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

During START triage, a non-walking adult is breathing 36 times a minute. Which category is the victim given?

  1. ABlack (expectant)
  2. BGreen (minor)
  3. CRed (immediate)
  4. DYellow (delayed)
2.Prioritization & delegationHard

A patient is deteriorating quickly. The nurse has called the provider twice, but the provider has not come. What is the best action?

  1. AAsk the patient’s family to call the provider
  2. BActivate the rapid response team
  3. CWait another hour and call the provider again
  4. DDocument the concern and continue routine care
3.Infection control & patient safetyMedium

A patient with a fentanyl skin patch wants to use a heating pad on the area. What should the nurse teach?

  1. AHeat only matters if the patch is on the chest
  2. BAvoid heat on or near the patch, because it increases how fast the drug is absorbed
  3. CHeat is fine to use, because it helps the patch stick better to the skin
  4. DHeat makes the patch last longer, so fewer patches are needed each month
4.Infection control & patient safetyHard

Minutes after the first IV dose of an antibiotic starts, the patient develops wheezing, hives and low blood pressure. What should the nurse do first?

  1. ASlow the infusion rate
  2. BStop the infusion
  3. CRecord the new allergy in the chart
  4. DGive an oral antihistamine
5.Lab values & electrolytesMedium

How does IV calcium gluconate help a patient with severe hyperkalemia?

  1. AIt stabilizes heart cell membranes without lowering potassium
  2. BIt increases potassium excretion by the kidneys
  3. CIt moves potassium from the blood into the cells
  4. DIt binds potassium in the gut so that it is passed in the stool
6.Lab values & electrolytesHard

A patient with heart failure takes lisinopril, spironolactone and a potassium supplement. Today the potassium is 6.0 mEq/L. What is the most likely explanation?

  1. ASpironolactone causes potassium loss
  2. BSeveral medicines that raise potassium are being taken together
  3. CLisinopril lowers potassium
  4. DPotassium supplements have no effect on the serum level
7.Clinical nursingMedium

A patient on insulin reports nightmares, night sweats and morning headaches. What should be suspected?

  1. ANight-time hypoglycaemia
  2. BA urinary tract infection
  3. CHyperthyroidism
  4. DRaised intracranial pressure
8.Clinical nursingHard

A patient on an anticoagulant falls and hits their head but appears well. What is the correct action?

  1. ANo action, because the patient appears well
  2. BGive an extra dose of anticoagulant
  3. CEncourage the patient to sleep without observations
  4. DArrange medical review and likely CT scan, with neurological observations
9.Med-surg: cardiovascular & respiratoryMedium

After a bronchoscopy with throat anaesthesia, when can the patient eat and drink?

  1. AWhen the gag and cough reflexes have returned
  2. BAfter a full 24 hours without food
  3. CImmediately after the scope is removed
  4. DOnly after a chest X-ray has been reported
10.Med-surg: cardiovascular & respiratoryHard

Before the morning dose of digoxin, a patient's apical pulse is 54/min and they feel nauseated. What should the nurse do?

  1. AGive the dose and an antiemetic, then recheck the pulse tomorrow
  2. BWithhold the dose and report it, as toxicity is possible
  3. CGive the dose, because only a radial pulse counts
  4. DGive half the dose and recheck the pulse in an hour
11.Med-surg: neuro, endocrine & renalMedium

After pituitary surgery, a patient passes 400 mL of urine per hour for three hours with a low specific gravity. What should the nurse suspect?

  1. ASIADH
  2. BAcute kidney injury
  3. CNormal diuresis
  4. DDiabetes insipidus
12.Med-surg: neuro, endocrine & renalHard

A patient with AKI has a low urine sodium and concentrated urine. What does this suggest?

  1. ADiabetes insipidus, with too little ADH
  2. BA post-renal blockage, with urine backed up
  3. CA pre-renal cause, with kidneys holding salt and water
  4. DAcute tubular necrosis, with damaged and leaking tubules
13.Med-surg: GI, perioperative & oncologyMedium

Which finding means a patient is usually ready to leave recovery for the ward?

  1. APain score 9/10 and vomiting repeatedly
  2. BStill drowsy and needing a jaw thrust to breathe
  3. CAwake, with a clear airway, stable observations and controlled pain
  4. DSystolic BP falling steadily over the last hour, with a rising pulse rate
14.Med-surg: GI, perioperative & oncologyHard

On day 6 after abdominal surgery, a patient says something "gave way" when coughing, and bowel is visible through the wound. What should the nurse do immediately?

  1. ACover with saline-soaked sterile dressings, bend the knees, call the surgeon
  2. BGive the patient a light meal to calm them while waiting for the team
  3. CLeave the wound uncovered and sit the patient fully upright in bed
  4. DPush the bowel back gently and tape the wound edges together firmly

3Solutions

1.Prioritization & delegation

Answer: C · Red (immediate)

Why this is the answer

In START, a respiratory rate over 30/min means the victim is tagged immediate (red). Rates of 30 or less move on to the perfusion and mental status checks.

