Mark Klimek Rules: Every Shortcut That Gets You Through the NCLEX (2026)
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Ask any nurse who passed the NCLEX what they remember from Mark Klimek and they will not quote a chapter. They will quote a rule. That is the whole point of his method: he replaces memorisation with decision rules you can apply under pressure, on question 87, when two answers both look right.
Here is every Klimek rule worth knowing, what it actually means, and how to use it on test day.
1. ROME: the fastest way to read an ABG
Respiratory Opposite, Metabolic Equal.
- Respiratory: pH and CO2 move in opposite directions. pH down, CO2 up equals respiratory acidosis.
- Metabolic: pH and bicarb move in the same direction. pH down, HCO3 down equals metabolic acidosis.
Look at the pH first to decide acidosis or alkalosis. Then check whether CO2 moved opposite (respiratory) or bicarb moved with it (metabolic). That is the entire decision in about four seconds.
2. The never-ever rules
These are answers a safe nurse would never choose, regardless of the scenario. Spotting one lets you eliminate it instantly:
- Never leave an unstable patient to go get something.
- Never delegate assessment, teaching, evaluation, or an unstable patient.
- Never pick an answer that delays treatment in an emergency.
- Never choose "call the doctor" if there is a nursing action you can take first.
- Never ignore a patient's stated symptom in favour of a machine reading.
Two eliminations on a four-option question turns a guess into a coin flip you can reason through.
3. Assessment before intervention (with one exception)
The default is assess first. Gather data before you act.
The exception is an emergency, where the action is the assessment. If someone is unresponsive and pulseless, you do not auscultate. You start CPR. Airway, breathing, circulation override the assessment-first rule every time.
4. The priority hierarchy
When several patients all need something, this order resolves it:
- Unstable before stable. The patient whose condition is changing goes first.
- Acute before chronic. New problems outrank long-standing ones.
- Unexpected before expected. Post-op day one pain is expected. Post-op day one chest pain is not.
- Actual before potential. A real problem outranks a risk.
Layer ABC on top of that and most "who do you see first" questions solve themselves.
5. Delegation logic
The rule is simple: if it requires nursing judgement, it stays with the RN.
| Role | Can do | Cannot do |
|---|---|---|
| UAP | Vitals on stable patients, ADLs, ambulating, feeding, positioning, I&O | Anything requiring assessment, teaching, or judgement |
| LPN/LVN | Stable patients, routine meds, dressing changes, reinforcing teaching | Initial assessment, IV push meds (most states), care plans, unstable patients |
| RN | Assessment, teaching, evaluation, unstable patients, blood products |
Memory hook: the RN keeps the four verbs, assess, teach, evaluate, plan. Everything else can potentially be delegated.
6. If it is a chemical, it is a problem
Klimek's shorthand for prioritising lab values and toxicities. Chemical imbalances (potassium, sodium, digoxin levels, lithium levels) tend to outrank mechanical complaints because they kill faster. When a question gives you a lab value out of range alongside a comfort issue, the lab wins.
7. Rules for select-all-that-apply
Treat every option as its own true or false question. Do not look for a pattern in how many are correct. On the Next Generation NCLEX many items carry partial credit, so evaluating each option independently is how you protect points.
The 2026 NCLEX Review Mega Bundle includes all 12 lectures with the matching PDF guides for $79. Instant access, lifetime updates.
The catch nobody mentions
Rules only work if you have practised applying them. Students who learn all seven of these and then walk into the exam without doing questions still miss, because knowing a rule and executing it on an unfamiliar case study are different skills.
Do the rules, then prove each one on 15 to 20 practice questions in the current NGN format. That is the whole method.
The NCLEX FastTrack All-in-One Bundle pairs the video lectures with a 3,000-question NGN-ready bank and full rationales, organised into a day-by-day plan. Learn the rule, then immediately drill it. $169, lifetime access, backed by our Pass Guarantee.
See what's inside FastTrack →Frequently asked questions
What is the ROME rule in nursing?
ROME stands for Respiratory Opposite, Metabolic Equal. In respiratory imbalances pH and CO2 move in opposite directions; in metabolic imbalances pH and bicarbonate move in the same direction. It is the fastest way to interpret an ABG.
What are Mark Klimek's never-ever rules?
Actions a safe nurse would never take regardless of context, such as leaving an unstable patient, delegating assessment or teaching, or delaying treatment in an emergency. They let you eliminate wrong answers on sight.
What can be delegated to a UAP on the NCLEX?
Vital signs on stable patients, activities of daily living, ambulating, feeding, positioning and intake and output. Never assessment, teaching, evaluation, or care of an unstable patient.
Which Klimek lecture covers the rules?
Lecture 12 covers prioritization, delegation and assignment, and Lecture 1 covers acid-base and ROME. Those two are the highest-value hours in the series.
You've got this. Learn the rule, drill the rule, and the exam stops feeling like a guessing game.
Nurse June, BSN, RN
Founder, Your Nursing Space
