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.

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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

Which scheduled medication is the most time-critical?

  1. AA daily stool softener due with breakfast
  2. BA daily multivitamin tablet due at 08:00
  3. CRapid-acting insulin due with a breakfast tray that has arrived
  4. DA daily cholesterol-lowering statin tablet due with breakfast at 08:00
2.Prioritization & delegationHard

A patient has peripheral arterial disease with a non-healing ulcer on the toe. Which advice about leg position is correct?

  1. AKeep the legs level or slightly lowered, not raised
  2. BWrap the legs tightly with compression bandages
  3. CKeep the legs raised above the heart as much as possible
  4. DSit with the legs crossed to improve blood flow
3.Infection control & patient safetyMedium

Which IV fluid can be given with packed red blood cells in the same line?

  1. ALactated Ringer’s (Hartmann’s) solution
  2. B0.9% sodium chloride
  3. C5% dextrose in water
  4. D5% dextrose in 0.45% sodium chloride
4.Infection control & patient safetyHard

A patient has a rash, and both smallpox and chickenpox are considered. Which finding suggests smallpox?

  1. ALesions at different stages, most dense on the trunk
  2. BA rash that is very itchy and starts on the trunk
  3. CLesions all at the same stage, most dense on the face and limbs
  4. DSmall crops of new lesions appearing over several days in a row
5.Lab values & electrolytesMedium

A urine culture report states "mixed growth of three organisms, likely contamination." What is the nurse's best response?

  1. ADiscard the report, because a mixed growth is always normal
  2. BInform the provider and arrange a new, correctly collected sample
  3. CRecord the result as a confirmed urinary tract infection
  4. DStart treatment for all three organisms with three antibiotics
6.Lab values & electrolytesHard

Why can a normal creatinine be misleading in a frail older adult with low muscle mass?

  1. AOlder adults always have a higher creatinine than younger adults do
  2. BCreatinine levels do not depend on muscle mass at all
  3. CLess muscle makes less creatinine, hiding reduced kidney function
  4. DA normal creatinine always proves normal kidney function
7.Clinical nursingMedium

What should a nurse do during a generalised tonic-clonic seizure?

  1. AGive the patient a drink of water
  2. BProtect the head, time the seizure and do not put anything in the mouth
  3. CPut a tongue depressor between the teeth so that the tongue is not bitten
  4. DHold the limbs firmly to stop the jerking and prevent injury
8.Clinical nursingHard

A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?

  1. AA stroke
  2. BVasovagal syncope
  3. CA hypoglycaemic coma
  4. DAnaphylaxis
9.Med-surg: cardiovascular & respiratoryMedium

A chest drain water-seal chamber bubbles continuously, even when the patient is not coughing. What does this suggest?

  1. AThe lung has fully re-expanded and the drain is ready to remove
  2. BThe suction source has been switched off
  3. CAn air leak from the lung or from the drainage system
  4. DThe drain is blocked by a clot in the tubing
10.Med-surg: cardiovascular & respiratoryHard

A patient with crushing chest pain has ST elevation in leads V1–V4. Which coronary artery is most likely blocked?

  1. AThe right coronary artery and its branches
  2. BThe left subclavian artery
  3. CThe circumflex artery
  4. DThe left anterior descending artery
11.Med-surg: neuro, endocrine & renalMedium

A patient on gliclazide (a sulfonylurea) is admitted with hypoglycaemia. Why is extended monitoring needed?

  1. ASulfonylureas cannot cause hypoglycaemia on their own
  2. BThe drug acts for many hours, so the low glucose can return
  3. CThe drug acts only at night, so morning checks are not useful
  4. DThe drug raises glucose after a delay of several hours
12.Med-surg: neuro, endocrine & renalHard

An older man has not passed urine for 10 hours, has lower abdominal pain and a bladder scan of 1100 mL. Creatinine has risen. What is the most likely cause and action?

  1. ADiabetes insipidus; give desmopressin and restrict fluids
  2. BDehydration; give a fluid bolus and recheck the creatinine tomorrow
  3. CUrinary retention; catheterise as prescribed and watch for a large diuresis
  4. DContrast nephropathy; arrange emergency haemodialysis today
13.Med-surg: GI, perioperative & oncologyMedium

Which electrolyte abnormality can contribute to a postoperative ileus?

  1. AHypokalaemia
  2. BHyperkalaemia
  3. CHypernatraemia
  4. DHyperphosphataemia
14.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient about a fentanyl skin patch. Which statement shows a need for further teaching?

  1. A"I'll fold used patches sticky sides together before disposal."
  2. B"I can cut the patch in half if I need less."
  3. C"I'll put the new patch on a different area of skin."
  4. D"I won't put a hot water bottle over the patch."

3Solutions

1.Prioritization & delegation

Answer: C · Rapid-acting insulin due with a breakfast tray that has arrived

Why this is the answer

Rapid-acting insulin is given with a meal; giving it late or without food can cause high or low blood glucose. The other daily medicines can be given a little later without harm.

