One-Pager
Physiological Adaptation: Conditions at a Glance
Cue cluster, first action, key drug, teaching and when to report, by body system, for the NCLEX-RN and NCLEX-PN
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How to read a condition question
- Name the condition from the cue cluster, not from one cue
- Ask what kills first: airway, breathing, circulation, then neuro change
- Pick the safe first action within nursing scope (position, stop the trigger, check the device, hold the drug)
- Report a change from baseline at once; do not wait for the next scheduled check
Neuro and spinal cord
| Condition | Cue cluster | First action | Report when |
|---|---|---|---|
| Rising ICP | Early: restlessness, confusion, drowsiness, headache, vomiting. Late: Cushing triad (high SBP with wide pulse pressure, slow HR, irregular breathing), fixed pupil | HOB 30°, head midline, avoid straining and hip flexion | Any drop in level of consciousness or new pupil change |
| Ischemic stroke | Sudden one-sided weakness, speech or vision loss; time last known well | Neuro checks, glucose, swallow screen before anything by mouth | BP above 185/110 before a clot-buster, new headache or bleeding during it |
| Hemorrhagic stroke or SAH | Worst headache, vomiting, stiff neck | Quiet dark room, seizure and fall precautions, stool softener | New confusion or weakness days 3 to 14 after SAH (vasospasm) |
| Autonomic dysreflexia (injury at T6 or above) | Pounding headache, very high BP, slow HR, flushing and sweating above the injury | Sit up, legs down, loosen clothing, then check catheter and tubing, then bowel | BP stays high once the trigger is removed |
| Spinal cord injury, high cervical | Weak cough, falling vital capacity; orthostatic dizziness later | Respiratory checks; binder, stockings, slow position changes | Shallow breathing or a falling vital capacity |
| Guillain-Barré | Ascending symmetric weakness, lost reflexes, labile BP | Serial vital capacity and swallow checks | Vital capacity falling toward 20 mL/kg, weak cough |
| Myasthenic vs cholinergic crisis | Both: weakness, trouble swallowing and breathing. Cholinergic: secretions, cramps, diarrhea soon after a dose | Protect the airway; hold the next dose until the provider decides | Any breathing difficulty |
| Status epilepticus | Seizure lasting 5 min or more, or back-to-back without waking | Side-lying, oxygen, glucose check, benzodiazepine as ordered (IM if no IV) | At 5 min, at once |
| Basilar skull fracture | Raccoon eyes, Battle sign, clear fluid from nose or ear | Do not pack or suction the nose; no nose blowing | Fever, stiff neck (meningitis) |
| VP shunt failure or infection | Headache, vomiting, drowsiness; infants: bulging fontanel, fast head growth, setting-sun eyes; fever or redness on the tract | Neuro checks, head circumference in infants | At once: needs imaging |
Endocrine
| Condition | Cue cluster | Key drug or action | Teach or report |
|---|---|---|---|
| Adrenal crisis (Addison disease, or long-term steroids stopped or not raised) | Hypotension that resists fluids, vomiting, confusion, low Na, low glucose; high K in primary disease | IV hydrocortisone 100 mg, dextrose in saline | Never stop steroids abruptly; double the dose when ill (more for high fever, per plan); injectable kit and alert ID |
| Cushing syndrome | Moon face, central obesity, thin bruising skin, high glucose, low K, high BP | Protect skin, check glucose and K, watch for masked infection | Stress-dose steroids around surgery; taper, never stop |
| Myxedema coma | Untreated hypothyroidism: low temperature, slow HR, slow breathing, drowsy to coma | Airway first; IV levothyroxine plus a glucocorticoid; slow rewarming, careful fluids | Report shallow breathing or a falling level of consciousness |
| Thyroid storm | High fever, very fast HR, agitation or delirium, vomiting, diarrhea, often after infection, trauma or surgery | Beta blocker, antithyroid drug (PTU) before iodine, hydrocortisone, cooling | Report rising temperature, new rhythm, confusion |
| Antithyroid drugs (methimazole, PTU) | Fever or sore throat; yellow skin | Report at once; the provider decides about holding the drug and checking a blood count (agranulocytosis; PTU liver injury) | Beta blocker may be ordered for symptoms meanwhile |
