1Formulas and methods
Prioritization & delegation
Method
- Ask what will harm the patient soonest if nothing is done.
- Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
- Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
- Assess before you act unless it is an emergency; then choose the step the others depend on.
- 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
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Lab values & electrolytes
Method
- Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
- Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
- Link the value to its typical signs and to the drugs and conditions that cause it.
- Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
- 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
- Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
- Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
- Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
- Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
- Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
- Check the glucose in every patient with new confusion, weakness or a seizure.
- Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
- For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
- For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
- For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
- Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
- Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
- For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
- For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
- 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
When making patient assignments, what should the charge nurse consider first?
- ALetting staff choose the patients they prefer
- BGiving the newest staff the most complex patients
- CMatching each patient’s needs to staff competence
- DGiving each nurse patients in rooms next to each other
2.Prioritization & delegationHard
Which patient’s planned discharge should the nurse question?
- AA patient with a stable cast who is walking safely with crutches
- BA patient after a hernia repair who is passing urine and eating
- CA patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
- DA patient with pneumonia who has been without fever for 48 hours on oral antibiotics
3.Infection control & patient safetyMedium
An older adult has trouble getting in and out of the bath. Which measures make bathing safer?
- ABath oil to help the person slide in and out
- BLocking the bathroom door for privacy
- CA shower chair, grab bars and a non-slip mat
- DA loose rug beside the tub to stand on
4.Infection control & patient safetyHard
A patient is receiving a high-alert drug by continuous infusion. At handover, which practice is safest?
- AThe incoming nurse checks it at the end of the shift
- BBoth nurses check the pump and bag against the prescription
- COnly the rate is checked, not the drug or concentration
- DThe outgoing nurse says that “the pump is fine” at the desk
5.Lab values & electrolytesMedium
Which treatment lowers serum potassium by moving it into the cells?
- AIV regular insulin given with glucose
- BIV calcium gluconate given over 10 minutes
- COral potassium chloride supplements
- DIV 0.45% sodium chloride infusion
6.Lab values & electrolytesHard
A patient on long-term amiodarone has fatigue and weight gain. TSH is 11 mIU/L and the free T4 is low. What is the most likely explanation?
- AA normal response to amiodarone needing no action
- BAmiodarone-induced hypothyroidism
- CAmiodarone-induced hyperthyroidism
- DSecondary hypothyroidism from pituitary failure
7.Clinical nursingMedium
Which is a recognised risk factor for postoperative nausea and vomiting?
- ABeing male
- BA short operation under local anaesthetic
- CBeing a smoker
- DUse of opioids after surgery
8.Clinical nursingHard
A patient with COPD on high-flow oxygen becomes drowsy with a bounding pulse and flushed skin. Blood gas shows a raised PaCO2 and low pH. What is the most likely cause?
- AOpioid allergy
- BHypercapnic respiratory failure, partly due to excessive oxygen
- CHypoglycaemia
- DMetabolic alkalosis from vomiting
9.Med-surg: cardiovascular & respiratoryMedium
Which ECG pattern is typical of acute pericarditis?
- ATall peaked T waves with a wide QRS
- BWidespread saddle-shaped ST elevation with PR depression
- CST elevation only in leads II, III and aVF with Q waves
- DA sawtooth baseline with a regular ventricular rate
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?
- AThe left anterior descending artery
- BThe circumflex artery
- CThe left subclavian artery
- DThe right coronary artery and its branches
11.Med-surg: neuro, endocrine & renalMedium
A patient's potassium stays low despite replacement. Which other level should be checked?
- ABilirubin
- BMagnesium
- CAmylase
- DFerritin
12.Med-surg: neuro, endocrine & renalHard
A patient with acute ischaemic stroke is not a thrombolysis candidate. On day 1 the BP is 190/100 mmHg with no other emergency. What is generally appropriate?
- ALower it rapidly to 110/70 mmHg with IV drugs
- BGive nitrate spray every 5 minutes until below 120 mmHg
- CAvoid aggressive lowering and follow the stroke team's targets
- DLie the patient flat and give a large fluid bolus
13.Med-surg: GI, perioperative & oncologyMedium
Which rule about the sterile field is correct?
- AA sterile pack stays sterile even when it is wet
- BThe area below a gowned person's waist is sterile
- CIf sterility is in doubt, the item is treated as contaminated
- DSterile items can be passed across a non-sterile area freely
14.Med-surg: GI, perioperative & oncologyHard
A patient is splashed in the eye with an alkaline cleaning product. What is the first action?
