Dysreflexia
Status epilepticus
A seizure lasting more than five minutes or repeated seizures without recovery, treated with IV lorazepam.
Delirium
A sudden, fluctuating, usually reversible confusion with inattention, often caused by infection, drugs, dehydration or pain.
📚 Learn it: Normal Aging Versus the Thing You Must Not Call Normal
Compartment syndrome
Rising pressure inside a muscle compartment that cuts off blood flow; the first signs are pain out of proportion and pain on passive stretch.
📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae
Fat embolism syndrome
Fat from a long-bone fracture reaching the lungs and brain within 24 to 72 hours, with dyspnea, confusion and chest petechiae.
📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae
Endocrine
Diabetic ketoacidosis (DKA)
High glucose with ketones and acidosis, usually in type 1 diabetes, treated with fluids, IV regular insulin and potassium.
📚 Learn it: DKA Versus HHS: Ketones, Fluids and the Potassium Trap
Hyperglycemic hyperosmolar state (HHS)
Extreme hyperglycemia without significant ketones, usually in type 2 diabetes, with severe dehydration and altered mental status.
📚 Learn it: DKA Versus HHS: Ketones, Fluids and the Potassium Trap
Addisonian crisis
Profound hypotension and shock from adrenal insufficiency, often triggered by illness, stress or abruptly stopped steroids; treated with IV hydrocortisone.
Thyroid storm
A life-threatening surge of thyroid hormone with high fever, severe tachycardia and agitation.
Myxedema coma
Severe hypothyroidism with hypothermia, bradycardia, hypotension and decreased consciousness.
Diabetes insipidus
Too little antidiuretic hormone, or kidneys that do not respond to it, producing large volumes of dilute urine and a rising sodium.
SIADH
Too much antidiuretic hormone, causing water retention, concentrated urine and a falling sodium.
GI, renal & post-op
Dumping syndrome
Cramping, sweating and diarrhea after meals when food rushes from the stomach into the intestine after gastric surgery.
Evisceration
Organs protruding through an opened surgical incision; cover with moist sterile gauze and call the surgeon.
Dehiscence
Separation of the edges of a surgical incision, often around days five to ten.
Paralytic ileus
A bowel that stops moving after surgery, with distention, no flatus and absent bowel sounds.
Stoma
The surgically created opening of an ostomy, healthy when pink and moist and an emergency when dusky or purple.
CAUTI
A catheter-associated urinary tract infection, prevented by sterile insertion, a closed system and early removal.
BUN-to-creatinine ratio
A ratio above about 20 to 1 with a normal creatinine suggests dehydration rather than kidney damage.
Maternity
Naegele's rule
Estimated due date: first day of the last period, minus three months, plus seven days, plus a year.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
VEAL CHOP
Variable means cord, early means head, accelerations are okay, late means placenta: the fetal heart rate decoder.
Late decelerations
Fetal heart rate dips that start after a contraction begins and recover after it ends, a sign of placental insufficiency.
Preeclampsia
New hypertension after 20 weeks with protein in the urine or organ involvement; magnesium sulfate prevents seizures.
📚 Learn it: Preeclampsia, Magnesium and the Reflexes You Check
Placenta previa
A placenta covering the cervix, causing painless bright red bleeding; no vaginal exams.
Abruptio placentae
Early separation of the placenta, causing painful bleeding, a rigid uterus and risk of shock.
Uterine atony
A uterus that fails to contract after birth, the most common cause of postpartum hemorrhage; massage the fundus first.
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
Lochia
Vaginal discharge after birth that progresses from red (rubra) to pink-brown (serosa) to white (alba).
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
APGAR score
A newborn score at 1 and 5 minutes for heart rate, breathing, tone, reflexes and color; 7 to 10 is normal.
📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar
Rh immune globulin
The injection given to Rh-negative mothers at 28 weeks and within 72 hours after delivering an Rh-positive baby, to prevent antibodies against future babies.
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
Pediatrics
Pincer grasp
Picking up a small object between the thumb and forefinger, expected by 9 to 12 months.
Live vaccine
A vaccine made from weakened virus, such as MMR or varicella, not given in pregnancy or severe immunosuppression.
Croup
A viral airway infection in young children with a barking cough and stridor, treated with dexamethasone and, for stridor at rest, nebulized epinephrine.
📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use
Epiglottitis
A bacterial swelling of the epiglottis with drooling and a tripod position; never examine the throat.
📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use
Tet spell
A sudden cyanotic episode in tetralogy of Fallot, relieved by the knee-chest position and oxygen.
📚 Learn it: Tet Spells, Coarctation and the Strawberry Tongue
Kawasaki disease
A childhood illness with five days of fever, a strawberry tongue and peeling hands, treated with IVIG and aspirin to protect the coronary arteries.
📚 Learn it: Tet Spells, Coarctation and the Strawberry Tongue
Intussusception
A telescoping bowel in infants with sudden pain, drawn-up knees and currant-jelly stools, reduced with an enema.
Pyloric stenosis
A narrowed stomach outlet in young infants causing projectile vomiting and an olive-shaped mass.
Separation anxiety
The protest, despair and detachment stages a hospitalized infant or toddler goes through when a parent leaves.
📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids
Mental health
Therapeutic communication
Techniques such as open-ended questions, reflection and silence that keep the focus on the client's feelings.
📚 Learn it: Never Ask Why: Therapeutic Communication That Passes
False reassurance
Telling a client everything will be fine, which dismisses the feeling and ends the conversation.
📚 Learn it: Never Ask Why: Therapeutic Communication That Passes
Serotonin syndrome
Agitation, fever, sweating, hyperreflexia and clonus from too much serotonergic medication.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Neuroleptic malignant syndrome (NMS)
High fever, lead-pipe rigidity and unstable vital signs from antipsychotics; stop the drug and cool the client.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Tyramine
A substance in aged cheese, cured meats and red wine that causes a hypertensive crisis with MAOIs.
📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause
Delirium tremens
Severe alcohol withdrawal, usually 48 to 96 hours (2 to 4 days) after the last drink, with confusion, agitation, hallucinations and unstable vital signs; it can be fatal.
📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt
Command hallucination
A voice telling the client to do something, an emergency when it orders harm to self or others.
📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis
Mandatory reporter
A professional, including every nurse, legally required to report suspected abuse of children, elders and dependent adults.
📚 Learn it: Recognizing Abuse: What You Document and Whom You Tell
Lab values
Shift to the left
A rise in immature neutrophils (bands) in the blood, a sign of acute bacterial infection.
Absolute neutrophil count (ANC)
White cells times the percentage of neutrophils and bands; under 1,500 is neutropenia, under 500 is severe, and precautions usually start below about 1,000 per policy.
Hemoglobin A1c
The average blood glucose over the past two to three months; 6.5% or higher diagnoses diabetes.
Urine specific gravity
How concentrated urine is, normally 1.005 to 1.030; high with dehydration, low with diabetes insipidus.
📚 Learn it: Urinalysis, Specific Gravity and Collecting It Right
Lactate
A marker of poor tissue perfusion; above 2 mmol/L is concerning and 4 or more in sepsis triggers the fluid bolus.
TSH
The pituitary hormone that is high in hypothyroidism and low in hyperthyroidism.
Digoxin level
Therapeutic range about 0.5 to 2.0 ng/mL; toxicity brings nausea, bradycardia and yellow-green visual halos.
Lithium level
Therapeutic range 0.6 to 1.2 mEq/L; above about 1.5 brings coarse tremor, vomiting and ataxia.
Red blood cell count (RBC)
About 4.7 to 6.1 million/mm³ in men and 4.2 to 5.4 million/mm³ in women; low means anemia or bleeding, high means dehydration, chronic hypoxia or polycythemia.
Hemoglobin (Hgb)
About 14 to 18 g/dL in men and 12 to 16 g/dL in women; a transfusion is usually considered below 7 to 8 g/dL, and below about 6 to 7 is a critical value.
Hematocrit (Hct)
About 42 to 52% in men and 37 to 47% in women, roughly three times the hemoglobin; it rises with dehydration and falls with bleeding or fluid overload even when red cell mass is unchanged.
White blood cell count (WBC)
Normal 5,000 to 10,000/mm³ (some labs 4,500 to 11,000); high means infection, inflammation, steroids or leukemia, low follows chemotherapy or marrow failure, and below about 2,000 or above about 30,000 is critical.
Platelets (PLT)
Normal 150,000 to 400,000/mm³; bleeding precautions start below about 50,000, spontaneous bleeding risk climbs below 20,000, and below about 10,000 to 20,000 is a critical value.
