IDCardiac
Sterile blood samples collected to identify bloodstream infection.
NCLEX focus
- If ordered and safe, collect cultures before antibiotics; do not delay emergency sepsis care.
Before
- Verify order, timing, site prep, labels, and whether multiple sites are required.
- Assess fever, chills, and antibiotic timing.
After
- Send promptly.
- Document collection sites/times.
- Monitor for bleeding or contamination issues.
Priority complications
- Delayed antibiotics in unstable sepsis
- Contaminated specimen
- Bleeding in anticoagulated clients
Bone marrow biopsy
Procedure
Heme
Needle sample of marrow, often from posterior iliac crest, to evaluate blood cell production or malignancy.
NCLEX focus
- Bleeding, infection, positioning, anxiety, and post-procedure pressure dressing are NCLEX cues.
Before
- Check consent, CBC/platelets/coagulation risk, allergies, and sedation plan.
- Explain positioning and pressure sensation.
After
- Apply pressure dressing per policy.
- Monitor bleeding, pain, vital signs, and infection signs.
- Keep site clean/dry per instructions.
Priority complications
- Bleeding
- Infection
- Uncontrolled pain
- Sedation reaction
Cardiac catheterization
Procedure
CardiacRenal
Catheter-based heart and vessel study or intervention.
NCLEX focus
- Contrast allergy, kidney function, distal pulses, bleeding, and chest pain after procedure are priority cues.
Before
- Check consent, allergies, kidney labs, anticoagulants, pregnancy status when relevant, and baseline distal pulses.
- Maintain NPO status if ordered.
After
- Monitor access site bleeding/hematoma.
- Check distal pulses, color, temperature, sensation, and pain.
- Promote fluids if ordered for contrast clearance.
Priority complications
- Bleeding
- Arterial occlusion
- Dysrhythmia
- Contrast reaction
- Kidney injury
Chest tube insertion and care
Procedure
RespCardiac
Tube placed into pleural space to remove air, blood, fluid, or pus.
NCLEX focus
- Respiratory status, drainage changes, air leak, water seal, occlusive dressing, and never clamping casually are key safety points.
Before
- Assess breath sounds, oxygenation, pain, allergies, consent, and emergency status.
- Prepare sterile setup and drainage system per policy.
After
- Keep system below chest.
- Monitor drainage amount/color, tidaling, bubbling, insertion dressing, and respiratory response.
- Keep emergency dressing supplies available.
Priority complications
- Tension pneumothorax
- Tube dislodgement
- Hemorrhage
- Infection
- Subcutaneous emphysema
Skin
Removal of dead or infected tissue from a wound or burn.
NCLEX focus
- Pain control, bleeding, infection prevention, and sterile/clean technique per wound type are testable.
Before
- Assess pain, circulation, wound appearance, allergies, and ordered analgesia.
- Verify wound-care order and supplies.
After
- Reassess pain and bleeding.
- Document wound bed, drainage, odor, size, and dressing.
- Monitor infection signs.
Priority complications
- Bleeding
- Uncontrolled pain
- Exposed structures
- Infection
CardiacPedsOB
Ultrasound of heart structure, valves, movement, and blood flow.
NCLEX focus
- Common diagnostic for valve disease, tamponade, cardiomyopathy, and congenital defects.
Before
- Explain painless ultrasound process.
- For TEE, check consent, NPO status, gag reflex plan, and sedation risk.
After
- For standard echo, routine care.
- For TEE, monitor airway, gag reflex return, sedation recovery, and sore throat.
Priority complications
- Aspiration after TEE
- Sedation reaction
- Delayed recognition of tamponade or poor perfusion
Electrocardiogram / telemetry
Procedure
CardiacRenal
Electrical tracing or monitoring of heart rhythm.
NCLEX focus
- Symptomatic rhythm changes, chest pain, electrolyte abnormalities, and rate-slowing meds are priority contexts.
Before
- Place leads on clean dry skin.
- Check client identity and symptoms.
- Compare to baseline when available.
After
- Report acute ischemic changes or dangerous rhythms promptly.
- Keep telemetry leads attached and alarms set per policy.
Priority complications
- Missed dysrhythmia
- Lead misplacement
- Artifact mistaken for rhythm
SkinResp
Surgical cuts through tight burn eschar to restore breathing or circulation.
NCLEX focus
- Circumferential chest or extremity burns with impaired ventilation or distal perfusion are emergency cues.
Before
- Assess distal pulses, capillary refill, pain, sensation, movement, chest expansion, and oxygenation.
- Prepare sterile setup and pain control per emergency plan.
After
- Reassess neurovascular status or chest expansion.
- Monitor bleeding, pain, infection, and dressing needs.
Priority complications
- Bleeding
- Persistent compartment compromise
- Infection
Exchange transfusion
Procedure
OBHeme
Removal and replacement of newborn blood in severe hyperbilirubinemia or selected hemolytic disease.
