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

A charge nurse needs to free a bed. Which patient is most appropriate for discharge or transfer to a lower level of care?

  1. ADay 1 after bowel surgery with a new temperature of 38.5 °C
  2. BPneumonia, with an oxygen need that rose overnight from 2 to 4 L/min
  3. CAdmitted two hours ago with chest pain; troponin result still pending
  4. DDay 3 after uncomplicated appendectomy, eating, on oral analgesia
2.Prioritization & delegationHard

Which patient is the best choice to move out of intensive care to make room for a new admission?

  1. AIntubated 1 hour ago for respiratory failure, still sedated
  2. BOn a norepinephrine infusion whose dose was increased this morning
  3. CAdmitted overnight with a GI bleed and still receiving blood
  4. DExtubated 2 days ago, stable on 2 L/min nasal oxygen, no vasoactive infusions
3.Infection control & patient safetyMedium

A patient has a non-violent restraint. In most nursing policies, how often at minimum is it released for range of motion, toileting and skin care?

  1. AOnce every 12-hour shift
  2. BOnly when the patient asks for it
  3. COnce a day, during the bath
  4. DAt least every 2 hours
4.Infection control & patient safetyHard

A hospital will introduce new infusion pumps and wants to find out how the process could fail before any harm occurs. Which method fits best?

  1. ARoot cause analysis (RCA) of the new pumps
  2. BFailure mode and effects analysis (FMEA)
  3. CAn incident report for each new pump
  4. DA morbidity and mortality meeting
5.Lab values & electrolytesMedium

A healthy patient has a mildly raised CK after running a marathon yesterday, without dark urine or symptoms. What is the most likely explanation?

  1. AAn acute myocardial infarction has occurred
  2. BThe patient has developed acute hepatitis
  3. CStrenuous exercise raised CK from skeletal muscle
  4. DThe patient has developed acute pancreatitis
6.Lab values & electrolytesHard

A patient with a round face, central weight gain and purple stretch marks has a glucose of 210 mg/dL (11.7 mmol/L) and a potassium of 3.1 mEq/L. Which condition fits best?

  1. ADiabetes insipidus
  2. BAdrenal insufficiency
  3. CCushing syndrome
  4. DHypothyroidism
7.Clinical nursingMedium

Why are patients with atrial fibrillation often given anticoagulants?

  1. ATo convert the rhythm back to normal
  2. BTo lower the blood pressure
  3. CTo slow the heart rate directly and prevent palpitations
  4. DTo reduce the risk of stroke from clots in the atria
8.Clinical nursingHard

An older patient with a hip fracture becomes breathless and confused, with a petechial rash on the chest two days after injury. Which complication should be suspected?

  1. AUrinary tract infection
  2. BFat embolism syndrome
  3. CCompartment syndrome
  4. DPressure ulcer
9.Med-surg: cardiovascular & respiratoryMedium

A patient with heart failure starts dapagliflozin, an SGLT2 inhibitor. Which teaching is most relevant?

  1. AKeep the genital area clean, as fungal infections are more common
  2. BExpect the urine to turn bright orange and stain underwear and clothes
  3. CTake an extra dose if the ankles swell
  4. DAvoid drinking any fluids at all for the first week of treatment
10.Med-surg: cardiovascular & respiratoryHard

A patient with a mechanical mitral valve replacement on warfarin has an INR of 2.2. What should the nurse consider?

  1. AThe INR is in range for every warfarin indication, so no action is needed
  2. BThe INR should be about 1.0 for mechanical valves
  3. CThe INR may be below this patient's higher target, so check it and report
  4. DThe INR is dangerously high and the dose must be withheld
11.Med-surg: neuro, endocrine & renalMedium

Which picture fits anterior cord syndrome?

  1. AArms much weaker than legs after a neck injury
  2. BWeakness on one side and loss of pain sensation on the other side
  3. CLoss of movement and pain sense, with position sense kept
  4. DNormal movement but complete loss of position sense
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. CSteal syndrome, which needs urgent review
  4. DAn allergic reaction to the dressing on the arm
13.Med-surg: GI, perioperative & oncologyMedium

What is anticipatory nausea in chemotherapy?

  1. ANausea caused only by the smell of food
  2. BNausea caused by low blood glucose
  3. CNausea that starts about a week after each cycle and lasts for days
  4. DNausea triggered by reminders of treatment before it is given
14.Med-surg: GI, perioperative & oncologyHard

A patient with cirrhosis takes spironolactone and furosemide. Which blood result should the nurse report before the next dose?

  1. APotassium 4.2 mmol/L
  2. BPotassium 6.0 mmol/L
  3. CSodium 138 mmol/L
  4. DSodium 141 mmol/L

3Solutions

1.Prioritization & delegation

Answer: D · Day 3 after uncomplicated appendectomy, eating, on oral analgesia

Why this is the answer

The appendectomy patient is stable, eating and managing with oral pain relief. A pending troponin, rising oxygen needs and a new fever all mean the patient’s course is not yet clear.