- AAdd a few drops of vinegar to neutralise it
- BAsk the patient to rub the eye to clear it
- CIrrigate the eye at once with large volumes of water or saline
- DCover the eye with a pad and wait for a doctor to examine it first
3Solutions
1.Prioritization & delegation
Answer: C · Matching each patient’s needs to staff competence
Why this is the answer
Assignments are based mainly on patient acuity and needs and on each staff member’s skills and scope. Geography and continuity of care help, but they come after safety.
C · Matching each patient’s needs to staff competence
2.Prioritization & delegation
Answer: C · A patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
Why this is the answer
A new fever and tachycardia after surgery can signal infection or another complication, so the nurse should assess and raise the concern before discharge. The other patients are stable and meeting expected goals.
C · A patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
3.Infection control & patient safety
Answer: C · A shower chair, grab bars and a non-slip mat
Why this is the answer
Shower chairs, grab bars and non-slip surfaces reduce slips and falls. Bath oils make surfaces slippery, and a locked door delays help if the person falls.
C · A shower chair, grab bars and a non-slip mat
4.Infection control & patient safety
Answer: B · Both nurses check the pump and bag against the prescription
Why this is the answer
A bedside check at handover, tracing the line from bag to patient and comparing the drug, concentration, dose and rate with the prescription, catches programming errors early.
B · Both nurses check the pump and bag against the prescription
5.Lab values & electrolytes
Answer: A · IV regular insulin given with glucose
Why this is the answer
Insulin activates the sodium–potassium pump and moves potassium into the cells; glucose is given with it to prevent hypoglycemia. Calcium gluconate protects the heart but does not lower the potassium level.Checked against: High potassium level · MedlinePlus (NIH) (2025)
A · IV regular insulin given with glucose
6.Lab values & electrolytes
Answer: B · Amiodarone-induced hypothyroidism
Why this is the answer
Amiodarone is rich in iodine and can cause either hypothyroidism or hyperthyroidism. A high TSH with a low free T4 shows primary hypothyroidism, so thyroid function is monitored before and during therapy; liver tests are monitored too.Checked against: Hypothyroidism · MedlinePlus (NIH) (2024)
B · Amiodarone-induced hypothyroidism
7.Clinical nursing
Answer: D · Use of opioids after surgery
Why this is the answer
Known risk factors include opioids, female sex, being a non-smoker, previous PONV or motion sickness and longer general anaesthetics. High-risk patients may be given preventive antiemetics.
D · Use of opioids after surgery
8.Clinical nursing
Answer: B · Hypercapnic respiratory failure, partly due to excessive oxygen
Why this is the answer
Uncontrolled oxygen in CO2-retaining patients can worsen hypercapnia and respiratory acidosis. Oxygen should be titrated to 88–92% and medical review sought, possibly for non-invasive ventilation.
B · Hypercapnic respiratory failure, partly due to excessive oxygen
9.Med-surg: cardiovascular & respiratory
Answer: B · Widespread saddle-shaped ST elevation with PR depression
Why this is the answer
Pericarditis often causes concave ST elevation across many leads and PR segment depression, because the inflammation is not limited to one coronary territory. Localised ST elevation with reciprocal changes suggests STEMI. Pericarditis is usually treated with NSAIDs and colchicine.
B · Widespread saddle-shaped ST elevation with PR depression
10.Med-surg: cardiovascular & respiratory
Answer: A · 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.
A · The left anterior descending artery
11.Med-surg: neuro, endocrine & renal
Answer: B · Magnesium
Why this is the answer
Hypomagnesaemia increases potassium loss in the urine and makes hypokalaemia hard to correct. Magnesium is checked and replaced as well.
12.Med-surg: neuro, endocrine & renal
Answer: C · Avoid aggressive lowering and follow the stroke team's targets
Why this is the answer
After ischaemic stroke, the penumbra depends on blood pressure for perfusion. Unless thrombolysis is planned or there is another emergency (such as aortic dissection or acute heart failure), guidelines often accept higher pressures early (for example treating only above 220/120 mmHg in some guidance). Targets are set by the stroke team.
C · Avoid aggressive lowering and follow the stroke team's targets
13.Med-surg: GI, perioperative & oncology
Answer: C · If sterility is in doubt, the item is treated as contaminated
Why this is the answer
Sterile technique treats any doubtful item as contaminated. A gown is sterile only from chest to waist in front, and wet packaging can let microorganisms through.
C · If sterility is in doubt, the item is treated as contaminated
14.Med-surg: GI, perioperative & oncology
Answer: C · Irrigate the eye at once with large volumes of water or saline
Why this is the answer
Alkali burns can cause severe, deep eye damage. Immediate, prolonged irrigation, checking the pH, and urgent ophthalmology review are needed. Neutralising agents are not used.
C · Irrigate the eye at once with large volumes of water or saline
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.