Answer

C · Rapid-acting insulin due with a breakfast tray that has arrived
2.Prioritization & delegation

Answer: A · Keep the legs level or slightly lowered, not raised

Why this is the answer

In arterial disease, gravity helps blood reach the feet, so legs are not elevated. Elevation and compression suit venous disease, and crossing the legs reduces flow further.

Answer

A · Keep the legs level or slightly lowered, not raised
3.Infection control & patient safety

Answer: B · 0.9% sodium chloride

Why this is the answer

Only 0.9% sodium chloride is compatible with blood. Dextrose (glucose) solutions can cause red cells to clump and break down, and the calcium in lactated Ringer’s (Hartmann’s) can cause clotting.

Answer

B · 0.9% sodium chloride
4.Infection control & patient safety

Answer: C · Lesions all at the same stage, most dense on the face and limbs

Why this is the answer

In smallpox, lesions develop at the same stage in any one area and are densest on the face and extremities. In chickenpox, crops appear at different stages and are densest on the trunk.

Answer

C · Lesions all at the same stage, most dense on the face and limbs
5.Lab values & electrolytes

Answer: B · Inform the provider and arrange a new, correctly collected sample

Why this is the answer

Several organisms in one urine sample usually mean contamination from the skin or perineum during collection. The provider is informed, and a new clean-catch or catheter-port sample is usually needed before an infection can be confirmed.

Answer

B · Inform the provider and arrange a new, correctly collected sample
6.Lab values & electrolytes

Answer: C · Less muscle makes less creatinine, hiding reduced kidney function

Why this is the answer

Creatinine is made by muscle. A person with little muscle makes little creatinine, so the value can look normal even when kidney function is reduced. Creatinine-based eGFR can overestimate function in the same way, so a measured creatinine clearance or a cystatin C–based estimate may be used when dosing drugs cleared by the kidneys.Checked against: Creatinine blood test · MedlinePlus (NIH) (2025)

Answer

C · Less muscle makes less creatinine, hiding reduced kidney function
7.Clinical nursing

Answer: B · Protect the head, time the seizure and do not put anything in the mouth

Why this is the answer

Remove nearby hazards, cushion the head, note the time and do not restrain or put objects in the mouth. Once jerking stops, place the patient in the recovery position and check the airway.

Answer

B · Protect the head, time the seizure and do not put anything in the mouth
8.Clinical nursing

Answer: B · Vasovagal syncope

Why this is the answer

Vasovagal syncope is a reflex drop in heart rate and blood pressure triggered by pain, fear or needles. Anaphylaxis would usually include skin, airway or breathing features and a fast pulse.

Answer

B · Vasovagal syncope
9.Med-surg: cardiovascular & respiratory

Answer: C · An air leak from the lung or from the drainage system

Why this is the answer

Intermittent bubbling on expiration or coughing is expected while a pneumothorax drains. Continuous bubbling suggests a persistent air leak from the lung (such as a bronchopleural fistula) or from a loose connection or a tube that has slipped out. Check the system from the patient downwards and report it.

Answer

C · An air leak from the lung or from the drainage system
10.Med-surg: cardiovascular & respiratory

Answer: D · The left anterior descending artery

Why this is the answer

ST elevation in V1–V4 indicates an anteroseptal STEMI, usually from LAD occlusion. Anterior MIs damage a large area of muscle and carry a high risk of heart failure and arrhythmias. Leads II, III and aVF suggest an inferior MI, usually from the right coronary artery.

Answer

D · The left anterior descending artery
11.Med-surg: neuro, endocrine & renal

Answer: B · The drug acts for many hours, so the low glucose can return

Why this is the answer

Sulfonylureas stimulate the pancreas to release insulin and have long durations of action, especially in older people and those with renal impairment. Hypoglycaemia can recur after initial treatment, so prolonged glucose monitoring is needed.

Answer

B · The drug acts for many hours, so the low glucose can return
12.Med-surg: neuro, endocrine & renal

Answer: C · Urinary retention; catheterise as prescribed and watch for a large diuresis

Why this is the answer

Urinary retention, often from prostatic enlargement, can cause post-renal AKI. Relieving the obstruction with a catheter is the treatment. After drainage of a large volume, some patients have a marked post-obstructive diuresis, so fluid balance, electrolytes and blood pressure are monitored.

Answer

C · Urinary retention; catheterise as prescribed and watch for a large diuresis
13.Med-surg: GI, perioperative & oncology

Answer: A · Hypokalaemia

Why this is the answer

Low potassium impairs smooth muscle contraction and is a common correctable contributor to ileus. Magnesium and other electrolytes are also checked and corrected.

Answer

A · Hypokalaemia
14.Med-surg: GI, perioperative & oncology

Answer: B · "I can cut the patch in half if I need less."

Why this is the answer

Cutting a fentanyl patch can release the drug unpredictably and cause overdose. Heat increases absorption, used patches still contain drug and must be folded and disposed of safely, and sites are rotated.

Answer

B · "I can cut the patch in half if I need less."

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