| Levothyroxine | Too much: palpitations, tremor, heat intolerance | Start low in older adults and heart disease | Lifelong, same time daily, empty stomach |
| Pheochromocytoma | Spells of high BP, headache, sweating, palpitations | No abdominal palpation; alpha blocker before any beta blocker | After removal: watch for low glucose (and BP) |
Cardiac and blood pressure
| Condition | Cue cluster | First action | Report when |
|---|---|---|---|
| Right ventricular (inferior) MI | Low BP, distended neck veins, clear lungs after nitroglycerin | Stop nitrates, legs up, fluid bolus as ordered | At once |
| Nitroglycerin infusion hypotension | SBP falls, dizziness | Slow or stop the drip, lower the head of the bed | SBP stays low |
| Mechanical complication days after MI | New loud murmur, sudden pulmonary edema | Oxygen, upright, monitor | Any new murmur, at once |
| Pericarditis | Sharp pain worse lying flat, eased leaning forward; friction rub | NSAID and colchicine as ordered; upright | Low BP, muffled heart sounds, JVD (tamponade) |
| Aortic dissection | Sudden tearing chest or back pain, arm BP difference | Notify; expect IV beta blocker first, then BP lowering | New neuro deficit or limb pain |
| Hypertensive emergency vs severe BP without symptoms | Emergency: headache, vision change, confusion, chest pain. Severe BP alone: no symptoms | Emergency: IV drug, lower BP no more than about 25% in the first hour. No symptoms: recheck, oral drug, adherence review | Any new organ sign |
| Bad BP reading | Sudden change, client looks the same | Recheck with the right cuff size and technique | Still high on recheck |
| Valve disease | Aortic stenosis: exertional syncope, angina. Mitral stenosis: atrial fibrillation, dyspnea, emboli | Activity limits; anticoagulation as ordered | Syncope, stroke signs, pulmonary edema |
| Infective endocarditis risk | Prosthetic valve or prior endocarditis | Antibiotic before dental work as prescribed | Fever, new murmur, petechiae |
| Femoral access bleeding after PCI | New back or flank pain, rising HR, falling BP, groin may look normal | Notify at once (retroperitoneal bleed) | At once |
GI, liver and renal
| Condition | Cue cluster | Key action or drug | Report when |
|---|---|---|---|
| Variceal bleeding (cirrhosis) | Vomiting large amounts of bright red blood | Side-lying, airway; two large IVs; octreotide and an antibiotic; banding within 12 h | Falling BP, confusion |
| Hepatic encephalopathy | Confusion, flapping tremor, high ammonia; trigger: bleeding, infection, constipation, sedatives | Lactulose to 2 to 3 soft stools a day, rifaximin; fall precautions, no sedatives | Deeper drowsiness |
| Ascites | Tense abdomen, weight gain | Sodium restriction, spironolactone with furosemide; daily weight and girth | Fever or belly pain (infected ascites) |
| Acute pancreatitis | Epigastric pain to the back | IV fluids, IV opioids, early feeding as tolerated | Low calcium, high glucose, breathing trouble |
| Chronic pancreatitis | Fatty stools, weight loss | Pancreatic enzymes with every meal and snack, swallowed whole | High glucose |
| Peptic ulcer perforation or appendix rupture | Sudden severe pain then rigid, board-like abdomen (appendix: pain suddenly stops, then spreads) | NPO, notify at once | At once |
| Bleeding after gastric surgery | NG drainage turns bright red again | Vital signs, notify; do not reposition the tube | At once |
| Post-strep glomerulonephritis | Dark (tea- or rust-colored) urine, puffy face or eyes, high BP, 1 to 2 weeks after a throat infection or 3 to 4 after a skin infection | Daily weight, I&O, BP; salt limits; diuretics as ordered | Headache or confusion (hypertensive encephalopathy) |
| Nephrotic syndrome | Massive edema, heavy proteinuria, low albumin | Steroids; skin care, weight and girth, infection precautions | Fever, clot signs |
| Rhabdomyolysis | Muscle pain, dark brown urine, very high CK | Large IV fluid volumes to keep urine output high | Falling output, high K |
| Kidney transplant rejection | Fever, graft tenderness, less urine, rising creatinine | Notify at once; strict immunosuppressant schedule | At once |
| Dialysis problems | PD: cloudy effluent, belly pain. First hemodialysis: headache, nausea, confusion (disequilibrium) | PD: send effluent for culture. HD: report; orders are changed | At once |