Answer

D · Day 3 after uncomplicated appendectomy, eating, on oral analgesia
2.Prioritization & delegation

Answer: D · Extubated 2 days ago, stable on 2 L/min nasal oxygen, no vasoactive infusions

Why this is the answer

The extubated patient on low-flow oxygen with no vasoactive drugs is stable and improving. Recent intubation, rising vasopressor needs and an active bleed all need ICU-level care.

Answer

D · Extubated 2 days ago, stable on 2 L/min nasal oxygen, no vasoactive infusions
3.Infection control & patient safety

Answer: D · At least every 2 hours

Why this is the answer

Restrained patients are checked often for circulation, skin and comfort, and the restraint is released at least every 2 hours for movement, toileting, fluids and skin care. Exact intervals follow the facility’s policy.

Answer

D · At least every 2 hours
4.Infection control & patient safety

Answer: B · Failure mode and effects analysis (FMEA)

Why this is the answer

FMEA is a proactive method that looks at each step of a process, asks how it could fail and what the effect would be, and changes the process in advance. Root cause analysis is used after an event has happened.

Answer

B · Failure mode and effects analysis (FMEA)
5.Lab values & electrolytes

Answer: C · Strenuous exercise raised CK from skeletal muscle

Why this is the answer

Strenuous exercise, IM injections and muscle trauma can raise CK from skeletal muscle. A very high CK with dark urine suggests rhabdomyolysis, and heart damage is assessed with troponin, not CK.Checked against: Creatine Kinase · MedlinePlus (NIH) (2023); Creatine phosphokinase test · MedlinePlus (NIH) (2025)

Answer

C · Strenuous exercise raised CK from skeletal muscle
6.Lab values & electrolytes

Answer: C · Cushing syndrome

Why this is the answer

Excess cortisol raises glucose, causes central obesity, a round face and purple striae, and has some mineralocorticoid effect that lowers potassium. Adrenal insufficiency causes low glucose and high potassium.Checked against: Hypercortisolism (Cushing Syndrome) · StatPearls (NCBI Bookshelf) (2025); Hypokalemia · StatPearls (NCBI Bookshelf) (2025)

Answer

C · Cushing syndrome
7.Clinical nursing

Answer: D · To reduce the risk of stroke from clots in the atria

Why this is the answer

In AF the atria do not contract effectively, so blood can pool and clot, especially in the left atrial appendage. A clot can travel to the brain, so anticoagulation reduces stroke risk.

Answer

D · To reduce the risk of stroke from clots in the atria
8.Clinical nursing

Answer: B · Fat embolism syndrome

Why this is the answer

Fat embolism typically appears 24–72 hours after a long-bone or pelvic fracture, with the triad of respiratory distress, neurological changes and a petechial rash.

Answer

B · Fat embolism syndrome
9.Med-surg: cardiovascular & respiratory

Answer: A · Keep the genital area clean, as fungal infections are more common

Why this is the answer

SGLT2 inhibitors increase glucose loss in the urine, raising the risk of genital thrush and urinary infections. They also cause mild diuresis, and in people with diabetes there is a rare risk of ketoacidosis, so they are paused during acute illness as advised. They improve outcomes in heart failure.

Answer

A · Keep the genital area clean, as fungal infections are more common
10.Med-surg: cardiovascular & respiratory

Answer: C · The INR may be below this patient's higher target, so check it and report

Why this is the answer

Mechanical heart valves, especially in the mitral position, often need a higher INR target (for example 2.5–3.5, depending on valve type and risk factors). An INR of 2.2 may be subtherapeutic, increasing the risk of valve thrombosis and stroke. The nurse checks the documented target and informs the prescriber. DOACs are not used for mechanical valves.

Answer

C · The INR may be below this patient's higher target, so check it and report
11.Med-surg: neuro, endocrine & renal

Answer: C · Loss of movement and pain sense, with position sense kept

Why this is the answer

Anterior cord syndrome usually follows damage to the anterior spinal artery. Motor, pain and temperature pathways are lost below the injury, but the dorsal columns (fine touch, vibration and proprioception) at the back are spared.

Answer

C · Loss of movement and pain sense, with position sense kept
12.Med-surg: neuro, endocrine & renal

Answer: C · 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

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

Answer: D · Nausea triggered by reminders of treatment before it is given

Why this is the answer

Anticipatory nausea is a conditioned response after previous poorly controlled nausea, triggered by sights or smells linked to treatment. Good antiemetic control from the first cycle helps prevent it; relaxation techniques and anxiolytics may help.

Answer

D · Nausea triggered by reminders of treatment before it is given
14.Med-surg: GI, perioperative & oncology

Answer: B · Potassium 6.0 mmol/L

Why this is the answer

Spironolactone blocks aldosterone and can cause hyperkalaemia, which risks arrhythmias. A potassium of 6.0 mmol/L is above the normal range (about 3.5–5.0) and needs urgent review before further doses.

Answer

B · Potassium 6.0 mmol/L

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