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

Which telephone call should a clinic nurse return first?

  1. AA parent of a 5-year-old with a runny nose for two days
  2. BA parent of a 6-week-old with a temperature of 38.3 °C
  3. CAn adult who wants to move a routine blood test appointment
  4. DAn adult asking for a repeat prescription for a statin
2.Prioritization & delegationHard

A patient has a heart rate of 38/min, feels dizzy and has a blood pressure of 80/50 mmHg. Which drug is usually given first, as prescribed?

  1. AAtropine
  2. BMetoprolol
  3. CDiltiazem
  4. DDigoxin
3.Infection control & patient safetyMedium

When putting on sterile gloves, how does the nurse put on the second glove?

  1. AUse the bare hand to adjust the outside of the first glove
  2. BPull the second glove on by its fingertips, using the bare hand
  3. CSlide the gloved fingers under the second glove’s cuff and pull it on
  4. DHold the inside of the second glove with the gloved hand
4.Infection control & patient safetyHard

A patient’s allergy band says “penicillin”, and an order has been written for amoxicillin. What should the nurse do?

  1. AGive the drug and watch the patient closely
  2. BHold the drug and contact the prescriber
  3. CGive an antihistamine first and then the drug
  4. DAsk the patient whether they would like to take it anyway
5.Lab values & electrolytesMedium

A patient taking empagliflozin (an SGLT2 inhibitor) has glucose in the urine but a normal blood glucose. What is the best interpretation?

  1. AA urinary tract infection
  2. BUncontrolled diabetes needing insulin
  3. CA sign of kidney failure
  4. DAn expected effect of the drug
6.Lab values & electrolytesHard

A patient has a hematocrit of 60% and a raised red cell mass. Which result suggests polycythemia vera rather than secondary polycythemia from chronic hypoxia?

  1. AA low erythropoietin level
  2. BA high carboxyhemoglobin
  3. CA low oxygen saturation
  4. DA high erythropoietin level
7.Clinical nursingMedium

A patient with type 1 diabetes is vomiting and eating little. What is correct sick-day advice?

  1. AStop insulin until eating normally again to avoid hypoglycaemia
  2. BHalve fluid intake to prevent vomiting
  3. CDo not stop insulin; check glucose and ketones more often
  4. DCheck glucose once a day only
8.Clinical nursingHard

During a general anaesthetic, a patient develops a rapidly rising temperature, muscle rigidity and rising carbon dioxide levels. What should be suspected?

  1. AMalignant hyperthermia
  2. BPostoperative infection
  3. CNeuroleptic malignant syndrome from antipsychotics
  4. DA normal response to surgery
9.Med-surg: cardiovascular & respiratoryMedium

A patient has exercise-induced asthma. Which advice is most appropriate?

  1. AExercise only in cold, dry air to toughen the airways
  2. BAvoid all forms of exercise permanently to prevent attacks
  3. CTake a beta-blocker before exercise
  4. DUse the reliever inhaler shortly before exercise and warm up
10.Med-surg: cardiovascular & respiratoryHard

A patient with a COPD exacerbation has been on NIV for two hours. They are now more drowsy, and the pH has fallen further despite a good mask fit. What should the nurse do?

  1. AGive a sedative to help the patient tolerate the mask
  2. BRemove the mask and give nebulised bronchodilators only from now on
  3. CEscalate urgently for review of intubation or a ceiling of care
  4. DContinue NIV unchanged and repeat the blood gas tomorrow morning
11.Med-surg: neuro, endocrine & renalMedium

A patient with atrial fibrillation has had an ischaemic stroke. Which long-term medicine type most reduces the risk of another stroke?

  1. AA beta-agonist inhaler
  2. BAn oral anticoagulant
  3. CA proton pump inhibitor
  4. DA loop diuretic
12.Med-surg: neuro, endocrine & renalHard

A patient with motor neurone disease reports morning headaches, poor sleep and sleepiness during the day. What do these symptoms suggest?

  1. ALow mood, which should be treated with an antidepressant first
  2. BA side effect of riluzole, which should be stopped straight away by the nurse
  3. CNormal tiredness that needs no specific action
  4. DWeak breathing at night, so a review for ventilation support
13.Med-surg: GI, perioperative & oncologyMedium

Which statement about pain in older adults is correct?

  1. AThey may under-report pain, so active assessment is needed
  2. BPain is a normal part of ageing and does not need any treatment at all
  3. COlder adults feel less pain because nerves wear out
  4. DOpioids must never be used in people over 70
14.Med-surg: GI, perioperative & oncologyHard

Four patients from a house fire arrive in the emergency department. Which should the nurse assess first?

  1. ARedness on the backs of both hands, and very anxious
  2. BCircumferential chest burns, with breathing becoming shallow and laboured
  3. CA blistered forearm burn and a small cut on the knee
  4. DPartial-thickness burns to both legs, with pain rated 8/10

3Solutions

1.Prioritization & delegation

Answer: B · A parent of a 6-week-old with a temperature of 38.3 °C

Why this is the answer

A fever in an infant under about 3 months old needs urgent assessment, because serious bacterial infection is more likely and signs can be subtle. The other calls are routine.

