High-yield on the NCLEX-RN means two things: topics that recur across the 2026 test plan categories, and numbers that decide a safe action. The decisions that recur most are priority setting, delegation, infection precautions, medication safety and reading labs and ABGs. This guide lists the facts to put on one-page sheets, grouped by area, with the guideline body each comes from. Lab ranges vary by laboratory, so learn the standard values and expect the stem to give its own.
How we chose these topics
NCSBN does not publish a list of favorite topics, and we do not use recalled exam questions. We chose from three sources: the 2026 test plan category weights, the guideline bodies the exam is built around (CDC, CMS, Joint Commission, AHA, ACOG, ADA and similar), and the areas where candidates commonly struggle: prioritization and delegation, pharmacology safety, select all that apply and Next Generation items, labs and ABGs, infection precautions and therapeutic communication.
The exam tests judgment at the application and analysis level. A number only helps if you know the action it triggers, so each fact below has an action attached. Reference values here are standard textbook values. If a stem gives a different range, use the stem.
Tier 1: frameworks that apply to nearly every item
- Airway, breathing, circulation. A compromised airway beats a bleeding problem beats a pain problem, unless the item says otherwise.
- Acute before chronic. Unstable before stable. Actual before potential. Use these to rank any list of clients or actions.
- Assess before you intervene, unless the client is unstable. Many wrong options jump to an intervention without a needed assessment.
- Least invasive safe option first. Reposition before you call for a procedure.
- Delegation. The RN keeps assessment, teaching, evaluation and clinical judgment. An LPN/LVN can do focused data collection on stable clients, reinforce teaching and give some medications per state rules. A UAP does activities of daily living, vital signs on stable clients, intake and output, ambulation and positioning. The five rights of delegation are task, circumstance, person, directions and communication, and supervision and evaluation.
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Infection prevention and safety
| Topic | Fact to know | Body |
|---|---|---|
| Airborne precautions | Private negative-pressure airborne infection isolation room and N95 or higher respirator for tuberculosis, measles, varicella and disseminated herpes zoster. | CDC |
| Droplet precautions | Private room preferred and surgical mask for influenza, pertussis, mumps, rubella, meningococcal disease (until 24 hours of effective therapy), Mycoplasma and adenovirus. | CDC |
| Contact precautions | Gown and gloves for MRSA, VRE, C. difficile, scabies, norovirus and RSV. Use soap and water for C. difficile and norovirus because alcohol rub does not kill spores. | CDC |
| PPE order | Put on: gown, mask or respirator, goggles or face shield, gloves. Take off: gloves, goggles or face shield, gown, mask or respirator last, then hand hygiene. | CDC |
| Hand hygiene | Alcohol-based rub when hands are not visibly soiled; soap and water for at least 20 seconds when visibly soiled. | CDC |
| Tuberculin skin test | Read at 48 to 72 hours. Induration of 5 mm is positive in HIV, recent contacts, immunosuppression or abnormal chest X-ray; 10 mm for high-risk settings, healthcare workers and certain conditions; 15 mm with no risk factors. | CDC |
| Restraints | For violent or self-destructive behavior only. The order cannot be PRN or standing. Per-order limits: 4 hours for adults, 2 hours for ages 9 to 17, 1 hour under 9. Face-to-face evaluation within 1 hour. Discontinue at the earliest possible time. | CMS (42 CFR 482.13) |
| Do-Not-Use list | U, IU, Q.D., Q.O.D., trailing zero, missing leading zero, MS, MSO4, MgSO4. | Joint Commission |
| Medication identification | Five rights plus documentation; two client identifiers (name and date of birth). | Joint Commission |
Medications and labs
Pharmacological and Parenteral Therapies is the second-largest category at a 16% midpoint. Learn each drug with three items: the monitoring parameter, the sign of toxicity and the antidote.