Mean corpuscular volume (MCV)
The average red cell size, normally about 80 to 100 fL; a low MCV points to iron deficiency, a high MCV to vitamin B12 or folate deficiency.
Ferritin
The body's iron store, about 12 to 300 ng/mL in men and 12 to 150 ng/mL in women; low confirms iron-deficiency anemia, while it rises with inflammation, so a normal value does not rule deficiency out.
Serum iron and TIBC
Serum iron about 60 to 170 mcg/dL and total iron-binding capacity about 250 to 450 mcg/dL; in iron deficiency the iron falls while the TIBC rises, the opposite of anemia of chronic disease.
Prothrombin time (PT)
About 11 to 13.5 seconds, with an INR of 0.8 to 1.2 off anticoagulants; it lengthens with warfarin, liver disease and vitamin K deficiency, and on warfarin the INR, not the seconds, is what you report.
aPTT normal range
About 30 to 40 seconds off anticoagulants; on a heparin infusion the goal is 1.5 to 2.5 times control (roughly 46 to 70 seconds), and above about 100 seconds is critical: stop the drip and call.
INR target with a mechanical heart valve
Most warfarin indications (atrial fibrillation, DVT, PE) aim for an INR of 2 to 3, a mechanical mitral valve for about 2.5 to 3.5, and an INR above 5 is critical: hold the dose and expect vitamin K.
Anti-Xa level (heparin)
The newer way to monitor a heparin infusion, aiming for about 0.3 to 0.7 units/mL for unfractionated heparin; it replaces the aPTT at many hospitals and is not thrown off by a client's baseline clotting.
Fibrinogen
Normal about 200 to 400 mg/dL; it falls below 100 in disseminated intravascular coagulation because clotting consumes it, so a low fibrinogen with a rising D-dimer in a bleeding client points to DIC.
D-dimer
A clot-breakdown fragment, normally under about 0.5 mcg/mL (500 ng/mL); a normal value helps rule out DVT and pulmonary embolism, while a high one is nonspecific and rises in DIC, surgery, pregnancy and infection.
📚 Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss
Sodium (Na+)
Normal 135 to 145 mEq/L; below 135 brings confusion and seizures when it falls fast, above 145 thirst and restlessness; critical below 120 or above 160, and correction runs no faster than about 8 to 12 mEq/L a day.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Potassium (K+)
Normal 3.5 to 5.0 mEq/L; low brings flat T waves, U waves and digoxin toxicity, high brings peaked T waves and arrest, and below 2.5 or above about 6.0 to 6.5 is critical.
Chloride (Cl-)
Normal about 98 to 106 mEq/L (some labs 96 to 106); it follows sodium, so it falls with vomiting and loop diuretics and rises with dehydration or large volumes of normal saline.
Bicarbonate (serum CO2)
The venous bicarbonate on a chemistry panel, normally 22 to 26 mEq/L (some labs 23 to 29); low means metabolic acidosis such as DKA or diarrhea, high means metabolic alkalosis such as vomiting, and below 10 is critical.
Blood urea nitrogen (BUN)
Normal 10 to 20 mg/dL; it rises with kidney dysfunction, dehydration, GI bleeding, high protein intake and steroids, so a high BUN with a normal creatinine usually means dehydration rather than kidney damage.
Serum creatinine
Normal about 0.6 to 1.2 mg/dL; it is the specific kidney marker because diet and hydration barely move it, and a doubling of the creatinine means the glomerular filtration rate has roughly halved.
Estimated GFR (eGFR)
Normal 90 mL/min/1.73 m² or higher; below 60 for three months defines chronic kidney disease, below 30 is severe, and below 15 is kidney failure, when dialysis or transplant is planned.
Fasting blood glucose
Normal 70 to 99 mg/dL; 100 to 125 is prediabetes and 126 or higher on two occasions diagnoses diabetes, while a random glucose of 200 or more with symptoms also diagnoses it.
Blood glucose critical values
Below 70 mg/dL is hypoglycemia (treat with 15 grams of carbohydrate if awake, IV dextrose or glucagon if not); below 40 or above about 500 is a critical value, and HHS runs above 600.
