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 with asthma has two inhalers: a corticosteroid and salbutamol (albuterol). Which statement shows a need for further teaching?

  1. A“I will use my steroid inhaler every day, even when I feel well.”
  2. B“I will rinse my mouth after using the steroid inhaler.”
  3. C“I will carry my salbutamol inhaler with me.”
  4. D“I will use my steroid inhaler when I have a sudden attack.”
2.Prioritization & delegationHard

A patient taking an MAO inhibitor antidepressant is taught about diet. Which statement shows a need for further teaching?

  1. A“I will avoid tap beer and red wine.”
  2. B“I can still eat aged cheese and cured salami.”
  3. C“A sudden severe headache is a warning sign.”
  4. D“I will check with the pharmacist before cold remedies.”
3.Infection control & patient safetyMedium

Which patient has the highest risk of a burn from a heating pad?

  1. AA patient with a sprained wrist who is fully alert
  2. BA healthy young adult with a strained muscle
  3. CA patient with diabetic peripheral neuropathy
  4. DA patient recovering from a cold
4.Infection control & patient safetyHard

Which position is especially dangerous for a patient in physical restraints?

  1. ALying on the back with the head raised
  2. BLying on the side
  3. CSitting upright in bed
  4. DLying face down (prone)
5.Lab values & electrolytesMedium

A patient has weight loss, tremor and heat intolerance. Which thyroid test pattern fits Graves disease?

  1. AHigh TSH with a normal free T4
  2. BLow TSH with a high free T4
  3. CHigh TSH with a low free T4
  4. DNormal TSH with a low free T4
6.Lab values & electrolytesHard

A patient has a hemoglobin of 11.2 g/dL (112 g/L), an MCV of 64 fL, a normal ferritin and a normal-to-high red cell count. What is the most likely cause?

  1. AIron deficiency
  2. BAcute blood loss
  3. CThalassemia trait
  4. DVitamin B12 deficiency
7.Clinical nursingMedium

Why is serum lactate measured in a patient with suspected sepsis?

  1. AA raised lactate indicates poor tissue perfusion and higher risk
  2. BIt measures the patient's blood glucose
  3. CIt shows whether the patient has a urinary tract infection
  4. DIt confirms which antibiotic to give
8.Clinical nursingHard

A patient with cirrhosis and a large tense abdomen undergoes paracentesis. Why may albumin be given?

  1. ATo increase urine potassium
  2. BTo stop the liver making more bile
  3. CTo reduce the risk of circulatory dysfunction after large-volume fluid removal
  4. DTo treat infection in the fluid
9.Med-surg: cardiovascular & respiratoryMedium

Which investigation is most often used to confirm a pulmonary embolism?

  1. ACT pulmonary angiography
  2. BPeak flow measurement
  3. CSputum culture
  4. DAbdominal ultrasound
10.Med-surg: cardiovascular & respiratoryHard

Which method best confirms that an endotracheal tube is in the trachea?

  1. AMisting inside the tube
  2. BThe patient's skin colour improving
  3. CThe chest rising on one side only
  4. DA sustained waveform on capnography
11.Med-surg: neuro, endocrine & renalMedium

In the first trimester of pregnancy, why is propylthiouracil often preferred to carbimazole for hyperthyroidism?

  1. APropylthiouracil works faster than any other drug
  2. BCarbimazole cannot cross into the mother's blood
  3. CCarbimazole has a higher risk of birth defects early on
  4. DPropylthiouracil has no side effects at all
12.Med-surg: neuro, endocrine & renalHard

During an alteplase infusion for stroke, the patient develops a severe headache, vomiting and a falling GCS. What should the nurse do first?

  1. AGive a sedative to settle the patient and continue
  2. BGive an antiemetic and recheck the GCS in an hour's time
  3. CSpeed up the infusion so that it finishes sooner
  4. DStop the infusion and call the stroke team urgently
13.Med-surg: GI, perioperative & oncologyMedium

Which presentation fits acute diverticulitis?

  1. ARight upper abdominal pain after fatty meals
  2. BPainless jaundice with a palpable gallbladder
  3. CLeft lower abdominal pain, fever and a raised CRP
  4. DCentral chest pain spreading to the left arm
14.Med-surg: GI, perioperative & oncologyHard

A patient with cirrhosis and ascites has a new fever, abdominal tenderness and worsening confusion. Which complication should be suspected?

  1. ANormal progression of ascites
  2. BSpontaneous bacterial peritonitis
  3. CAcute pancreatitis
  4. DSimple constipation

3Solutions

1.Prioritization & delegation

Answer: D · “I will use my steroid inhaler when I have a sudden attack.”

Why this is the answer

Inhaled corticosteroids reduce inflammation over time and do not relieve an acute attack. Salbutamol (albuterol) is the quick-relief inhaler; rinsing after steroids helps prevent oral thrush.

Answer

D · “I will use my steroid inhaler when I have a sudden attack.”
2.Prioritization & delegation

Answer: B · “I can still eat aged cheese and cured salami.”

