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 finding is an early sign of compartment syndrome in a patient with a lower leg fracture?

  1. AA strong pedal pulse with warm, pink toes and pain that settles with analgesia
  2. BItching under the cast during the first week after it was applied
  3. CPain out of proportion to the injury that worsens when the toes are stretched
  4. DMild bruising around the fracture site on the second day
2.Prioritization & delegationHard

An adult choking on food is coughing forcefully and can speak a little. What should the nurse do?

  1. ASweep the mouth blindly with a finger
  2. BGive abdominal thrusts straight away until the food comes out
  3. CGive the patient water to wash the food down
  4. DEncourage the patient to keep coughing and stay with them
3.Infection control & patient safetyMedium

Which patient safety measure is most appropriate for a patient with a latex allergy?

  1. AUsing latex gloves and washing hands well afterwards
  2. BUsing latex-free equipment and documenting the allergy clearly
  3. CUsing powdered latex gloves only
  4. DAvoiding all gloves during patient care
4.Infection control & patient safetyHard

During a sterile central line dressing change, a colleague reaches across the open sterile field to pass the nurse a roll of tape. What should the nurse do?

  1. ACover the field with a sterile towel and continue on top of it
  2. BTreat the field as contaminated and set up a new one
  3. CContinue, because the colleague did not touch any sterile item
  4. DRemove only the items nearest to where the arm passed over
5.Lab values & electrolytesMedium

A patient with hyperkalemia is prescribed an oral potassium binder such as patiromer or sodium zirconium cyclosilicate. How does this drug lower potassium?

  1. AIt stops the kidneys from absorbing water in the tubules
  2. BIt moves potassium into cells in the next few minutes
  3. CIt binds potassium in the gut so it leaves in the stool
  4. DIt protects the heart muscle against high potassium levels
6.Lab values & electrolytesHard

A patient without symptoms has a finger-stick glucose of 340 mg/dL (18.9 mmol/L). The previous values were normal, and the patient has just peeled an orange. What should the nurse do first?

  1. AGive a correction dose of insulin for a glucose of 340 mg/dL
  2. BHave the patient wash and dry their hands, then repeat the test
  3. CReport the result as a new diagnosis of diabetes mellitus
  4. DAsk the laboratory to measure HbA1c from the same drop of blood
7.Clinical nursingMedium

A patient with renal colic is asked to pass urine through a strainer. Why?

  1. ATo remove bacteria from the urine
  2. BTo make passing urine less painful
  3. CTo catch any stone so that it can be analysed
  4. DTo measure the urine's pH and specific gravity
8.Clinical nursingHard

In a patient with a head injury, which is usually the earliest sign of rising intracranial pressure?

  1. AA change in level of consciousness
  2. BA slow pulse with high blood pressure
  3. CIrregular breathing pauses
  4. DA fixed, dilated pupil on both sides
9.Med-surg: cardiovascular & respiratoryMedium

A patient with hypertension takes amlodipine. Which side effect is the nurse most likely to observe?

  1. AAnkle swelling
  2. BWheeze
  3. CDry, tickly cough
  4. DHyperkalaemia
10.Med-surg: cardiovascular & respiratoryHard

During tracheal suctioning, a patient's heart rate drops from 88/min to 48/min. What should the nurse do?

  1. AGive a dose of atropine without a prescription
  2. BContinue suctioning until the airway is completely clear
  3. CIncrease the suction pressure to finish faster
  4. DStop suctioning, give oxygen and monitor the patient
11.Med-surg: neuro, endocrine & renalMedium

A patient's potassium stays low despite replacement. Which other level should be checked?

  1. AFerritin
  2. BMagnesium
  3. CAmylase
  4. DBilirubin
12.Med-surg: neuro, endocrine & renalHard

A patient with raised intracranial pressure needs endotracheal suctioning. Which approach is most appropriate?

  1. ASuction every 15 minutes as a routine, even without secretions
  2. BSuction for at least 30 seconds to clear all secretions at once
  3. CPre-oxygenate, keep each pass short and limit the number of passes
  4. DLie the patient flat with the head turned during suctioning
13.Med-surg: GI, perioperative & oncologyMedium

Which diet is usually recommended for a patient with cirrhosis and hepatic encephalopathy?

  1. ANormal protein and enough calories, with a late-evening snack
  2. BOnly clear fluids for several weeks
  3. CA very low-protein diet for the rest of their life to lower ammonia
  4. DNo food at all until the confusion settles
14.Med-surg: GI, perioperative & oncologyHard

Four hours after surgery, a catheterised patient's urine output has been 10 mL/h for two hours. Vital signs are stable. What should the nurse check first?

  1. AWhether the patient wants a cup of tea
  2. BThe time the patient last ate
  3. CThat the catheter and tubing are not kinked or blocked
  4. DYesterday's chest X-ray and blood gas results

3Solutions

1.Prioritization & delegation

Answer: C · Pain out of proportion to the injury that worsens when the toes are stretched

Why this is the answer

The earliest sign is severe pain that is not relieved by usual analgesia and worsens on passive stretch. Loss of pulse is a late sign, so the nurse reports pain early.