| Drug or test | Know this |
|---|---|
| Heparin | aPTT about 1.5 to 2.5 times control (about 60 to 80 seconds; lab-specific). Antidote: protamine sulfate. Watch platelets for heparin-induced thrombocytopenia. |
| Warfarin | INR 2.0 to 3.0 for most indications (2.5 to 3.5 for a mechanical mitral valve). Antidote: vitamin K. Teach steady vitamin K intake. |
| Digoxin | Therapeutic about 0.5 to 2.0 ng/mL. Hold and notify for an apical pulse below 60 in adults. Low potassium raises toxicity risk. Antidote: digoxin immune fab. |
| Lithium | Therapeutic about 0.6 to 1.2 mEq/L; above 1.5 mEq/L is toxic. Keep sodium and fluid intake steady; avoid NSAIDs and thiazides. |
| Acetaminophen | Antidote: acetylcysteine. FDA labeling maximum is 4 g a day for adults in OTC use; many facilities cap lower. |
| Opioids and benzodiazepines | Hold the opioid if respiratory rate is below 12 or sedation is high. Naloxone reverses opioids; flumazenil reverses benzodiazepines. |
| Magnesium sulfate | Therapeutic about 4 to 7 mEq/L. Toxicity: loss of deep tendon reflexes, respiratory rate below 12, urine output below 30 mL/h. Antidote: calcium gluconate. |
| Blood transfusion | Two-nurse bedside verification; only 0.9% sodium chloride; stay and monitor closely for the first 15 minutes; complete within 4 hours of leaving the blood bank. In a reaction: stop the transfusion, keep the IV open with new tubing and saline, notify the provider and blood bank. |
| Typical adult labs | K 3.5 to 5.0 mEq/L; Na 135 to 145 mEq/L; Ca 8.5 to 10.5 mg/dL; Mg 1.5 to 2.5 mg/dL; phosphorus 2.5 to 4.5 mg/dL; BUN 10 to 20 mg/dL; creatinine 0.6 to 1.2 mg/dL; platelets 150,000 to 400,000/mm3. |
| Arterial blood gas | pH 7.35 to 7.45; PaCO2 35 to 45 mmHg; HCO3 22 to 26 mEq/L; PaO2 80 to 100 mmHg; SaO2 95 to 100%. |
Reference ranges differ between laboratories. NCLEX stems normally supply the range when the answer depends on it. Memorize the textbook values so you recognize direction (high, low, critical), not to the decimal.
Emergency and cardiovascular care
- Adult CPR. Rate 100 to 120 per minute, depth at least 2 inches (5 cm) and not more than about 2.4 inches (6 cm), full recoil, 30:2 for a single rescuer. The AHA published new guidelines in October 2025; check the AHA executive summary for any change to sequences before you rely on older notes.
- Cardiac arrest drugs. Epinephrine 1 mg IV or IO every 3 to 5 minutes. Amiodarone 300 mg first dose, then 150 mg for refractory ventricular fibrillation or pulseless ventricular tachycardia. The shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.
- Acute coronary syndrome. 12-lead ECG within 10 minutes of arrival. Aspirin 162 to 325 mg chewed unless allergic. Door-to-balloon goal of 90 minutes for STEMI. Avoid nitroglycerin if a PDE-5 inhibitor was taken within 24 to 48 hours, or with right ventricular infarct or hypotension.
- Acute ischemic stroke. Noncontrast CT first. Thrombolysis window within 4.5 hours of last known well, with BP below 185/110.
- Blood pressure categories (ACC/AHA 2017). Normal below 120/80; elevated 120 to 129 and below 80; stage 1 130 to 139 or 80 to 89; stage 2 at least 140/90; hypertensive crisis above 180/120.
- Sepsis. Measure lactate, take blood cultures before antibiotics, give antibiotics within 1 hour for shock or high likelihood of sepsis, 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more, norepinephrine first-line to a mean arterial pressure of 65 mmHg.
Diabetes and endocrine
Hypoglycemia is level 1 below 70 mg/dL and level 2 below 54 mg/dL. Use the rule of 15: 15 g of fast carbohydrate, then recheck in 15 minutes. Diabetes is diagnosed at fasting glucose of at least 126 mg/dL or A1c of at least 6.5%. In diabetic ketoacidosis, replace fluids first and confirm potassium is at least 3.3 mEq/L before starting an insulin infusion; add dextrose when glucose falls to about 200 to 250 mg/dL.
Maternal and newborn
- Naegele's rule: first day of the last menstrual period, minus 3 months, plus 7 days. Full term is 39 0/7 to 40 6/7 weeks.
- Preeclampsia: BP of at least 140/90 on two readings 4 hours apart after 20 weeks with proteinuria or severe features; severe range at least 160/110.
- Fetal heart rate: baseline 110 to 160. Early decelerations are benign head compression. Variable decelerations point to cord compression: reposition. Late decelerations point to uteroplacental insufficiency: left lateral position, oxygen, IV fluid bolus, stop oxytocin.