Answer

C · Red (immediate)
2.Prioritization & delegation

Answer: B · Activate the rapid response team

Why this is the answer

Nurses can call the rapid response team directly when a patient is deteriorating. The nurse also informs the charge nurse and follows the chain of command about the provider’s lack of response.

Answer

B · Activate the rapid response team
3.Infection control & patient safety

Answer: B · Avoid heat on or near the patch, because it increases how fast the drug is absorbed

Why this is the answer

Heat from heating pads, electric blankets, hot tubs or fever increases fentanyl absorption and can cause an overdose. Patients are taught to avoid heat over the patch.

Answer

B · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
4.Infection control & patient safety

Answer: B · Stop the infusion

Why this is the answer

These are signs of anaphylaxis. The nurse stops the infusion at once, calls for help and supports the airway, and intramuscular epinephrine (adrenaline) is the first-line treatment. Documentation comes later.

Answer

B · Stop the infusion
5.Lab values & electrolytes

Answer: A · It stabilizes heart cell membranes without lowering potassium

Why this is the answer

Calcium counteracts the effect of high potassium on the heart’s electrical activity within minutes. The potassium must still be lowered by shifting it into cells (insulin with glucose) and removing it (binders, diuretics or dialysis).Checked against: High potassium level · MedlinePlus (NIH) (2025)

Answer

A · It stabilizes heart cell membranes without lowering potassium
6.Lab values & electrolytes

Answer: B · Several medicines that raise potassium are being taken together

Why this is the answer

ACE inhibitors and spironolactone both make the kidneys retain potassium, and a supplement adds more. The nurse holds the supplement, informs the prescriber and checks kidney function and the ECG.Checked against: High potassium level · MedlinePlus (NIH) (2025); Spironolactone · MedlinePlus (NIH) (2018)

Answer

B · Several medicines that raise potassium are being taken together
7.Clinical nursing

Answer: A · Night-time hypoglycaemia

Why this is the answer

Nocturnal hypoglycaemia can cause sweating, restless sleep, nightmares and morning headache. Checking glucose overnight and reviewing insulin doses can confirm and correct it.

Answer

A · Night-time hypoglycaemia
8.Clinical nursing

Answer: D · Arrange medical review and likely CT scan, with neurological observations

Why this is the answer

Anticoagulated patients have a high risk of intracranial bleeding after head injury, even with mild symptoms, so guidelines recommend early imaging and neurological monitoring.

Answer

D · Arrange medical review and likely CT scan, with neurological observations
9.Med-surg: cardiovascular & respiratory

Answer: A · When the gag and cough reflexes have returned

Why this is the answer

Local anaesthetic sprayed on the throat abolishes the gag and cough reflexes for a time, so food or fluid could be aspirated. The nurse checks that the reflexes have returned (often after about one to two hours) before giving sips of water and then food.

Answer

A · When the gag and cough reflexes have returned
10.Med-surg: cardiovascular & respiratory

Answer: B · Withhold the dose and report it, as toxicity is possible

Why this is the answer

A common rule is to withhold digoxin and inform the prescriber if the apical pulse is below 60/min (or below the set parameter) or if there are toxic features such as nausea, vomiting, visual disturbance or a new arrhythmia. A digoxin level, ECG, potassium and renal function are usually checked. The nurse does not change a dose on their own initiative.

Answer

B · Withhold the dose and report it, as toxicity is possible
11.Med-surg: neuro, endocrine & renal

Answer: D · Diabetes insipidus

Why this is the answer

Damage to the posterior pituitary or hypothalamus can stop ADH release, causing cranial DI with large volumes of dilute urine. The nurse reports it, monitors fluid balance and serum sodium closely and anticipates treatment with desmopressin.

Answer

D · Diabetes insipidus
12.Med-surg: neuro, endocrine & renal

Answer: C · A pre-renal cause, with kidneys holding salt and water

Why this is the answer

In pre-renal AKI, the tubules work normally and conserve sodium and water, so urine sodium is low and urine is concentrated. In acute tubular necrosis, damaged tubules cannot conserve sodium, so urine sodium is higher.

Answer

C · A pre-renal cause, with kidneys holding salt and water
13.Med-surg: GI, perioperative & oncology

Answer: C · Awake, with a clear airway, stable observations and controlled pain

Why this is the answer

Discharge criteria include a protected airway, adequate breathing and oxygen saturation, stable vital signs, acceptable pain and nausea control, and no active bleeding, as set by local recovery criteria.

Answer

C · Awake, with a clear airway, stable observations and controlled pain
14.Med-surg: GI, perioperative & oncology

Answer: A · Cover with saline-soaked sterile dressings, bend the knees, call the surgeon

Why this is the answer

Evisceration is a surgical emergency. Cover the organs with sterile, saline-moistened dressings, place the patient in a low Fowler's position with knees flexed to reduce tension, keep them nil by mouth, monitor for shock and call the surgeon. Never try to replace the organs.

Answer

A · Cover with saline-soaked sterile dressings, bend the knees, call the surgeon

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