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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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 patient has a sudden nosebleed, is alert and is breathing normally. What does the nurse do first?

  1. ATilt the head back and apply ice to the back of the neck
  2. BAsk the patient to blow the nose hard to clear the clots
  3. CLie the patient flat on their back with a pillow under the knees
  4. DSit the patient up, lean them forward and pinch the soft part of the nose
2.Prioritization & delegationHard

During an infusion of a thrombolytic drug for stroke, the patient develops a severe headache and starts vomiting. What should the nurse do first?

  1. AContinue the infusion, because headache is expected
  2. BStop the infusion and inform the provider at once
  3. CGive a dose of aspirin for the headache
  4. DSlow the infusion and give an antiemetic as prescribed
3.Infection control & patient safetyMedium

A patient with a fever and a cough arrives in a crowded clinic waiting room. What should the nurse do?

  1. AGive everyone else in the waiting room a mask instead
  2. BDo nothing until the patient is seen by the provider
  3. CGive the patient a mask and seat them apart from others
  4. DAsk the patient to wait outside in the car park
4.Infection control & patient safetyHard

A nurse calculates a child’s prescribed dose and finds it is ten times higher than the usual dose for the child’s weight. What should the nurse do?

  1. AGive half the dose and watch the child closely
  2. BGive it, because the prescriber must have a reason
  3. CHold the dose and verify it with the prescriber and pharmacist
  4. DGive one-tenth of the dose without telling anyone about it
5.Lab values & electrolytesMedium

A patient takes low-dose methotrexate weekly for rheumatoid arthritis. Which laboratory tests are monitored regularly?

  1. AComplete blood count, liver tests and kidney function
  2. BTroponin, creatine kinase and myoglobin
  3. CSerum amylase, lipase and blood ketones
  4. DSerum lithium, sodium and urine specific gravity
6.Lab values & electrolytesHard

A patient recovering from acute tubular necrosis now passes 4–5 L of urine a day. Which electrolyte changes should the nurse watch for?

  1. AHigh potassium and high sodium from retention
  2. BNo changes, because the kidneys are now normal
  3. CHigh calcium and high phosphate from bone loss
  4. DLow potassium and low sodium from urine losses
7.Clinical nursingMedium

Which is a first-line nursing measure to help prevent constipation in hospital?

  1. AKeeping the patient in bed
  2. BRestricting fluids to reduce urine output
  3. CEncouraging fluids, fibre and mobility
  4. DGiving an enema to every patient on admission
8.Clinical nursingHard

After a head injury, a patient passes very large volumes of dilute urine and the serum sodium is rising. What is most likely?

  1. ADiabetes mellitus
  2. BDiabetes insipidus
  3. CAcute kidney injury
  4. DSyndrome of inappropriate ADH secretion
9.Med-surg: cardiovascular & respiratoryMedium

Rheumatic heart disease most often follows which infection?

  1. AA group A streptococcal throat infection
  2. BA fungal infection of the lungs
  3. CStaphylococcal infection of the skin
  4. DA viral infection of the upper airway
10.Med-surg: cardiovascular & respiratoryHard

A patient on warfarin for atrial fibrillation has an INR of 8.5 but no bleeding. What is the most likely management?

  1. AContinue the usual dose and recheck the INR in a month
  2. BGive IV protamine sulfate immediately to reverse it
  3. CWithhold warfarin, inform the prescriber and recheck the INR soon
  4. DGive prothrombin complex concentrate and a blood transfusion
11.Med-surg: neuro, endocrine & renalMedium

Which criterion for acute kidney injury (KDIGO) relates to urine output?

  1. ABelow 2 mL/kg/h for 1 hour
  2. BBelow 0.5 mL/kg/h for 6 hours or more
  3. CBelow 1 L in 24 hours whatever the intake
  4. DAny change in the colour of the urine
12.Med-surg: neuro, endocrine & renalHard

A patient with a brain injury has a mean arterial pressure of 80 mmHg and an ICP of 25 mmHg. How should the nurse interpret this?

  1. AThe cerebral perfusion pressure is 105 mmHg, which is too high
  2. BThe cerebral perfusion pressure is 80 mmHg, which is normal
  3. CThe ICP cannot affect brain perfusion if the blood pressure is normal
  4. DThe cerebral perfusion pressure is 55 mmHg, below the usual target
13.Med-surg: GI, perioperative & oncologyMedium

In the UK National Early Warning Score (NEWS2), what does an aggregate score of 5 or more usually trigger?

  1. AAn urgent review by a clinician skilled in acute illness
  2. BDischarge planning for the next day
  3. CRoutine observations once every 12 hours, with no other change in care
  4. DNo change unless the patient complains
14.Med-surg: GI, perioperative & oncologyHard

A patient with diabetes has rapidly spreading redness around a small wound, severe pain out of proportion, fever and crackling under the skin. What should the nurse suspect?

  1. AA healing venous ulcer
  2. BNecrotising fasciitis
  3. CA simple insect bite
  4. DMild contact dermatitis

3Solutions

1.Prioritization & delegation

Answer: D · Sit the patient up, lean them forward and pinch the soft part of the nose

Why this is the answer

Leaning forward keeps blood out of the airway and stomach, and firm pressure on the soft part of the nose usually stops the bleeding. Tilting the head back or lying flat lets blood run into the throat.

