1Formulas and methods
Prioritization & delegation
Method
- Ask what will harm the patient soonest if nothing is done.
- Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
- Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
- Assess before you act unless it is an emergency; then choose the step the others depend on.
- 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
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Lab values & electrolytes
Method
- Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
- Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
- Link the value to its typical signs and to the drugs and conditions that cause it.
- Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
- 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
- Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
- Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
- Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
- Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
- Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
- Check the glucose in every patient with new confusion, weakness or a seizure.
- Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
- For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
- For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
- For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
- Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
- Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
- For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
- For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
- 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
A patient just told they have cancer is crying, but has also vomited several times and cannot keep fluids down. What does the nurse address first?
- AEmotional support about the diagnosis
- BThe vomiting and fluid loss
- CTeaching about chemotherapy
- DContacting the hospital chaplain
2.Prioritization & delegationHard
Two weeks after birth, a mother says she hears voices telling her the baby is evil. What is the priority?
- AKeep the mother and baby safe and arrange urgent psychiatric care
- BReassure her that this is normal “baby blues”
- CLeave her alone with the baby to bond
- DAdvise more sleep and book a routine follow-up visit for next month
3.Infection control & patient safetyMedium
Why must visible dirt be removed from equipment before it is disinfected?
- ADisinfectants only work on wet surfaces
- BOrganic matter can shield organisms and weaken the disinfectant
- CDirt makes the disinfectant react and work too strongly on the surface
- DCleaning first is only needed for metal items
4.Infection control & patient safetyHard
Which patient with a suspected infection meets at least two SIRS criteria?
- ARespiratory rate 16/min and WBC 8,000/mm3
- BTemperature 38.6 °C and heart rate 112/min
- CTemperature 36.8 °C and respiratory rate 18/min
- DTemperature 37.2 °C and heart rate 80/min
5.Lab values & electrolytesMedium
A patient taking furosemide has a potassium of 3.3 mEq/L and is told to eat more potassium-rich foods. Which snack is the best choice?
- ARice cakes
- BDried apricots
- CWhite bread
- DPlain crackers
6.Lab values & electrolytesHard
A patient's total calcium is 7.6 mg/dL and the albumin is 2.0 g/dL. Using the common correction (add 0.8 mg/dL for each 1 g/dL that albumin is below 4.0), what is the corrected calcium?
- A11.6 mg/dL, above the normal range
- B6.0 mg/dL, well below the normal range
- C7.6 mg/dL, below the normal range
- D9.2 mg/dL, within the normal range
7.Clinical nursingMedium
Which is a major risk factor for Clostridioides difficile infection?
- ARecent broad-spectrum antibiotic use
- BTaking regular paracetamol
- CRegular exercise
- DA diet high in fibre and fresh fruit
8.Clinical nursingHard
A patient with acute pancreatitis is in severe epigastric pain radiating to the back. Which nursing care is most important?
- ARestricting all fluids
- BAdequate pain relief, IV fluids and close fluid balance monitoring
- CA large fatty meal to stimulate the pancreas
- DStrict bed rest without observations
9.Med-surg: cardiovascular & respiratoryMedium
Which set of side effects is typical of thiazide or thiazide-like diuretics such as indapamide?
- AHigh potassium and sodium, low uric acid and low blood glucose
- BLow potassium and sodium, raised uric acid and raised glucose
- CDry cough, taste disturbance and swelling of the lips
- DHigh sodium and magnesium, with low blood glucose
10.Med-surg: cardiovascular & respiratoryHard
During CPR on an adult, a nurse notices a colleague compressing at about 140/min and leaning on the chest between compressions. Which correction is most appropriate?
- AStop compressions until a pulse is felt
- BSlow to 100–120/min and allow full chest recoil
- CPress more gently, to a depth of about 2 cm
- DSpeed up to about 160/min to improve the blood flow
11.Med-surg: neuro, endocrine & renalMedium
Which headache feature most suggests raised intracranial pressure from a brain tumour?
- AOnly present after reading for a long time
- BWorse on waking and on coughing, with vomiting
- CBetter in the morning and worse with stress
- DA tight band across the forehead that eases with rest
12.Med-surg: neuro, endocrine & renalHard
A patient had a left-arm AV fistula created yesterday and needs routine bloods. Which instruction is most important?
- AUse a tight tourniquet on the left arm to find a good vein
- BTake blood from the fistula, as it is easy to find and large
- CUse the right arm; check the left hand's circulation and thrill
- DWrap the left arm tightly in a bandage to protect the fistula
13.Med-surg: GI, perioperative & oncologyMedium
Why are patients taught to support their abdominal wound with a pillow when coughing?
- AIt replaces the need for regular analgesia
- BIt reduces pain and strain, so they can cough well
- CIt makes the cough weaker so the wound is not put at risk
- DIt speeds up the healing of the skin edges
14.Med-surg: GI, perioperative & oncologyHard
Which fluid strategy is generally recommended in the first hours of acute pancreatitis?
- AVery large volumes, whatever the patient's response
- BNo IV fluid at all, only small sips of oral water
- CGoal-directed balanced crystalloid, guided by the response
- DIV albumin alone instead of any crystalloid
3Solutions
1.Prioritization & delegation
Answer: B · The vomiting and fluid loss
Why this is the answer
Ongoing vomiting threatens fluid and electrolyte balance, a physiological need. Emotional support is important and should follow soon, but the physical threat is addressed first.