- Rh immune globulin 300 mcg IM at about 28 weeks and within 72 hours after delivery of an Rh-positive infant to an Rh-negative unsensitized mother.
- Postpartum hemorrhage: blood loss of 1,000 mL or more or signs of hypovolemia within 24 hours; fundal massage and oxytocin first. Avoid carboprost in asthma and methylergonovine in hypertension.
- Newborn: Apgar at 1 and 5 minutes; vitamin K 1 mg IM, erythromycin ophthalmic ointment and a hepatitis B birth dose within 24 hours if stable.
- Safe sleep: on the back, firm flat surface, no soft bedding, room-sharing without bed-sharing.
Screening, prevention and nursing care
| Topic | Fact to know |
|---|---|
| Breast cancer (USPSTF) | Biennial mammography, ages 40 to 74. |
| Colorectal cancer | Screening ages 45 to 75. |
| Cervical cancer | Cytology every 3 years for ages 21 to 29; ages 30 to 65 cytology every 3 years, HPV testing every 5 years, or cotesting every 5 years. |
| Lung cancer | Annual low-dose CT, ages 50 to 80, at least 20 pack-years, current smoker or quit within 15 years. |
| Abdominal aortic aneurysm | One-time ultrasound for men 65 to 75 who ever smoked. |
| Tetanus and influenza vaccines | Td or Tdap every 10 years; Tdap once in every pregnancy. Annual influenza vaccine for all adults. |
| Braden scale | Range 6 to 23. At risk at 18 or lower. 15 to 18 mild, 13 to 14 moderate, 10 to 12 high, 9 or lower very high. |
| Glasgow Coma Scale | Range 3 to 15. A score of 8 or below indicates severe impairment and airway risk. |
| Enteral feeding | Head of bed at least 30 degrees during and after feeds. Radiograph is the gold standard for confirming new blind tube placement. |
US legal and ethical points
- The provider obtains informed consent for medical and surgical procedures; the nurse witnesses the client's signature. The nurse obtains consent for nursing procedures. A minor generally needs a parent or guardian, with exceptions for emancipated minors and some state-specific situations.
- HIPAA minimum necessary standard: share information only with people involved in care and with client permission.
- The Patient Self-Determination Act (1990) requires Medicare and Medicaid facilities to inform clients about advance directive rights.
- Mandatory reporting duties (abuse, certain communicable diseases) follow state law.
How to use this list
Build three one-page sheets from the tables: labs and ABGs, drugs with antidotes, and precautions with PPE. Recite one each morning. Link each fact to its action when you practice. For example, K below 3.5 means check ECG changes and replace carefully, not just "low". Then see how these appear in the domain pages: Pharmacological and Parenteral Therapies, Safety and Infection Prevention and Control and Reduction of Risk Potential. If you trained abroad, add US drug names and delegation rules from the IEN guide.
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Frequently asked questions
What topics are most tested on the NCLEX-RN?
NCSBN does not publish a favorites list. By weight, Management of Care (15-21%) and Pharmacological and Parenteral Therapies (13-19%) are the largest categories. Prioritization, delegation, infection precautions, medication safety and lab interpretation recur across categories.
Do I need to memorize lab values for the NCLEX-RN?
Learn the standard adult ranges so you can recognize high, low and critical values. Stems usually give the laboratory's range when the answer depends on it.
What are the NCLEX delegation rules in short?
The RN keeps assessment, teaching, evaluation and clinical judgment. LPN/LVNs can do focused data collection on stable clients and reinforce teaching. UAPs do activities of daily living, vital signs on stable clients, intake and output, ambulation and positioning.
Which antidotes should I know?
Heparin: protamine sulfate. Warfarin: vitamin K. Digoxin: digoxin immune fab. Acetaminophen: acetylcysteine. Opioids: naloxone. Benzodiazepines: flumazenil. Magnesium sulfate: calcium gluconate.
Are the AHA CPR guidelines tested?
CPR and ACLS content is tested within emergency care. The AHA published new guidelines in October 2025, so check its executive summary for sequence changes before relying on older notes.
Which numbers are the most useful to memorize first?
Start with ABG and electrolyte ranges, INR and aPTT targets, digoxin and lithium levels, restraint time limits, and the airborne, droplet and contact precaution lists.