📚 Learn it: DKA Versus HHS: Ketones, Fluids and the Potassium Trap
Hemoglobin A1c target in diabetes
For most adults with diabetes the treatment goal is an A1c under 7%, roughly an average glucose of 150 mg/dL; a less strict goal under 8% is used for frail or older clients at risk of hypoglycemia.
Total calcium (Ca)
Normal 9 to 10.5 mg/dL; low brings tingling, tetany, Chvostek's and Trousseau's signs and laryngospasm, high brings weakness, constipation, stones and confusion, and below about 6 or above about 13 is critical.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Ionized calcium
The active, unbound calcium, normally about 4.5 to 5.6 mg/dL (1.1 to 1.4 mmol/L); it is the value to trust when albumin is low, because a low albumin drags the total calcium down without changing the ionized fraction.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Magnesium (Mg)
Normal about 1.5 to 2.5 mEq/L (some labs 1.3 to 2.1); low brings tremor, hyperreflexia and torsades, high brings lost reflexes, hypotension and respiratory depression, and below about 1 or above about 5 is critical.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
Phosphorus (PO4)
Normal 2.5 to 4.5 mg/dL and inverse to calcium; it rises in kidney failure (binders, low-phosphorus diet) and falls with refeeding and malnutrition, and below about 1 mg/dL is critical.
Albumin
Normal 3.5 to 5 g/dL; low albumin causes edema and a falsely low total calcium and reflects liver synthesis, protein loss or inflammation, so it is not a reliable nutrition marker on its own.
Prealbumin
Normal about 15 to 36 mg/dL; with a half-life of two days it tracks recent protein intake faster than albumin, below about 10 to 11 suggests severe protein depletion, and inflammation also lowers it.
Total protein
Normal about 6 to 8 g/dL, the sum of albumin and globulins; low with malnutrition, liver disease and nephrotic protein loss, high with dehydration and some blood cancers such as multiple myeloma.
Ammonia (NH3)
Normal about 15 to 45 mcg/dL; it climbs in liver failure and causes hepatic encephalopathy (confusion, asterixis), treated with lactulose titrated to two or three soft stools a day, and GI bleeding or a high-protein diet raise it.
AST (aspartate aminotransferase)
Normal about 10 to 40 U/L; it leaks from injured liver cells in hepatitis, alcohol and acetaminophen toxicity, and from heart and skeletal muscle too, so it is less liver-specific than ALT.
ALT (alanine aminotransferase)
Normal about 7 to 40 U/L (upper limits vary by lab); it is the more liver-specific transaminase, rising with hepatitis, fatty liver, statins and acetaminophen overdose, often into the thousands in acute hepatitis.
Alkaline phosphatase (ALP)
Normal about 30 to 120 U/L; it rises with biliary obstruction (with GGT and bilirubin), bone growth or disease such as Paget's and bone metastases, and normally in growing children and late pregnancy.
Total bilirubin
Normal about 0.1 to 1.2 mg/dL; jaundice becomes visible above about 2 to 3, and a rising level means hemolysis, liver damage or a blocked bile duct, with clay-colored stools and dark urine in obstruction.
Newborn bilirubin
Physiologic jaundice appears after 24 hours and peaks around 5 to 6 mg/dL on days 3 to 5; jaundice in the first 24 hours is pathologic, phototherapy thresholds follow the hour-specific AAP chart, and levels near 20 to 25 risk kernicterus.
📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar
Lipase and amylase
Lipase about 0 to 160 U/L and amylase about 30 to 110 U/L; both rise in acute pancreatitis within hours, and lipase is the more specific and stays up longer, so it is the one the exam trusts.
CK-MB
The heart-specific creatine kinase, normally about 0 to 3 ng/mL or under 5% of total CK; it rises 4 to 6 hours after infarction, peaks at 12 to 24 hours and normalizes in 2 to 3 days, so it flags reinfarction.
Total cholesterol
Desirable under 200 mg/dL, borderline 200 to 239, high 240 or above; it is drawn after a 9 to 12 hour fast with the full lipid panel, and the statin decision rests more on LDL and overall risk.
LDL cholesterol
The artery-clogging cholesterol, optimal under 100 mg/dL (under 70 for clients with known heart disease or diabetes), near optimal 100 to 129, high 160 or above; statins, exercise and less saturated fat lower it.
