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 nurse teaches a patient who uses crutches. Which statement shows a need for further teaching?

  1. A“I will take my weight on my hands, not on my armpits.”
  2. B“I will remove loose rugs from the floor at home.”
  3. C“I will lean on the crutch pads under my arms to rest.”
  4. D“I will keep the crutch tips in good condition.”
2.Prioritization & delegationHard

A patient taking an SSRI is also given tramadol. A few hours later the patient is agitated, sweating and has a fever, jerking muscles and brisk reflexes. What is the most likely cause?

  1. AOpioid withdrawal
  2. BNeuroleptic malignant syndrome
  3. CAn anxiety attack
  4. DSerotonin syndrome
3.Infection control & patient safetyMedium

Why are independent double checks used for some medicines, such as insulin and heparin infusions?

  1. ATo make the preparation process faster
  2. BBecause these drugs are very expensive to waste
  3. CA second person checking separately catches missed errors
  4. DTo share responsibility between two nurses if an error happens
4.Infection control & patient safetyHard

A visitor becomes very agitated and starts shouting at the nurse in a patient’s room. What should the nurse do first?

  1. ATurn away from the visitor and continue with the patient’s care as normal
  2. BKeep a safe distance and a clear exit, speak calmly and call security if needed
  3. CRaise the voice to show who is in charge
  4. DTouch the visitor’s arm to help them calm down
5.Lab values & electrolytesMedium

Which instruction is correct for a patient starting oral iron tablets?

  1. ATake each tablet with milk to protect the stomach
  2. BTake the tablet with an antacid to improve absorption
  3. CYour stools may turn dark green or black
  4. DYour urine will turn bright orange while you take it
6.Lab values & electrolytesHard

The nurse teaches a patient with chronic kidney disease about a potassium-restricted diet. Which statement shows a need for further teaching?

  1. A"I can leach potatoes by soaking them before cooking them"
  2. B"I'll limit bananas, oranges and potatoes in my meals"
  3. C"I'll check food labels and ask my dietitian about portion sizes"
  4. D"Dried apricots and raisins will be a good snack for me now"
7.Clinical nursingMedium

A patient is having a 12-lead ECG. Where are the chest electrodes placed?

  1. AOn both shoulders and both hips only
  2. BAnywhere on the chest where the skin is clear
  3. CIn standard numbered positions across the front and left of the chest
  4. DIn a straight line down the centre of the sternum from top to bottom
8.Clinical nursingHard

Three days after bowel surgery, a patient has a distended abdomen, vomiting and absent bowel sounds, without colicky pain. What is most likely?

  1. AAcute cholecystitis
  2. BParalytic ileus
  3. CA urinary tract infection
  4. DNormal recovery after surgery
9.Med-surg: cardiovascular & respiratoryMedium

Shortly after a permanent pacemaker is inserted via the subclavian vein, the patient becomes breathless with reduced breath sounds on that side. What complication should be suspected?

  1. APericarditis
  2. BPulmonary oedema
  3. CAsthma
  4. DPneumothorax
10.Med-surg: cardiovascular & respiratoryHard

During tracheal suctioning, a patient's heart rate drops from 88/min to 48/min. What should the nurse do?

  1. AContinue suctioning until the airway is completely clear
  2. BStop suctioning, give oxygen and monitor the patient
  3. CIncrease the suction pressure to finish faster
  4. DGive a dose of atropine without a prescription
11.Med-surg: neuro, endocrine & renalMedium

A bladder scan straight after voiding shows 450 mL of urine still in the bladder. What does this show?

  1. AThe bladder is not emptying properly
  2. BThe patient is passing urine normally
  3. CThe kidneys are making too little urine
  4. DThe patient has drunk too little fluid
12.Med-surg: neuro, endocrine & renalHard

A patient with myasthenia gravis is admitted with pneumonia. Which newly prescribed antibiotic should the nurse question?

  1. ABenzylpenicillin
  2. BGentamicin
  3. CAmoxicillin
  4. DCeftriaxone
13.Med-surg: GI, perioperative & oncologyMedium

Why is the "whoosh" test no longer used to check nasogastric tube position?

  1. AIt needs an X-ray machine at the bedside
  2. BThe air always makes the tube block
  3. CThe test is far too painful for most patients to tolerate
  4. DAir can be heard even when the tube is in the lung
14.Med-surg: GI, perioperative & oncologyHard

At the end of an operation, the final count shows one swab missing. What should happen?

  1. AClose the wound, as the swab was probably thrown away
  2. BLet the patient leave and search the theatre later
  3. CRecord the count as correct to avoid a delay
  4. DTell the surgeon, search, and X-ray if it is not found

3Solutions

1.Prioritization & delegation

Answer: C · “I will lean on the crutch pads under my arms to rest.”

Why this is the answer

Leaning on the axillary pads can compress the nerves in the armpit. Weight should be taken through the hands, and the home should be made safe from trip hazards.