Answer

B · A parent of a 6-week-old with a temperature of 38.3 °C
2.Prioritization & delegation

Answer: A · Atropine

Why this is the answer

Atropine is the first-line drug for symptomatic bradycardia. Metoprolol, digoxin and diltiazem slow the heart and would make things worse; pacing may be needed if atropine does not work.

Answer

A · Atropine
3.Infection control & patient safety

Answer: C · Slide the gloved fingers under the second glove’s cuff and pull it on

Why this is the answer

The first glove is handled only by the inside of its cuff with the bare hand. The gloved hand then touches only the outside of the second glove, under its folded cuff. The inside of a glove is not sterile once skin has touched it.

Answer

C · Slide the gloved fingers under the second glove’s cuff and pull it on
4.Infection control & patient safety

Answer: B · Hold the drug and contact the prescriber

Why this is the answer

Amoxicillin is a penicillin, so it could cause a serious allergic reaction. The nurse holds the drug, clarifies the allergy and contacts the prescriber for a safe alternative.

Answer

B · Hold the drug and contact the prescriber
5.Lab values & electrolytes

Answer: D · An expected effect of the drug

Why this is the answer

SGLT2 inhibitors block glucose reabsorption in the proximal tubule, so glycosuria is expected even with normal blood glucose. Urine glucose cannot be used to monitor control in these patients. The drugs also raise the risk of genital infections and DKA.Checked against: Ketones blood test · MedlinePlus (NIH) (2025)

Answer

D · An expected effect of the drug
6.Lab values & electrolytes

Answer: A · A low erythropoietin level

Why this is the answer

In polycythemia vera, a marrow mutation (usually JAK2) drives red cell production, so erythropoietin is low. In secondary polycythemia from hypoxia (COPD, high altitude, smoking), erythropoietin is high. Often white cells and platelets are also raised in polycythemia vera.Checked against: Erythropoietin test · MedlinePlus (NIH) (2025); Polycythemia vera · MedlinePlus (NIH) (2025)

Answer

A · A low erythropoietin level
7.Clinical nursing

Answer: C · Do not stop insulin; check glucose and ketones more often

Why this is the answer

Stopping insulin in type 1 diabetes can quickly cause DKA. Patients should continue insulin, monitor glucose and ketones, drink fluids and seek help if ketones rise.

Answer

C · Do not stop insulin; check glucose and ketones more often
8.Clinical nursing

Answer: A · Malignant hyperthermia

Why this is the answer

Malignant hyperthermia is a hypermetabolic reaction triggered by volatile anaesthetics or suxamethonium (succinylcholine) in susceptible people. It is treated urgently with dantrolene, cooling and stopping the trigger.

Answer

A · Malignant hyperthermia
9.Med-surg: cardiovascular & respiratory

Answer: D · Use the reliever inhaler shortly before exercise and warm up

Why this is the answer

A short-acting bronchodilator taken shortly before exercise, a gradual warm-up and covering the mouth in cold air help prevent symptoms. Frequent exercise symptoms may mean asthma is poorly controlled and preventer treatment needs review.

Answer

D · Use the reliever inhaler shortly before exercise and warm up
10.Med-surg: cardiovascular & respiratory

Answer: C · Escalate urgently for review of intubation or a ceiling of care

Why this is the answer

Worsening acidosis and consciousness on NIV mean treatment is failing. Senior review is needed to decide on intubation and ventilation or, if agreed in advance, a ceiling of care. Ideally the plan for NIV failure is documented when NIV is started. Sedation would depress breathing further.

Answer

C · Escalate urgently for review of intubation or a ceiling of care
11.Med-surg: neuro, endocrine & renal

Answer: B · An oral anticoagulant

Why this is the answer

In AF the main cause of stroke is a clot from the left atrium. Oral anticoagulants such as a DOAC or warfarin prevent this far better than antiplatelets. The start date after a stroke depends on its size and bleeding risk.

Answer

B · An oral anticoagulant
12.Med-surg: neuro, endocrine & renal

Answer: D · Weak breathing at night, so a review for ventilation support

Why this is the answer

Weak respiratory muscles cause nocturnal hypoventilation and a rise in CO2, leading to morning headaches, disturbed sleep and daytime drowsiness. Non-invasive ventilation can improve symptoms and survival, in line with the patient's wishes.

Answer

D · Weak breathing at night, so a review for ventilation support
13.Med-surg: GI, perioperative & oncology

Answer: A · They may under-report pain, so active assessment is needed

Why this is the answer

Older adults may minimise pain or have cognitive or sensory problems that hinder reporting. Regular assessment with suitable tools and careful analgesia, starting low and adjusting slowly, are recommended.

Answer

A · They may under-report pain, so active assessment is needed
14.Med-surg: GI, perioperative & oncology

Answer: B · Circumferential chest burns, with breathing becoming shallow and laboured

Why this is the answer

Circumferential full-thickness burns of the chest form rigid eschar that restricts chest expansion and can cause respiratory failure. This patient needs immediate breathing assessment, senior help and possibly urgent escharotomy. The others need care but are not immediately life-threatening.

Answer

B · Circumferential chest burns, with breathing becoming shallow and laboured

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