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
A patient on a nasal cannula at 6 L/min still has a low SpO₂. What should the nurse do?
- ARecheck the SpO₂ at the next routine set of observations in four hours
- BReport it, because a different oxygen device is likely to be needed
- CRemove the oxygen to see if the SpO₂ changes
- DTurn the nasal cannula up to 15 L/min
2.Prioritization & delegationHard
Four patients arrive at the emergency department at the same time. Who should be seen first?
- AAn adult with kidney stone pain of 9/10 and stable vital signs
- BAn older adult with weakness on one side that began 40 minutes ago
- CA young adult with a swollen, painful ankle after a fall on the stairs
- DA child with a temperature of 39 °C who is alert and drinking
3.Infection control & patient safetyMedium
A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?
- AGive syrup of ipecac from the medicine cabinet
- BWait to see whether any symptoms develop over the next day
- CContact the local poison advice service now for specific advice
- DMake the child vomit, using a finger at the back of the throat
4.Infection control & patient safetyHard
A patient restrained because of violent behavior is now calm, oriented and following instructions. What should the nurse do?
- AKeep the restraints until the next provider visit
- BKeep the restraints until the order expires
- CRemove one restraint each day to test the patient’s behavior
- DRemove the restraints, because the reason for them has ended
5.Lab values & electrolytesMedium
A patient with HIV on antiretroviral therapy has an undetectable viral load. What does this mean?
- AThe treatment can now be stopped without any risk
- BThe virus has been completely cured and removed
- CThe treatment is suppressing the virus very well
- DThe CD4 count must now be dangerously low too
6.Lab values & electrolytesHard
A patient's potassium is 7.2 mEq/L, and the monitor shows wide QRS complexes. Several treatments are prescribed. Which should be given first?
- AIV furosemide (a loop diuretic)
- BIV calcium gluconate (or chloride)
- CAn oral potassium binder dose
- DUrgent hemodialysis session
7.Clinical nursingMedium
After removing a peripheral IV cannula, what should the nurse check?
- AThat the site is left uncovered and bleeding freely
- BThat the cannula is put back in its sterile packet for the next patient
- CThat the cannula is intact, and apply pressure until bleeding stops
- DThat the patient's blood glucose is normal before removal
8.Clinical nursingHard
Why must blood samples for a cross-match be labelled at the bedside immediately after they are taken?
- ATo keep the sample warm so the cells do not break down in transit
- BTo let the patient sign the label
- CTo prevent "wrong blood in tube" errors that can cause fatal reactions
- DTo speed up the laboratory's computer system and reduce the waiting time
9.Med-surg: cardiovascular & respiratoryMedium
Why should a beta-blocker not be stopped suddenly in a patient with ischaemic heart disease?
- AThe drug stays stored in the tissues for several months afterwards
- BSudden stopping causes severe and prolonged hypoglycaemia
- CRebound tachycardia and hypertension can trigger angina or MI
- DThe heart rate becomes permanently slow afterwards
10.Med-surg: cardiovascular & respiratoryHard
An older inpatient develops sudden fever, muscle aches and a dry cough during the winter influenza season. Which plan is most appropriate?
- ALeave them in the open bay and give a course of antibiotics only
- BIsolate with droplet precautions, test and expect early antivirals
- CWait a week to see whether the symptoms settle before testing
- DIsolate only if they develop a rash
11.Med-surg: neuro, endocrine & renalMedium
A patient has acute low back pain with no red flags. Which advice is most appropriate?
- AWear a rigid back brace all day and night for at least three months
- BStay as active as possible and use simple pain relief
- CStay in bed for two weeks until the pain is gone
- DAvoid all movement until an MRI scan has been done
12.Med-surg: neuro, endocrine & renalHard
A nurse teaches a young adult with newly diagnosed epilepsy. Which statement shows a need for further teaching?
- A"I will tell my friends what to do if I have a seizure."
- B"I will keep a record of any seizures I have."
- C"I will take a shower rather than a bath."
- D"As long as I take my tablets, I can swim alone."
13.Med-surg: GI, perioperative & oncologyMedium
A dying patient can no longer drink. Which mouth care is most appropriate?
- ALemon and glycerine swabs every hour to stimulate saliva
- BBrushing hard with a stiff toothbrush twice a day
- CFrequent, gentle moistening of the mouth and lips
- DNo mouth care, to avoid disturbing the patient
14.Med-surg: GI, perioperative & oncologyHard
A patient is booked for a urea breath test for H. pylori. Which medicine should usually be stopped 2 weeks before the test?
- ALevothyroxine
- BAmlodipine
- COmeprazole
- DParacetamol (acetaminophen)
3Solutions
1.Prioritization & delegation
Answer: B · Report it, because a different oxygen device is likely to be needed
Why this is the answer
Standard nasal cannulas are usually run at up to about 6 L/min; higher flows dry the nose without much benefit. If the patient still needs more oxygen, the nurse assesses and escalates for a different device.