HDL cholesterol
The protective cholesterol, which should be above 40 mg/dL in men and above 50 in women; below 40 raises heart risk, and exercise, weight loss and quitting smoking raise it.
Triglycerides
Normal under 150 mg/dL, borderline 150 to 199, high 200 to 499 and very high at 500 or above, where pancreatitis becomes a risk; alcohol, sugar and uncontrolled diabetes drive them up.
Free T4 (thyroxine)
Free T4 about 0.8 to 1.8 ng/dL (total T4 about 5 to 12 mcg/dL); it is high with a low TSH in hyperthyroidism and low with a high TSH in hypothyroidism, and the levothyroxine dose is adjusted by TSH.
Cortisol (morning serum)
About 5 to 25 mcg/dL at 8 AM, lower in the evening; low points to Addison's disease or long-term steroid suppression, high to Cushing's syndrome or stress, and a very low value in shock is an adrenal crisis.
Arterial pH
Normal 7.35 to 7.45; below 7.35 is acidosis and above 7.45 alkalosis, and below about 7.2 or above 7.6 is critical, at which point the heart, brain and drugs all stop working normally.
PaCO2
Normal 35 to 45 mmHg, the respiratory side of ROME; high means hypoventilation (respiratory acidosis, as in COPD or opioids), low means hyperventilation or compensation, and below 20 or above about 60 to 70 is critical.
HCO3 (bicarbonate on an ABG)
Normal 22 to 26 mEq/L, the metabolic side of ROME; it moves the same direction as pH in metabolic problems (low in DKA, high with vomiting) and shifts to compensate for respiratory ones.
PaO2
Normal 80 to 100 mmHg; below 80 is hypoxemia, below 60 usually means the client needs supplemental oxygen or more support, and below about 40 is critical.
SaO2 / SpO2 (oxygen saturation)
Normal 95 to 100%; 88 to 92% is the accepted target in COPD to avoid blunting the drive to breathe, and below 90% in anyone else means give oxygen and find the cause.
Phenytoin level
Therapeutic 10 to 20 mcg/mL; above 20 brings nystagmus, ataxia and slurred speech, and the drug also causes gingival hyperplasia with long use, so teach good oral care and never stop it abruptly.
Theophylline level
Therapeutic about 10 to 20 mcg/mL (newer targets 5 to 15); above 20 brings nausea, tachycardia and seizures, and caffeine, smoking changes and many antibiotics shift the level.
Carbamazepine level
Therapeutic 4 to 12 mcg/mL; above about 12 to 15 brings dizziness, diplopia and ataxia, and the drug can suppress the marrow, so report fever, sore throat or bruising and expect periodic CBCs.
Valproic acid level
Therapeutic 50 to 100 mcg/mL; above about 100 to 150 brings sedation, tremor and confusion, and the drug can injure the liver and lower platelets, so liver enzymes and a CBC are checked.
Vancomycin level
The trough goal was 10 to 20 mcg/mL (15 to 20 for serious MRSA infections); many pharmacies now dose to an AUC of 400 to 600 instead, and levels above that range threaten the kidneys and hearing.
Acetaminophen level (toxic)
A level above about 150 mcg/mL drawn 4 hours after ingestion is toxic on the Rumack-Matthew nomogram and calls for acetylcysteine; liver enzymes often peak 2 to 4 days later, after the early nausea has settled.
Magnesium sulfate therapeutic level
About 4 to 7 mEq/L when infused for preeclampsia; lost deep tendon reflexes are the first sign of toxicity, then respirations under 12 and urine under 30 mL/hr, and calcium gluconate is the antidote at the bedside.
📚 Learn it: Preeclampsia, Magnesium and the Reflexes You Check
Urine pH
Normally about 4.5 to 8 (average 6); acidic urine comes with a high-protein diet, acidosis and starvation, alkaline urine with a vegetarian diet, UTI with urea-splitting bacteria, and some kidney stones.
📚 Learn it: Urinalysis, Specific Gravity and Collecting It Right
Urine protein
Normally negative on dipstick (under about 150 mg a day); persistent protein means kidney damage, and in pregnancy 300 mg or more in 24 hours, a protein-to-creatinine ratio of 0.3, or a 2+ dipstick helps define preeclampsia.