B · The vomiting and fluid loss
2.Prioritization & delegation
Answer: A · Keep the mother and baby safe and arrange urgent psychiatric care
Why this is the answer
Hallucinations and delusions after birth suggest postpartum psychosis, a psychiatric emergency with risk to mother and baby. Safety and urgent specialist care are the priorities.
A · Keep the mother and baby safe and arrange urgent psychiatric care
3.Infection control & patient safety
Answer: B · Organic matter can shield organisms and weaken the disinfectant
Why this is the answer
Blood, secretions and soil protect organisms and can inactivate disinfectants. Cleaning is always done first, followed by disinfection or sterilization as required.
B · Organic matter can shield organisms and weaken the disinfectant
4.Infection control & patient safety
Answer: B · Temperature 38.6 °C and heart rate 112/min
Why this is the answer
SIRS criteria include a temperature above 38 °C or below 36 °C, heart rate above 90/min, respiratory rate above 20/min and a WBC above 12,000 or below 4,000/mm3. Only the first patient meets two.
B · Temperature 38.6 °C and heart rate 112/min
5.Lab values & electrolytes
Answer: B · Dried apricots
Why this is the answer
Dried fruits such as apricots, raisins and prunes are rich in potassium, as are bananas, oranges, potatoes, beans and tomatoes. Refined grain products such as white bread and crackers are low in potassium.Checked against: Potassium in diet · MedlinePlus (NIH) (2026)
6.Lab values & electrolytes
Answer: D · 9.2 mg/dL, within the normal range
Why this is the answer
Corrected calcium = 7.6 + 0.8 × (4.0 − 2.0) = 9.2 mg/dL, which is normal. Low albumin lowers the bound fraction of calcium; the correction is only an estimate, and an ionized calcium is more accurate when it matters.Checked against: Calcium blood test · MedlinePlus (NIH) (2025)
D · 9.2 mg/dL, within the normal range
7.Clinical nursing
Answer: A · Recent broad-spectrum antibiotic use
Why this is the answer
Broad-spectrum antibiotics disrupt normal gut flora, letting C. difficile overgrow. Older age, hospital stay and proton pump inhibitors also increase the risk.
A · Recent broad-spectrum antibiotic use
8.Clinical nursing
Answer: B · Adequate pain relief, IV fluids and close fluid balance monitoring
Why this is the answer
Acute pancreatitis can cause large fluid losses and organ failure. Care focuses on fluid resuscitation, analgesia, monitoring urine output, glucose and early nutrition when possible.
B · Adequate pain relief, IV fluids and close fluid balance monitoring
9.Med-surg: cardiovascular & respiratory
Answer: B · Low potassium and sodium, raised uric acid and raised glucose
Why this is the answer
Thiazides cause hypokalaemia, hyponatraemia, hypomagnesaemia, hyperuricaemia (gout), hyperglycaemia and hypercalcaemia (they reduce calcium excretion). Dry cough and angioedema are ACE inhibitor effects.
B · Low potassium and sodium, raised uric acid and raised glucose
10.Med-surg: cardiovascular & respiratory
Answer: B · Slow to 100–120/min and allow full chest recoil
Why this is the answer
High-quality adult CPR uses a rate of 100–120/min, a depth of 5–6 cm, full recoil after each compression and minimal interruptions. Leaning prevents the chest from re-expanding, so the heart fills less. Compressors should swap about every 2 minutes to avoid fatigue.
B · Slow to 100–120/min and allow full chest recoil
11.Med-surg: neuro, endocrine & renal
Answer: B · Worse on waking and on coughing, with vomiting
Why this is the answer
Headaches from raised ICP are often worse on waking, when coughing, sneezing or bending, and may come with vomiting or visual changes. A new headache with these features needs prompt assessment.
B · Worse on waking and on coughing, with vomiting
12.Med-surg: neuro, endocrine & renal
Answer: C · Use the right arm; check the left hand's circulation and thrill
Why this is the answer
A new fistula is protected from compression and puncture. Nurses check the thrill and bruit, and the hand for warmth, colour and sensation, because the fistula can "steal" blood from the hand. A fistula usually takes several weeks to mature before it can be used for dialysis.
C · Use the right arm; check the left hand's circulation and thrill
13.Med-surg: GI, perioperative & oncology
Answer: B · It reduces pain and strain, so they can cough well
Why this is the answer
Supporting the incision reduces pain and pressure on the wound, so the patient can deep breathe and cough effectively to clear secretions and prevent chest infection. Adequate analgesia is also needed.
B · It reduces pain and strain, so they can cough well
14.Med-surg: GI, perioperative & oncology
Answer: C · Goal-directed balanced crystalloid, guided by the response
Why this is the answer
Pancreatitis causes fluid loss into the tissues, so early IV fluid is important. Recent guidance favours moderate, goal-directed resuscitation with balanced crystalloids such as Hartmann's or lactated Ringer's, adjusted to heart rate, blood pressure and urine output, because very aggressive fluids increase overload without benefit.
C · Goal-directed balanced crystalloid, guided by the response
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.