Why this is the answer

MAO inhibitors with tyramine-rich foods, such as aged cheese and cured meats, can cause a hypertensive crisis. Patients avoid these foods, check medicines with a pharmacist and report a severe headache.

Answer

B · “I can still eat aged cheese and cured salami.”
3.Infection control & patient safety

Answer: C · A patient with diabetic peripheral neuropathy

Why this is the answer

Reduced sensation, as in peripheral neuropathy, prevents a person from feeling heat damage. Patients with poor sensation, poor circulation or confusion need very close monitoring if heat is used at all.

Answer

C · A patient with diabetic peripheral neuropathy
4.Infection control & patient safety

Answer: D · Lying face down (prone)

Why this is the answer

Restraining a person face down can restrict breathing and has caused deaths from positional asphyxia. Restrained patients are positioned to protect the airway and are watched closely.

Answer

D · Lying face down (prone)
5.Lab values & electrolytes

Answer: B · Low TSH with a high free T4

Why this is the answer

In Graves disease, antibodies stimulate the thyroid to make too much hormone. The high free T4 suppresses TSH from the pituitary through negative feedback, so TSH is low. A high TSH with a low T4 fits primary hypothyroidism.Checked against: TSH test · MedlinePlus (NIH) (2026); Thyroxine (T4) Test · MedlinePlus (NIH) (2024); Graves disease · MedlinePlus (NIH) (2026)

Answer

B · Low TSH with a high free T4
6.Lab values & electrolytes

Answer: C · Thalassemia trait

Why this is the answer

Thalassemia trait causes microcytosis from reduced globin production, often with a normal or high red cell count and normal ferritin. Iron deficiency has low ferritin. Iron supplements do not help thalassemia trait and can cause iron overload.Checked against: Thalassemia - Medical Encyclopedia · MedlinePlus (NIH) (2026); Red Blood Cell (RBC) Indices · MedlinePlus (NIH) (2024)

Answer

C · Thalassemia trait
7.Clinical nursing

Answer: A · A raised lactate indicates poor tissue perfusion and higher risk

Why this is the answer

Lactate rises when tissues are poorly perfused. A high lactate in sepsis signals greater severity and is used to guide fluid resuscitation.

Answer

A · A raised lactate indicates poor tissue perfusion and higher risk
8.Clinical nursing

Answer: C · To reduce the risk of circulatory dysfunction after large-volume fluid removal

Why this is the answer

Large-volume paracentesis can cause hypotension and renal impairment. Albumin infusion helps maintain the circulating volume.

Answer

C · To reduce the risk of circulatory dysfunction after large-volume fluid removal
9.Med-surg: cardiovascular & respiratory

Answer: A · CT pulmonary angiography

Why this is the answer

CT pulmonary angiography (CTPA) shows filling defects in the pulmonary arteries. It uses iodinated contrast, so renal function and contrast allergy are checked. A ventilation–perfusion (V/Q) scan is an alternative, for example in pregnancy or renal impairment.

Answer

A · CT pulmonary angiography
10.Med-surg: cardiovascular & respiratory

Answer: D · A sustained waveform on capnography

Why this is the answer

A sustained exhaled carbon dioxide waveform confirms tracheal placement. Misting and chest movement can be misleading, and skin colour changes late. A chest X-ray shows the depth of the tube but does not prove it is in the trachea.

Answer

D · A sustained waveform on capnography
11.Med-surg: neuro, endocrine & renal

Answer: C · Carbimazole has a higher risk of birth defects early on

Why this is the answer

Carbimazole is linked to congenital abnormalities when used in early pregnancy, so propylthiouracil is often used in the first trimester. Propylthiouracil can cause serious liver injury, so it is not preferred at other times.

Answer

C · Carbimazole has a higher risk of birth defects early on
12.Med-surg: neuro, endocrine & renal

Answer: D · Stop the infusion and call the stroke team urgently

Why this is the answer

New headache, vomiting, hypertension or neurological deterioration during or after thrombolysis may indicate symptomatic intracranial haemorrhage. The infusion is stopped, urgent medical review arranged and an urgent CT scan and coagulation tests anticipated.

Answer

D · Stop the infusion and call the stroke team urgently
13.Med-surg: GI, perioperative & oncology

Answer: C · Left lower abdominal pain, fever and a raised CRP

Why this is the answer

Diverticulitis usually causes left iliac fossa pain and tenderness with fever, raised inflammatory markers and a change in bowel habit. CT confirms the diagnosis and shows complications such as abscess.

Answer

C · Left lower abdominal pain, fever and a raised CRP
14.Med-surg: GI, perioperative & oncology

Answer: B · Spontaneous bacterial peritonitis

Why this is the answer

Spontaneous bacterial peritonitis is infection of ascitic fluid without an obvious source. It can present with fever, abdominal pain, encephalopathy or kidney injury. A diagnostic ascitic tap (neutrophil count) and prompt antibiotics are needed.

Answer

B · Spontaneous bacterial peritonitis

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