| Postobstructive diuresis | Large hourly urine after a catheter relieves retention; dizziness on sitting | Hourly output, orthostatic vitals, electrolytes | Hourly totals stay high |
Blood and cancer emergencies
| Condition | Cue cluster | First action | Report when |
|---|---|---|---|
| Sickle cell pain crisis | Severe pain in legs, back, chest; triggers: dehydration, infection, cold, exertion | Scheduled opioids or PCA, IV and oral fluids, warmth, oxygen if hypoxemic | Chest pain, fever, cough |
| Acute chest syndrome | Fever, chest pain, new infiltrate, hypoxemia | Oxygen, antibiotics, incentive spirometry, transfusion as ordered | At once |
| Splenic sequestration (children) | Sudden big spleen, Hgb falls 2 g/dL or more, shock | Fluids and transfusion as ordered | At once |
| Tumor lysis syndrome | After first chemo: high K, phosphate, uric acid, rising creatinine | Hydration, allopurinol or rasburicase, cardiac monitor | Rhythm change, falling urine output |
| Superior vena cava syndrome | Face and arm swelling, neck vein distention, worse bending or lying | HOB up, oxygen; no IV or BP in the arms | Stridor or confusion |
| Spinal cord compression from cancer | Back pain worse lying down, then leg weakness and bladder trouble | Notify now: urgent MRI, dexamethasone | At once: delay means paralysis |
| DIC | Oozing sites, petechiae, low platelets, long PT/aPTT, high D-dimer | Bleeding precautions; treat the cause; products as ordered | New bleeding or organ signs |
| Macrocytic anemia | High MCV; numb feet points to B12 (alcohol, gastric surgery) | B12 replacement; folate alone can hide B12 nerve damage | Worsening neuropathy |
| HIV with low CD4 | Opportunistic infection risk | Prophylaxis such as TMP-SMX as prescribed; ART at any count | Fever, cough, new neuro signs |
Respiratory
| Condition | Cue cluster | First action | Report when |
|---|---|---|---|
| Severe asthma | Single words, accessory muscles; a quiet chest means little air moves | Nebulized bronchodilators, steroids, oxygen; prepare for intubation | Silent chest, drowsiness, rising CO₂ |
| Beta-agonist side effects | Tremor, tachycardia after albuterol | Expected: continue and monitor | Chest pain, new rhythm |
| ARDS | Hypoxemia despite high oxygen, fast breathing, crackles after sepsis or pneumonia | Call the rapid response team; stay with the client | At once |
| Pneumonia | Fever, crackles, productive cough | Fluids, deep breathing, walking, oxygen to target | Falling SpO₂, confusion, low BP |
| Cystic fibrosis | Thick secretions, fatty stools, salty sweat | Airway clearance several times a day; enzymes with meals and snacks | Exacerbation signs |
Children
| Condition | Cue cluster | Key action | Teach or report |
|---|---|---|---|
| Kawasaki disease | Fever 5 days or longer, red eyes without discharge, red cracked lips, strawberry tongue, swollen hands and feet, rash | IVIG and aspirin | Heart follow-up (coronary aneurysm risk) |
| Heart failure from a left-to-right shunt (VSD) | Sweating and tiring with feeds, fast breathing, poor weight gain | Small frequent high-calorie feeds, upright | Weight loss, worse breathing |
| Hirschsprung disease | No meconium, distended belly, bilious vomiting | NPO, report; rectal biopsy confirms | Fever and explosive diarrhea (enterocolitis) |
| Pyloric stenosis | Projectile non-bilious vomiting, hungry, olive mass | Fluids and electrolytes before surgery | Dehydration signs |
| Wilms tumor | Painless abdominal mass | Sign at the bed: do not palpate the abdomen | High BP, blood in urine |
Injury, heat and cold
| Condition | Cue cluster | First action | Report when |
|---|---|---|---|
| Compartment syndrome | Pain out of proportion, worse on passive stretch; pulse may still be present | Loosen cast, splint or dressing; limb at heart level, not raised | At once: pallor and pulselessness are late |
| Heat stroke | Core above 40 °C with confusion | Rapid cooling (cold water immersion or ice); stop at about 38.5 to 39 °C | Dark urine, bleeding |
| Hypothermia | Confused, no longer shivering | Remove wet clothing, rewarm, handle gently (ventricular fibrillation risk) | Rhythm change |
| Phantom limb pain | Pain in the missing limb | Believe it, assess it, treat it | Pain not controlled |
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In depth
The one-page summary above is what the PDF prints. These sections go further.