Answer

D · Sit the patient up, lean them forward and pinch the soft part of the nose
2.Prioritization & delegation

Answer: B · Stop the infusion and inform the provider at once

Why this is the answer

A new severe headache, vomiting or neurological decline during thrombolysis can mean intracranial bleeding. The infusion is stopped, the provider informed and an urgent scan arranged.

Answer

B · Stop the infusion and inform the provider at once
3.Infection control & patient safety

Answer: C · Give the patient a mask and seat them apart from others

Why this is the answer

Offering a mask to people with respiratory symptoms and separating them from others reduces the spread of droplets. Tissues, hand hygiene products and waste bins are also provided.

Answer

C · Give the patient a mask and seat them apart from others
4.Infection control & patient safety

Answer: C · Hold the dose and verify it with the prescriber and pharmacist

Why this is the answer

Tenfold errors are common in pediatrics, usually from decimal or unit mistakes. The nurse holds the dose and clarifies it, and never changes the dose on their own.

Answer

C · Hold the dose and verify it with the prescriber and pharmacist
5.Lab values & electrolytes

Answer: A · Complete blood count, liver tests and kidney function

Why this is the answer

Methotrexate can cause bone marrow suppression, liver toxicity and, as it is cleared by the kidneys, toxicity when kidney function falls. The CBC, liver tests and creatinine are checked regularly, and folic acid is usually given to reduce adverse effects.Checked against: Methotrexate · StatPearls (NCBI Bookshelf) (2024)

Answer

A · Complete blood count, liver tests and kidney function
6.Lab values & electrolytes

Answer: D · Low potassium and low sodium from urine losses

Why this is the answer

In the diuretic phase of AKI, the recovering tubules lose large amounts of water and electrolytes, so dehydration, hypokalemia and hyponatremia can occur. Daily weights, intake and output, and frequent electrolytes guide replacement.Checked against: Acute tubular necrosis · MedlinePlus (NIH) (2025)

Answer

D · Low potassium and low sodium from urine losses
7.Clinical nursing

Answer: C · Encouraging fluids, fibre and mobility

Why this is the answer

Adequate fluids, a fibre-rich diet, mobility and privacy for toileting help prevent constipation. Laxatives are added if needed, especially with opioids.

Answer

C · Encouraging fluids, fibre and mobility
8.Clinical nursing

Answer: B · Diabetes insipidus

Why this is the answer

Cranial diabetes insipidus is a lack of ADH, so the kidneys cannot concentrate urine. Water loss raises sodium; strict fluid balance and replacement are needed.

Answer

B · Diabetes insipidus
9.Med-surg: cardiovascular & respiratory

Answer: A · A group A streptococcal throat infection

Why this is the answer

Rheumatic fever is an autoimmune reaction weeks after group A streptococcal pharyngitis. It can permanently damage heart valves, most often the mitral valve. Prompt antibiotic treatment of strep throat prevents it.

Answer

A · A group A streptococcal throat infection
10.Med-surg: cardiovascular & respiratory

Answer: C · Withhold warfarin, inform the prescriber and recheck the INR soon

Why this is the answer

A very high INR without bleeding is usually managed by withholding warfarin, informing the prescriber and repeating the INR. Low-dose oral vitamin K may also be prescribed depending on the INR and local protocol (UK guidance gives it above an INR of 8; US guidance mainly above 10 or with high bleeding risk). Prothrombin complex concentrate and IV vitamin K are used for major bleeding. Protamine reverses heparin. The reason for the rise (new drugs, illness, diet) should be explored.

Answer

C · Withhold warfarin, inform the prescriber and recheck the INR soon
11.Med-surg: neuro, endocrine & renal

Answer: B · Below 0.5 mL/kg/h for 6 hours or more

Why this is the answer

KDIGO defines AKI as a creatinine rise of ≥26.5 µmol/L (0.3 mg/dL) within 48 hours, a rise to ≥1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours. Accurate fluid balance charts are therefore essential.

Answer

B · Below 0.5 mL/kg/h for 6 hours or more
12.Med-surg: neuro, endocrine & renal

Answer: D · The cerebral perfusion pressure is 55 mmHg, below the usual target

Why this is the answer

CPP = MAP − ICP, so 80 − 25 = 55 mmHg. A CPP below about 60 mmHg risks brain ischaemia. The team will act to lower the ICP and support the MAP.

Answer

D · The cerebral perfusion pressure is 55 mmHg, below the usual target
13.Med-surg: GI, perioperative & oncology

Answer: A · An urgent review by a clinician skilled in acute illness

Why this is the answer

NEWS2 scores respiratory rate, SpO₂, oxygen use, BP, pulse, consciousness or new confusion, and temperature. A score of 5–6 needs an urgent response, and 7 or more an emergency response.

Answer

A · An urgent review by a clinician skilled in acute illness
14.Med-surg: GI, perioperative & oncology

Answer: B · Necrotising fasciitis

Why this is the answer

Necrotising soft tissue infection spreads rapidly along fascial planes and can cause septic shock. It is a surgical emergency needing urgent debridement, IV antibiotics and sepsis care.

Answer

B · Necrotising fasciitis

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.

ExamProblems · examproblems.com/courses/nclex-style-prioritization-and-delegation