NCLEX-style Prioritization & Delegation: cram pack

Formula sheets, the key method steps for every topic and 14 practice problems, with full solutions at the back.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

1Formulas and methods

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

2Practice problems

1.Prioritization & delegationMedium

During an IV antibiotic infusion, a patient develops hives, wheezing and a hoarse voice. What does the nurse do first?

  1. ADocument the reaction in the chart
  2. BGive oral diphenhydramine
  3. CStop the infusion
  4. DSlow the infusion to half the rate
2.Prioritization & delegationHard

A patient with diabetes takes propranolol. Which sign of hypoglycemia is most likely to still appear?

  1. APalpitations
  2. BTachycardia
  3. CSweating
  4. DTremor
3.Infection control & patient safetyMedium

Which cleaning product is recommended for the room of a patient with Clostridioides difficile?

  1. AA scented air freshener spray
  2. BA sporicidal agent, such as a chlorine-based solution
  3. CPlain water and a clean microfiber cloth
  4. DAlcohol-based wipes, used on every surface twice a day
4.Infection control & patient safetyHard

A nurse arrives at the scene of a fire in a corridor and the fire is spreading. Patients are in nearby rooms. What should the nurse do after raising the alarm?

  1. AOpen all doors and windows to let the smoke escape
  2. BClose doors and move patients in danger horizontally behind fire doors
  3. CTry to put out the spreading fire alone with an extinguisher
  4. DTake patients to the ground floor in the nearest elevator
5.Lab values & electrolytesMedium

A patient on warfarin for atrial fibrillation has an INR of 1.4. What does this mean?

  1. AAnticoagulation is below target, so clots and stroke are more likely
  2. BThe dose is exactly right and needs no change
  3. CThe patient no longer needs to take warfarin
  4. DThe patient is at a high risk of bleeding and needs vitamin K at once
6.Lab values & electrolytesHard

A child with sickle cell disease and a recent viral illness is pale and tired. The hemoglobin has fallen sharply, and the reticulocyte count is very low. What is the most likely problem?

  1. AIron deficiency from a poor diet over months
  2. BAn aplastic crisis, often caused by parvovirus B19
  3. CA vaso-occlusive pain crisis in the bones
  4. DA normal finding in sickle cell disease
7.Clinical nursingMedium

A nurse gives a patient analgesia for post-operative pain. What should be done next?

  1. AReassess the pain and any side effects once the drug has had time to work
  2. BAssume the pain has gone if the patient is quiet and has their eyes closed
  3. CWait until the next shift before asking the patient about the pain
  4. DGive a second analgesic straight away just in case
8.Clinical nursingHard

Why should "units" never be abbreviated to "U" or "IU" on an insulin prescription?

  1. AThe letters can be misread as a zero, causing a tenfold overdose
  2. BThe abbreviation is only allowed on prescriptions for children
  3. CPharmacists cannot dispense insulin written that way
  4. DIt changes the type of insulin given
9.Med-surg: cardiovascular & respiratoryMedium

A patient has a raised B-type natriuretic peptide (BNP or NT-proBNP). What does this mainly reflect?

  1. AIschaemic damage to the heart muscle
  2. BStretch and pressure overload of the ventricles
  3. CInflammation of the liver from congestion
  4. DDamage to skeletal muscle after a fall
10.Med-surg: cardiovascular & respiratoryHard

Seconds after an intramuscular injection, a patient becomes pale, sweaty and faint, with a heart rate of 48/min. There is no rash, wheeze or swelling, and they recover quickly when laid flat. What is the most likely cause?

  1. AAnaphylaxis
  2. BA myocardial infarction
  3. CA vasovagal reaction
  4. DA tension pneumothorax
11.Med-surg: neuro, endocrine & renalMedium

Why may a person with long-standing diabetes have a heart attack without typical chest pain?

  1. ANerve damage can blunt the pain signals
  2. BInsulin acts as a strong painkiller
  3. CPeople with diabetes do not have heart attacks
  4. DHigh glucose protects the heart from pain
12.Med-surg: neuro, endocrine & renalHard

A patient with a new arm fistula says their hand on that side is cold, pale and painful, especially during dialysis. What is the concern?

  1. ANormal healing that needs no action
  2. BFluid overload in the arm
  3. CAn allergic reaction to the dressing on the arm
  4. DSteal syndrome, which needs urgent review
13.Med-surg: GI, perioperative & oncologyMedium

A patient received IV morphine 20 minutes ago and the surgical consent form has not been signed. What should the nurse do?

  1. AAsk a relative to sign instead of the patient
  2. BAsk the patient to sign quickly before they get sleepier
  3. CTell the surgeon, as the patient may not be able to consent now
  4. DSign the form on the patient's behalf as a witness
14.Med-surg: GI, perioperative & oncologyHard

Which group of signs suggests that a patient is entering the last days of life?

  1. AHigh blood pressure and very fast weight gain
  2. BRising appetite, more energy and normal skin colour and warmth
  3. CReduced intake, mottled skin and changes in breathing
  4. DClearer thinking and increased movement

3Solutions

1.Prioritization & delegation

Answer: C · Stop the infusion

Why this is the answer

Stopping the drug stops further exposure to the allergen. The nurse then calls for help and prepares epinephrine as prescribed for anaphylaxis. Slowing the infusion still gives more of the drug, and documentation comes later.