Why the first actions work
- Autonomic dysreflexia: a stimulus below the injury sets off a sympathetic surge the brain cannot damp. Sitting up pools blood in the legs; removing the trigger (bladder first, then bowel, then skin and clothing) ends it. The client may have no symptoms despite a dangerous BP.
- Adrenal crisis: without cortisol the vessels do not respond to fluids or vasopressors.
- Thyroid storm: PTU goes before iodine because iodine given first can feed new hormone synthesis.
- Myxedema coma: drugs are cleared slowly and water is not excreted well, so fast fluids and fast rewarming cause harm (low BP, arrhythmias).
- Pheochromocytoma: a beta blocker without alpha blockade leaves alpha vasoconstriction unopposed and can raise the pressure.
- Compartment syndrome: capillary flow fails while the artery still pulses, which is why a palpable pulse does not rule it out. Raising the limb lowers the pressure driving blood into the compartment.
Classic teaching points kept
Some rows keep standard nursing teaching that the open sources read for this page do not state in these words: warmth rather than cold for sickle cell pain, report fever or sore throat on antithyroid drugs, lifelong levothyroxine taken at the same time daily on an empty stomach, keep an ischemic limb level, double flushing and distance after radioactive iodine, no nose blowing with a CSF leak, and no palpation of a Wilms tumor. They are kept because the exam teaches them and no source read contradicts them.
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Related one-pagers
- Mobility, Assistive Devices and ImmobilityCanes, walkers and crutches, transfers and safe handling, casts, traction, halo, amputation care and the hazards of bed rest for the NCLEX
- Elimination, Ostomy and Catheter CareStomas and pouching, high-output ileostomy, ileal conduit, irrigation, bowel programs, impaction, bladder training, catheters, CAUTI, specimens, sitz baths and PD sites for the NCLEX
- Hygiene, Sensory Deficits and Comfort MeasuresHearing aids, Deaf clients and interpreters, vision loss and eye devices, ear and oral care, bathing and diabetic feet, heat and cold, and communicating after a stroke for the NCLEX
- Nutrition, Tube Feeding and Medications by TubeTube placement checks, residuals, aspiration precautions, flushing, drugs through tubes, NG suction, PEG care, TPN basics and diets for GI symptoms for the NCLEX-RN and PN
- End of Life, Hospice, Pain and SleepSigns that death is near, comfort in the last days, around-the-clock opioids, fentanyl patches and PCA, pain without self-report, sleep, fatigue and postmortem care for the NCLEX
Sources
- Grossman AB. Primary Adrenal Insufficiency (Addison Disease). Merck Manual Professional Edition, reviewed January 2026. Link
- Boucai L. Hyperthyroidism (thyroid storm, antithyroid drugs, preparation for thyroidectomy). Merck Manual Professional Edition, reviewed January 2026. Link
- Boucai L. Hypothyroidism (myxedema coma, levothyroxine dosing). Merck Manual Professional Edition, reviewed January 2026. Link
- Grossman AB. Pheochromocytoma. Merck Manual Professional Edition, reviewed January 2026. Link
- Gerber GF. Sickle Cell Disease. Merck Manual Professional Edition, reviewed April 2026. Link
- Campagne D. Compartment Syndrome. Merck Manual Professional Edition, reviewed March 2025. Link
- MedlinePlus Medical Encyclopedia. Autonomic dysreflexia. U.S. National Library of Medicine, reviewed May 2026. Link
- MedlinePlus Medical Encyclopedia. Poststreptococcal glomerulonephritis (GN). U.S. National Library of Medicine, reviewed September 2025. Link
- Centers for Disease Control and Prevention. About Kawasaki Disease. January 2026. Link