Answer

C · “I will lean on the crutch pads under my arms to rest.”
2.Prioritization & delegation

Answer: D · Serotonin syndrome

Why this is the answer

SSRIs and tramadol both raise serotonin. Agitation, fever, clonus and hyperreflexia that start quickly suggest serotonin syndrome; neuroleptic malignant syndrome follows antipsychotics and causes rigid muscles with slow reflexes.

Answer

D · Serotonin syndrome
3.Infection control & patient safety

Answer: C · A second person checking separately catches missed errors

Why this is the answer

In an independent double check, a second qualified person checks the order, the drug, the dose, the calculation and the pump settings on their own. This catches errors that could cause serious harm with high-alert medications.

Answer

C · A second person checking separately catches missed errors
4.Infection control & patient safety

Answer: B · Keep a safe distance and a clear exit, speak calmly and call security if needed

Why this is the answer

In a potentially violent situation, the nurse keeps a safe distance and a clear path to the door, uses calm, simple words and gets help early. Touching or arguing with an agitated person can make things worse.

Answer

B · Keep a safe distance and a clear exit, speak calmly and call security if needed
5.Lab values & electrolytes

Answer: C · Your stools may turn dark green or black

Why this is the answer

Oral iron commonly darkens the stools, which is harmless, but black tarry stools with abdominal pain should be reported. Milk, antacids and tea reduce absorption; vitamin C or orange juice can improve it.Checked against: Ferrograd C patient information leaflet (ferrous sulfate + vitamin C) · electronic medicines compendium (eMC), UK (2018)

Answer

C · Your stools may turn dark green or black
6.Lab values & electrolytes

Answer: D · "Dried apricots and raisins will be a good snack for me now"

Why this is the answer

Dried fruits such as apricots and raisins are very high in potassium and should be limited in kidney disease with hyperkalemia. Limiting high-potassium foods, leaching vegetables and reading labels are correct strategies.Checked against: Potassium in diet · MedlinePlus (NIH) (2026); Spironolactone · MedlinePlus (NIH) (2018)

Answer

D · "Dried apricots and raisins will be a good snack for me now"
7.Clinical nursing

Answer: C · In standard numbered positions across the front and left of the chest

Why this is the answer

The six chest leads (V1–V6) have standard anatomical positions, from the 4th intercostal space beside the sternum to the mid-axillary line. Wrong placement can change the ECG and lead to misinterpretation.

Answer

C · In standard numbered positions across the front and left of the chest
8.Clinical nursing

Answer: B · Paralytic ileus

Why this is the answer

Paralytic ileus is a temporary loss of gut movement, common after abdominal surgery. Bowel sounds are absent, unlike mechanical obstruction where they are often high-pitched. Management includes nil by mouth, NG decompression, fluids and correcting electrolytes.

Answer

B · Paralytic ileus
9.Med-surg: cardiovascular & respiratory

Answer: D · Pneumothorax

Why this is the answer

Subclavian puncture can injure the pleura and cause a pneumothorax. A chest X-ray is usually taken after implantation. Other complications include haematoma, lead displacement and infection.

Answer

D · Pneumothorax
10.Med-surg: cardiovascular & respiratory

Answer: B · Stop suctioning, give oxygen and monitor the patient

Why this is the answer

Suctioning can cause hypoxaemia and vagal stimulation, leading to bradycardia and arrhythmias. The nurse stops, gives oxygen and observes. Each pass should be short (usually no more than about 10–15 seconds), with pre-oxygenation if needed.

Answer

B · Stop suctioning, give oxygen and monitor the patient
11.Med-surg: neuro, endocrine & renal

Answer: A · The bladder is not emptying properly

Why this is the answer

A large post-void residual means incomplete emptying, for example from obstruction or a weak detrusor. It raises the risk of infection and overflow incontinence and may need intermittent catheterisation or treatment of the cause.

Answer

A · The bladder is not emptying properly
12.Med-surg: neuro, endocrine & renal

Answer: B · Gentamicin

Why this is the answer

Aminoglycosides such as gentamicin can impair neuromuscular transmission and trigger a myasthenic crisis. Fluoroquinolones, magnesium and some other drugs carry similar warnings. The nurse checks with the prescriber before giving it.

Answer

B · Gentamicin
13.Med-surg: GI, perioperative & oncology

Answer: D · Air can be heard even when the tube is in the lung

Why this is the answer

Auscultation of injected air cannot distinguish the stomach from the lungs or oesophagus, and misplaced tubes have caused deaths. pH testing of aspirate or X-ray is used instead.

Answer

D · Air can be heard even when the tube is in the lung
14.Med-surg: GI, perioperative & oncology

Answer: D · Tell the surgeon, search, and X-ray if it is not found

Why this is the answer

Any discrepancy is reported immediately, the wound is checked before closure, the area and waste are searched, and an X-ray is taken if the item is not found. The event is documented and reported.

Answer

D · Tell the surgeon, search, and X-ray if it is not found

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