Answer

C · Stop the infusion
2.Prioritization & delegation

Answer: C · Sweating

Why this is the answer

Beta-blockers can hide tachycardia, palpitations and tremor during hypoglycemia. Sweating is mainly cholinergic, so it usually remains, and patients are taught to check glucose when they sweat.

Answer

C · Sweating
3.Infection control & patient safety

Answer: B · A sporicidal agent, such as a chlorine-based solution

Why this is the answer

C. difficile spores resist alcohol and many standard disinfectants, so a sporicidal agent such as a chlorine-based product is used for the environment and equipment.

Answer

B · A sporicidal agent, such as a chlorine-based solution
4.Infection control & patient safety

Answer: B · Close doors and move patients in danger horizontally behind fire doors

Why this is the answer

Closing doors slows the spread of smoke and fire. Patients in immediate danger are moved horizontally to a safe area behind fire doors, followed by further evacuation if needed. Elevators are not used, and a spreading fire is left to firefighters.

Answer

B · Close doors and move patients in danger horizontally behind fire doors
5.Lab values & electrolytes

Answer: A · Anticoagulation is below target, so clots and stroke are more likely

Why this is the answer

An INR below the target range means the blood clots too readily for this indication. The prescriber is informed, and the dose and possible causes, such as missed doses or interactions, are reviewed.Checked against: Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024)

Answer

A · Anticoagulation is below target, so clots and stroke are more likely
6.Lab values & electrolytes

Answer: B · An aplastic crisis, often caused by parvovirus B19

Why this is the answer

Patients with sickle cell disease depend on a high reticulocyte count because their red cells live only a short time. Parvovirus B19 can stop red cell production for days, causing a rapid fall in hemoglobin with very low reticulocytes. Transfusion may be needed.Checked against: Reticulocyte Count · MedlinePlus (NIH) (2024)

Answer

B · An aplastic crisis, often caused by parvovirus B19
7.Clinical nursing

Answer: A · Reassess the pain and any side effects once the drug has had time to work

Why this is the answer

The effect of analgesia should be reassessed when it is expected to work, with side effects such as sedation and breathing checked. The result is documented and the plan adjusted.

Answer

A · Reassess the pain and any side effects once the drug has had time to work
8.Clinical nursing

Answer: A · The letters can be misread as a zero, causing a tenfold overdose

Why this is the answer

"U" can be misread as 0, so "10U" might be read as 100, and "IU" can be mistaken for "IV" or "10". Writing "units" in full is a standard safety rule (ISMP), because insulin errors can cause severe hypoglycaemia.

Answer

A · The letters can be misread as a zero, causing a tenfold overdose
9.Med-surg: cardiovascular & respiratory

Answer: B · Stretch and pressure overload of the ventricles

Why this is the answer

Natriuretic peptides are released by ventricular myocytes in response to wall stretch. A normal level makes heart failure unlikely; a raised level supports the diagnosis and reflects severity. Levels can also be raised in renal failure and older age. Troponin, not BNP, reflects myocardial necrosis.

Answer

B · Stretch and pressure overload of the ventricles
10.Med-surg: cardiovascular & respiratory

Answer: C · A vasovagal reaction

Why this is the answer

Vasovagal reactions cause bradycardia, pallor, sweating and fainting, and resolve quickly when lying flat. Anaphylaxis usually causes tachycardia, airway or breathing problems and often skin changes, and does not settle on its own. If in doubt, treat as anaphylaxis.

Answer

C · A vasovagal reaction
11.Med-surg: neuro, endocrine & renal

Answer: A · Nerve damage can blunt the pain signals

Why this is the answer

Autonomic neuropathy can make a myocardial infarction "silent" or atypical, with breathlessness, fatigue, nausea or sweating rather than chest pain. A low threshold for an ECG is needed.

Answer

A · Nerve damage can blunt the pain signals
12.Med-surg: neuro, endocrine & renal

Answer: D · Steal syndrome, which needs urgent review

Why this is the answer

In steal syndrome, the fistula diverts arterial blood from the hand, causing ischaemia: coldness, pallor, pain, numbness or weakness. It must be reported urgently, because severe cases can cause tissue loss.

Answer

D · Steal syndrome, which needs urgent review
13.Med-surg: GI, perioperative & oncology

Answer: C · Tell the surgeon, as the patient may not be able to consent now

Why this is the answer

Opioids and sedatives can impair understanding, so consent may not be valid. The surgeon is informed; consent is obtained when the patient has capacity, or other legal processes are followed in an emergency.

Answer

C · Tell the surgeon, as the patient may not be able to consent now
14.Med-surg: GI, perioperative & oncology

Answer: C · Reduced intake, mottled skin and changes in breathing

Why this is the answer

Signs include increasing drowsiness, reduced intake, mottled cool peripheries, changes in breathing such as pauses, and noisy secretions. Recognising them allows care to focus on comfort and family support.

Answer

C · Reduced intake, mottled skin and changes in breathing

This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.

ExamProblems · examproblems.com/courses/nclex-style-prioritization-and-delegation