NCLEX focus
- Used when bilirubin is dangerously high or not responding; monitor thermoregulation, glucose, calcium, infection, and hemodynamics.
Before
- Verify consent, blood product checks, bilirubin trend, baseline vitals, glucose, and temperature.
- Maintain cardiorespiratory monitoring.
After
- Monitor bilirubin rebound, glucose, calcium, temperature, bleeding, and infection signs.
Priority complications
- Hypocalcemia
- Hypoglycemia
- Dysrhythmia
- Infection
- Bleeding
Gastric decompression
Procedure
GIOBPeds
NG or OG tube used to remove stomach or bowel contents and reduce distention/vomiting.
NCLEX focus
- Airway protection, tube placement verification, output monitoring, and electrolyte/fluid balance are priority.
Before
- Assess vomiting, distention, aspiration risk, nares/oral route, and contraindications.
- Verify order and placement-check policy.
After
- Monitor output amount/color, abdominal assessment, electrolytes, mucosa, and tube security.
- Keep suction settings as ordered.
Priority complications
- Aspiration
- Tube misplacement
- Fluid/electrolyte imbalance
- Mucosal injury
Gluten-free diet teaching
Teaching
Auto/GenGIPeds
Diet education to eliminate gluten sources for celiac disease.
NCLEX focus
- Wheat, barley, rye, hidden gluten, cross-contamination, and lifelong adherence are the major teaching points.
Before
- Assess baseline diet, reading level, food access, and cultural preferences.
- Verify diagnosis and dietitian referral.
After
- Reinforce label reading.
- Monitor weight, symptoms, iron/vitamin levels, and growth in children.
Priority complications
- Malnutrition
- Persistent diarrhea
- Anemia
- Poor growth
Auto/GenPedsCardiac
Intravenous immune globulin given for selected immune, inflammatory, or infectious indications.
NCLEX focus
- Watch for infusion reaction, fluid status, renal risk, and vaccine timing teaching after IVIG when applicable.
Before
- Check allergies, baseline vitals, renal risk, hydration, and ordered rate/premeds.
- Verify product and dose.
After
- Monitor fever, chills, headache, back pain, dyspnea, hypotension, and urine output.
- Teach follow-up instructions, including vaccine timing if relevant.
Priority complications
- Anaphylaxis
- Thrombosis
- Renal injury
- Fluid overload
Renal
Procedure that breaks kidney stones into smaller pieces.
NCLEX focus
- Pain, hematuria, stone fragments, hydration, and obstruction/infection signs are testable.
Before
- Check pregnancy status when relevant, anticoagulants, infection signs, pain, and kidney function.
- Teach procedure expectations.
After
- Strain urine if ordered.
- Encourage fluids if not contraindicated.
- Monitor pain, fever, urine output, and hematuria.
Priority complications
- Obstruction
- Infection/sepsis
- Bleeding
- Uncontrolled pain
NeuroID
Needle procedure to collect cerebrospinal fluid or measure pressure.
NCLEX focus
- Neuro status, infection precautions, anticoagulants, positioning, and post-procedure headache/CSF leak are key cues.
Before
- Check consent, neuro status, platelets/anticoagulants, allergies, and if imaging is required before procedure.
- Position correctly and maintain sterile field.
After
- Monitor neuro status, headache, drainage, pain, and infection signs.
- Follow ordered positioning and fluid instructions.
Priority complications
- Herniation risk with increased ICP
- Bleeding
- Infection
- CSF leak
Nasal suctioning
Procedure
RespPedsOB
Clearing nasal secretions to improve infant breathing and feeding.
NCLEX focus
- Use before feeds when congestion limits intake; avoid aggressive suctioning that causes trauma or bradycardia.
Before
- Assess work of breathing, oxygen saturation, feeding ability, and secretion burden.
- Use correct device and gentle technique.
After
- Reassess breathing, feeding, mucosal trauma, and tolerance.
- Stop if distress or bradycardia occurs.
Priority complications
- Bradycardia
- Mucosal trauma
- Worsening distress
Needle decompression
Procedure
RespCardiac
Emergency needle placement to release trapped pleural air in tension pneumothorax.
NCLEX focus
- Severe respiratory distress, absent unilateral breath sounds, hypotension, JVD, and tracheal deviation are emergency cues.
Before
- Recognize tension physiology quickly.
- Prepare oxygen, emergency equipment, and provider/rapid response support.
After
- Reassess breathing and circulation.
- Prepare for chest tube.
- Monitor recurrence and site complications.
Priority complications
- Persistent tension pneumothorax
- Bleeding
- Organ injury
- Respiratory arrest
Neutropenic precautions
Infection control
HemeID
Infection-prevention practices for clients with low neutrophils.
NCLEX focus
- Fever is emergency; hand hygiene, avoiding sick contacts, and policy-specific diet/environment rules matter.
Before
- Check ANC, temperature, mucosa, lines, skin, and current symptoms.
- Clarify facility policy for food, flowers, visitors, and room placement.