📚 Learn it: Urinalysis, Specific Gravity and Collecting It Right
Urine ketones
Normally negative; moderate or large ketones with a high glucose mean the body is burning fat for fuel, as in diabetic ketoacidosis, so sick-day teaching checks them every 4 hours and reports persistent ketones or vomiting.
📚 Learn it: DKA Versus HHS: Ketones, Fluids and the Potassium Trap
Minimum urine output
Adults should make at least 30 mL/hr (0.5 mL/kg/hr) and children at least 1 mL/kg/hr; less for two hours means poor kidney perfusion, as in shock, dehydration or magnesium toxicity, and is reported before the creatinine rises.
📚 Learn it: Four Kinds of Shock and the First Hour of Sepsis
Newborn blood glucose
A newborn glucose below about 40 to 45 mg/dL is hypoglycemia; infants of diabetic mothers, large or small for dates, preterm or cold-stressed are screened, and jitteriness, poor feeding or apnea call for feeding or IV dextrose.
📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar
Hemoglobin in pregnancy
Anemia in pregnancy is a hemoglobin under 11 g/dL in the first and third trimesters and under 10.5 g/dL in the second, because plasma volume expands faster than red cells; iron with vitamin C is the usual fix.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
Gestational diabetes screen (1-hour glucose challenge)
At 24 to 28 weeks the client drinks 50 grams of glucose and a 1-hour value of 130 to 140 mg/dL or higher (the cutoff varies by practice) is a positive screen that sends her to the 3-hour test.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
3-hour glucose tolerance test (gestational diabetes)
After a 100-gram glucose load the cutoffs are fasting 95, 1-hour 180, 2-hour 155 and 3-hour 140 mg/dL (Carpenter-Coustan), and two or more values at or above them diagnose gestational diabetes.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
Mnemonics
EAT (what the RN never delegates)
Evaluate, Assess, Teach: the three tasks a registered nurse keeps when assigning work to LPNs and assistive personnel, along with nursing judgment and any unstable client.
📚 Learn it: Delegation Cheat Code: Never Delegate What You EAT
MY CHICKEN HEZ TB (airborne precautions)
My = Measles, Chicken = Chickenpox (varicella), Hez = Herpes zoster when disseminated, TB = Tuberculosis: the diseases that need an N95 respirator and a negative-pressure room.
SPIDERMAN (droplet precautions)
meningococcal Sepsis, Scarlet fever, Strep throat, Parvovirus, Pneumonia (some types), Pertussis, Influenza, Diphtheria, Epiglottitis, Rubella, Mumps, meningococcal Meningitis, Mycoplasma, Adenovirus: diseases needing a surgical mask on entering the room.
MRS. WEE (contact precautions)
Multidrug-resistant organisms, Respiratory syncytial virus, Skin infections (scabies, impetigo, herpes simplex), Wound infections (draining), Enteric infections (C. difficile), Eye infections (viral conjunctivitis): the diseases that need a gown and gloves.
-OLOL (beta blockers)
A generic name ending in -olol (metoprolol, atenolol, propranolol) is a beta blocker: check the pulse, hold for a heart rate under 60, and never stop it abruptly.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
-PRIL (ACE inhibitors)
A generic name ending in -pril (lisinopril, enalapril, captopril) is an ACE inhibitor: watch for a dry cough, check potassium, and treat angioedema as an emergency.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
-SARTAN (angiotensin receptor blockers)
A generic name ending in -sartan (losartan, valsartan) is an angiotensin receptor blocker: the ACE-inhibitor alternative without the cough, with the same potassium and pregnancy warnings.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
-STATIN (cholesterol drugs)
A generic name ending in -statin (atorvastatin, simvastatin) lowers cholesterol: take simvastatin in the evening (atorvastatin any time), report muscle pain (rhabdomyolysis), and check liver enzymes before starting.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
SLUDGE (cholinergic crisis)
Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis: the signs of too much acetylcholine (organophosphate poisoning or cholinergic crisis), reversed with atropine.
TIRED (hypoglycemia signs)
Tachycardia, Irritability, Restlessness, Excessive hunger, Diaphoresis: the early signs of low blood sugar, checked at insulin peak times and treated with 15 grams of carbohydrate.
ROME (ABG interpretation)
Respiratory Opposite (pH and PaCO2 move in opposite directions), Metabolic Equal (pH and HCO3 move together): the two-step check for naming any acid-base imbalance.