B · Report it, because a different oxygen device is likely to be needed
2.Prioritization & delegation
Answer: B · An older adult with weakness on one side that began 40 minutes ago
Why this is the answer
Sudden one-sided weakness suggests a stroke, and treatment depends on how quickly it starts. Severe kidney stone pain needs prompt pain relief, but the patient is stable.
B · An older adult with weakness on one side that began 40 minutes ago
3.Infection control & patient safety
Answer: C · Contact the local poison advice service now for specific advice
Why this is the answer
A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.
C · Contact the local poison advice service now for specific advice
4.Infection control & patient safety
Answer: D · Remove the restraints, because the reason for them has ended
Why this is the answer
Restraints are used only as long as needed to keep people safe. Once the patient no longer presents a danger, the restraints are removed, even if the order has not yet expired.
D · Remove the restraints, because the reason for them has ended
5.Lab values & electrolytes
Answer: C · The treatment is suppressing the virus very well
Why this is the answer
An undetectable viral load shows that antiretroviral therapy is suppressing viral replication. The virus remains in the body, so treatment must continue. People with a sustained undetectable viral load do not transmit HIV sexually.
C · The treatment is suppressing the virus very well
6.Lab values & electrolytes
Answer: B · IV calcium gluconate (or chloride)
Why this is the answer
With ECG changes, IV calcium is given first to stabilize the cardiac membrane within minutes. It does not lower potassium, so insulin with glucose (and sometimes albuterol/salbutamol) follows to shift potassium into cells, then binders, diuretics or dialysis remove it.Checked against: High potassium level - Medical Encyclopedia · MedlinePlus (NIH) (2025)
B · IV calcium gluconate (or chloride)
7.Clinical nursing
Answer: C · That the cannula is intact, and apply pressure until bleeding stops
Why this is the answer
The nurse checks that the whole cannula has been removed, applies pressure and a dressing, and records the removal. Any signs of phlebitis are noted.
C · That the cannula is intact, and apply pressure until bleeding stops
8.Clinical nursing
Answer: C · To prevent "wrong blood in tube" errors that can cause fatal reactions
Why this is the answer
A sample labelled with the wrong patient's details can lead to incompatible blood being issued. Labelling at the bedside after positive identification is a key transfusion safety step.
C · To prevent "wrong blood in tube" errors that can cause fatal reactions
9.Med-surg: cardiovascular & respiratory
Answer: C · Rebound tachycardia and hypertension can trigger angina or MI
Why this is the answer
Long-term beta-blockade increases the number and sensitivity of beta receptors. Abrupt withdrawal exposes them to normal adrenaline levels, which can cause rebound tachycardia, hypertension and myocardial ischaemia. Doses are tapered.
C · Rebound tachycardia and hypertension can trigger angina or MI
10.Med-surg: cardiovascular & respiratory
Answer: B · Isolate with droplet precautions, test and expect early antivirals
Why this is the answer
Influenza spreads mainly by droplets and contact, so the patient is isolated with droplet precautions and tested. Antivirals such as oseltamivir work best if started early, ideally within 48 hours of symptoms, and are recommended for hospitalised and high-risk patients. Vaccination of staff and patients reduces outbreaks.
B · Isolate with droplet precautions, test and expect early antivirals
11.Med-surg: neuro, endocrine & renal
Answer: B · Stay as active as possible and use simple pain relief
Why this is the answer
Most acute low back pain improves within weeks. Staying active, simple analgesia and gradual return to normal activities help recovery. Imaging is usually not needed without red flags.
B · Stay as active as possible and use simple pain relief
12.Med-surg: neuro, endocrine & renal
Answer: D · "As long as I take my tablets, I can swim alone."
Why this is the answer
People with epilepsy should never swim alone, even if their seizures are well controlled. Showers are safer than baths. Telling friends about first aid and keeping a seizure diary are good practice.
D · "As long as I take my tablets, I can swim alone."
13.Med-surg: GI, perioperative & oncology
Answer: C · Frequent, gentle moistening of the mouth and lips
Why this is the answer
Regular gentle mouth care with water or saliva substitutes and lip balm relieves dryness and discomfort. Lemon and glycerine swabs can dry the mouth further. Families can be involved if they wish.
C · Frequent, gentle moistening of the mouth and lips
14.Med-surg: GI, perioperative & oncology
Answer: C · Omeprazole
Why this is the answer
PPIs suppress H. pylori and can give false-negative breath or stool tests, so they are usually stopped 2 weeks before. Antibiotics are usually stopped 4 weeks before testing.
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