After
- Continue temperature and infection surveillance.
- Teach fever reporting and safe hygiene habits.
Priority complications
- Sepsis
- Pneumonia
- Line infection
- Mucositis infection
Pericardiocentesis
Procedure
Cardiac
Needle drainage of fluid from the pericardial sac.
NCLEX focus
- Used for tamponade; monitor hemodynamics, rhythm, pain, and recurrence.
Before
- Assess vitals, pulse pressure, heart sounds, JVD, oxygenation, ECG, consent/emergency status, and IV access.
- Prepare sterile setup and echo guidance if ordered.
After
- Monitor blood pressure, rhythm, breath sounds, pain, drainage, and signs of recurrent tamponade.
- Send fluid specimens if ordered.
Priority complications
- Dysrhythmia
- Cardiac puncture
- Bleeding
- Recurrent tamponade
- Pneumothorax
OBPeds
Light treatment that helps break down bilirubin in newborn jaundice.
NCLEX focus
- Eye protection, skin exposure, hydration, stooling, temperature, and bilirubin trends are key.
Before
- Check bilirubin level, age in hours, weight, temperature, hydration, and eye protection setup.
- Undress to diaper as ordered.
After
- Monitor temperature, stools, urine output, skin, hydration, and bilirubin rebound.
- Support feeding.
Priority complications
- Dehydration
- Temperature instability
- Eye injury if unprotected
- Worsening bilirubin
Prostaglandin infusion
Procedure
OBCardiacPeds
Medication infusion used to keep the ductus arteriosus open in ductal-dependent congenital heart disease.
NCLEX focus
- Maintains systemic or pulmonary blood flow but can cause apnea, hypotension, fever, or flushing.
Before
- Assess oxygenation, perfusion, glucose, temperature, IV access, and emergency airway readiness.
- Verify dose and pump settings carefully.
After
- Monitor apnea, respiratory status, blood pressure, temperature, pulses, and perfusion.
- Keep resuscitation equipment available.
Priority complications
- Apnea
- Hypotension
- Ductal closure if interrupted
- Shock
Skin
Surgical placement of skin over a wound or burn area.
NCLEX focus
- Immobilization/protection of graft, infection prevention, donor-site pain, and perfusion are key.
Before
- Assess wound bed, infection signs, nutrition, consent, and pain control plan.
- Prepare donor and recipient site teaching.
After
- Protect graft from shear/pressure.
- Monitor color, adherence, drainage, odor, and temperature.
- Manage donor-site pain and dressing per order.
Priority complications
- Graft failure
- Infection
- Bleeding
- Fluid loss
RespID
Respiratory specimen collected to identify infectious organisms.
NCLEX focus
- Collect before antibiotics when ordered; specimen should be sputum from lower airway, not saliva.
Before
- Explain deep cough collection.
- Perform oral care if ordered.
- Use correct container and isolation precautions.
After
- Send promptly.
- Document specimen quality and timing.
- Monitor respiratory status.
Priority complications
- Poor specimen quality
- Delayed antibiotics when unstable
- Exposure risk
Resp
Needle removal of fluid or air from pleural space for diagnosis or relief.
NCLEX focus
- Positioning, respiratory assessment, post-procedure pneumothorax signs, and specimen handling are key.
Before
- Check consent, coagulation risk, allergies, baseline breath sounds, oxygenation, and positioning.
- Instruct not to cough or move during needle insertion.
After
- Monitor breath sounds, oxygen saturation, cough, chest pain, bleeding, and puncture site.
- Send specimens and obtain chest x-ray if ordered.
Priority complications
- Pneumothorax
- Bleeding
- Re-expansion pulmonary edema
- Infection
Blood transfusion
Procedure
HemeOB
Administration of blood products such as packed RBCs, platelets, plasma, or cryoprecipitate.
NCLEX focus
- Correct client/product check, first 15 minutes, reaction recognition, and stopping transfusion are core NCLEX points.
Before
- Verify consent, type/screen, IV access, baseline vitals, product, two-person check, and transfusion history.
- Prime with normal saline per policy.
After
- Monitor vital signs and response.
- Stop transfusion and keep IV open with saline for suspected reaction per policy.
- Document volume and tolerance.
Priority complications
- Acute hemolytic reaction
- Fluid overload
- TRALI
- Fever/allergy
- Infection
Ventriculoperitoneal shunt
Procedure
NeuroPedsOB
Shunt drains excess CSF from ventricles to the peritoneal cavity.
NCLEX focus
- Monitor for shunt infection or malfunction: fever, vomiting, lethargy, irritability, headache, bulging fontanel, or redness along tract.
Before
- Assess neuro status, head circumference/fontanel in infants, infection signs, and consent.
- Prepare caregiver teaching.
After
- Monitor neuro status, vitals, incision/shunt tract, abdominal signs, and signs of increased ICP.
- Position per order and protect incision.
Priority complications
- Shunt obstruction
- Shunt infection
- Increased ICP
- Overdrainage