MURDER (hyperkalemia signs)
Muscle weakness, Urine output low, Respiratory distress, Decreased cardiac contractility, ECG changes (peaked T waves), Reflexes abnormal: the signs of potassium above 5.0 mEq/L.
SALT LOSS (hyponatremia signs)
Seizures, Abdominal cramps, Lethargy, Tendon reflexes diminished, Loss of urine and appetite, Orthostatic hypotension, Shallow breathing, Spasms: the signs of sodium below 135 mEq/L.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
FRIED (hypernatremia signs)
Fever and flushed skin, Restlessness, Increased fluid retention and blood pressure, Edema, Decreased urine output and dry mouth: the signs of sodium above 145 mEq/L.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
CATS (hypocalcemia signs)
Convulsions, Arrhythmias, Tetany, Spasms and stridor: the signs of calcium below about 9 mg/dL, the picture to watch for after thyroid or parathyroid surgery.
📚 Learn it: Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat
MONA (heart attack drugs)
Morphine, Oxygen, Nitroglycerin, Aspirin: the classic recall list for a suspected heart attack; today aspirin comes first, oxygen only below 90% saturation, and morphine only if nitrates fail.
LEFT = LUNGS, RIGHT = REST (heart failure sides)
Left-sided failure backs up into the Lungs (crackles, dyspnea, frothy sputum) and Right-sided failure into the Rest of the body (edema, neck veins, liver): the heart failure symptom sorter.
VEAL CHOP (fetal heart rate decelerations)
Variable = Cord compression, Early = Head compression, Accelerations = Okay, Late = Placental insufficiency: how to read each deceleration pattern on a fetal monitor.
TORCH (infections that cross the placenta)
Toxoplasmosis, Other (syphilis, varicella, parvovirus, HIV), Rubella, Cytomegalovirus, Herpes simplex: infections that can pass to the fetus or newborn, in pregnancy or at birth, and cause birth defects.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
APGAR (newborn score)
Appearance (color), Pulse, Grimace (reflex irritability), Activity (muscle tone), Respiration: the five newborn signs scored 0 to 2 each at 1 and 5 minutes.
📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar
BUBBLE-LE (postpartum assessment)
Breasts, Uterus (fundus firm, midline), Bladder, Bowel, Lochia, Episiotomy or incision, Legs (clots), Emotions: the postpartum head-to-toe order (older form BUBBLE-HE, H for Homans' sign).
📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs
GTPAL (obstetric history)
Gravida (total pregnancies), Term births (37 weeks or more), Preterm births (20 to 36 weeks), Abortions (losses before 20 weeks), Living children: how to record an obstetric history.
📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs
PROVe (tetralogy of Fallot)
Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, Ventricular septal defect: the four defects of tetralogy of Fallot, the cyanotic heart defect behind tet spells.
📚 Learn it: Tet Spells, Coarctation and the Strawberry Tongue
SIG E CAPS (depression symptoms)
Sleep change, Interest lost, Guilt, Energy low, Concentration poor, Appetite change, Psychomotor slowing or agitation, Suicidal thoughts: the depression symptoms to screen for, five or more for two weeks.
SAD PERSONS (suicide risk factors)
Sex male, Age under 19 or over 45, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness: the classic suicide risk checklist.
HOT AND NERVOUS, COLD AND SLUGGISH (thyroid)
Hyperthyroidism runs hot and nervous (heat intolerance, weight loss, tachycardia, tremor); hypothyroidism runs cold and sluggish (cold intolerance, weight gain, bradycardia, constipation): the thyroid symptom sorter.
ADDISON'S = ADD, CUSHING'S = CUSHION (adrenal disorders)
Addison's is too little cortisol, so ADD steroids (low pressure, low sodium, high potassium); Cushing's is too much, a CUSHION of fat (moon face, high glucose, high pressure).
RACE (fire response)
Rescue anyone in danger, Alarm (pull it and call), Confine the fire by closing doors, Extinguish or Evacuate: the order of actions when you discover a fire.
📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight
PASS (fire extinguisher)
Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side: how to use a fire extinguisher once RACE has been started.
📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight
FAST (stroke recognition)
Face drooping, Arm weakness, Speech difficulty, Time to call for help and note the time: the public stroke screen (BE FAST adds Balance and Eyes).
NCLEX-style questions, XP and streaks in the app. No sign-up needed.