Answer

C · Pain out of proportion to the injury that worsens when the toes are stretched
2.Prioritization & delegation

Answer: D · Encourage the patient to keep coughing and stay with them

Why this is the answer

A partial obstruction with a forceful cough is best cleared by the patient’s own coughing. The nurse stays and is ready to act if the cough becomes weak or the patient cannot speak or breathe.

Answer

D · Encourage the patient to keep coughing and stay with them
3.Infection control & patient safety

Answer: B · Using latex-free equipment and documenting the allergy clearly

Why this is the answer

The allergy is documented and the patient wears an allergy band. Latex-free gloves, catheters and other equipment are used, and the room may be cleared of latex products. Powdered latex gloves are especially risky because the powder carries the protein into the air.

Answer

B · Using latex-free equipment and documenting the allergy clearly
4.Infection control & patient safety

Answer: B · Treat the field as contaminated and set up a new one

Why this is the answer

Reaching across a sterile field with non-sterile arms or items contaminates it, even without touching. The field is replaced, and non-sterile items are passed around the field, not over it. When sterility is in doubt, the field is treated as contaminated.

Answer

B · Treat the field as contaminated and set up a new one
5.Lab values & electrolytes

Answer: C · It binds potassium in the gut so it leaves in the stool

Why this is the answer

Potassium binders exchange potassium in the gut for another ion, so potassium is removed from the body in the stool. They act over hours, so they are not used alone for emergencies; calcium protects the heart, and insulin with glucose shifts potassium into cells quickly.Checked against: High potassium level · MedlinePlus (NIH) (2025)

Answer

C · It binds potassium in the gut so it leaves in the stool
6.Lab values & electrolytes

Answer: B · Have the patient wash and dry their hands, then repeat the test

Why this is the answer

Sugar residue on the fingers can give a falsely high finger-stick result. The hands are washed with soap and water and dried, and the test repeated. If the value is still high, it is confirmed and reported. Treating a false result could cause hypoglycemia.

Answer

B · Have the patient wash and dry their hands, then repeat the test
7.Clinical nursing

Answer: C · To catch any stone so that it can be analysed

Why this is the answer

Collecting a passed stone allows its composition to be identified, which helps guide diet and treatment to prevent recurrence.

Answer

C · To catch any stone so that it can be analysed
8.Clinical nursing

Answer: A · A change in level of consciousness

Why this is the answer

Subtle changes in consciousness, such as restlessness, confusion or a falling GCS, are often the first signs. Pupil changes and Cushing's triad (hypertension, bradycardia, irregular breathing) are late signs.

Answer

A · A change in level of consciousness
9.Med-surg: cardiovascular & respiratory

Answer: A · Ankle swelling

Why this is the answer

Dihydropyridine calcium channel blockers such as amlodipine dilate arterioles, raising capillary pressure and causing peripheral oedema, flushing and headache. Dry cough is typical of ACE inhibitors, and wheeze of non-selective beta-blockers in asthma.

Answer

A · Ankle swelling
10.Med-surg: cardiovascular & respiratory

Answer: D · Stop suctioning, give oxygen and monitor the patient

Why this is the answer

Suctioning can cause hypoxaemia and vagal stimulation, leading to bradycardia and arrhythmias. The nurse stops, gives oxygen and observes. Each pass should be short (usually no more than about 10–15 seconds), with pre-oxygenation if needed.

Answer

D · Stop suctioning, give oxygen and monitor the patient
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.

Answer

B · Magnesium
12.Med-surg: neuro, endocrine & renal

Answer: C · Pre-oxygenate, keep each pass short and limit the number of passes

Why this is the answer

Suctioning raises ICP through coughing, hypoxia and hypercapnia. It is done only when needed, with pre-oxygenation, passes of no more than about 10–15 seconds, few passes and the head kept elevated and midline. Sedation or lidocaine may be used in some units.

Answer

C · Pre-oxygenate, keep each pass short and limit the number of passes
13.Med-surg: GI, perioperative & oncology

Answer: A · Normal protein and enough calories, with a late-evening snack

Why this is the answer

Protein restriction worsens malnutrition and muscle loss and is no longer routinely advised. Adequate protein and energy, small frequent meals and a late-evening snack are recommended.

Answer

A · Normal protein and enough calories, with a late-evening snack
14.Med-surg: GI, perioperative & oncology

Answer: C · That the catheter and tubing are not kinked or blocked

Why this is the answer

A sudden low output may be due to a kinked tube or blocked catheter. If drainage is normal, hypovolaemia or kidney injury is considered and the team is informed, with a fluid assessment.

Answer

C · That the catheter and tubing are not kinked or blocked

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