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 patient is most suitable for the nurse to assign to a nurse who has just finished orientation?

  1. AA patient with stable cellulitis on scheduled IV antibiotics
  2. BA patient with a new tracheostomy who needs frequent suctioning
  3. CA patient on a continuous heparin infusion with rising aPTT values
  4. DA patient with sepsis whose blood pressure is falling
2.Prioritization & delegationHard

A patient rescued from a house fire has burns to the face, singed nasal hair and a hoarse voice. What is the priority?

  1. AStarting IV fluid resuscitation calculated from the burn size
  2. BProtecting the airway, preparing for early airway support
  3. CGiving pain relief
  4. DCleaning and dressing the facial burns
3.Infection control & patient safetyMedium

Which practice with medication vials and syringes is safe?

  1. AUsing the same syringe for two patients if it is flushed
  2. BUsing a new sterile needle and syringe every time a vial is entered
  3. CLeaving a needle in the vial’s stopper for later use
  4. DReusing a syringe if a new needle is attached
4.Infection control & patient safetyHard

Several patients on a ward develop vomiting and diarrhea within two days, and a norovirus outbreak is suspected. What should the nurse do first?

  1. AAsk visitors to bring in bottled water for all patients
  2. BWait for all the stool results to come back before taking any action
  3. CMove the affected patients to different wards so that fewer people are exposed
  4. DNotify the infection prevention team and place affected patients on contact precautions
5.Lab values & electrolytesMedium

A patient had a total thyroidectomy yesterday. Which laboratory value is most important to monitor in the first days after surgery?

  1. ASerum sodium
  2. BSerum potassium
  3. CSerum calcium
  4. DSerum glucose
6.Lab values & electrolytesHard

A patient who had pituitary surgery has fatigue and cold intolerance. The free T4 is low and the TSH is low. What does this pattern suggest?

  1. APrimary hypothyroidism from failure of the thyroid gland
  2. BNormal thyroid function with a laboratory error in T4
  3. CHyperthyroidism from overactivity of the thyroid gland
  4. DSecondary (central) hypothyroidism from pituitary failure
7.Clinical nursingMedium

Modern wound care generally aims to keep a healing wound bed:

  1. ASoaked in antiseptic solution every day
  2. BTightly packed with dry gauze
  3. CCompletely dry and open to the air
  4. DMoist but not wet
8.Clinical nursingHard

A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?

  1. AMedicines reconciliation against reliable sources, such as primary care records
  2. BPrescribing only the medicines that the patient can remember taking
  3. CStopping all regular medicines until the day the patient is discharged
  4. DDoubling the doses to make up for any missed while at home
9.Med-surg: cardiovascular & respiratoryMedium

In heart failure, why does activation of the renin–angiotensin–aldosterone system worsen symptoms over time?

  1. AIt slows the heart rate dangerously
  2. BIt lowers the blood pressure to very low levels over time
  3. CIt makes the kidneys pass too much dilute urine each day
  4. DIt causes sodium and water retention and vasoconstriction
10.Med-surg: cardiovascular & respiratoryHard

Seconds after an intramuscular injection, a patient becomes pale, sweaty and faint, with a heart rate of 48/min. There is no rash, wheeze or swelling, and they recover quickly when laid flat. What is the most likely cause?

  1. AA tension pneumothorax
  2. BA myocardial infarction
  3. CA vasovagal reaction
  4. DAnaphylaxis
11.Med-surg: neuro, endocrine & renalMedium

Which criterion for acute kidney injury (KDIGO) relates to urine output?

  1. ABelow 2 mL/kg/h for 1 hour
  2. BAny change in the colour of the urine
  3. CBelow 0.5 mL/kg/h for 6 hours or more
  4. DBelow 1 L in 24 hours whatever the intake
12.Med-surg: neuro, endocrine & renalHard

A patient on haemodialysis is on a medical ward. Which task can the registered nurse delegate to a healthcare assistant (nursing assistant)?

  1. ATeaching the patient about fluid restriction
  2. BDeciding which morning medicines to hold
  3. CAssessing the thrill and bruit of the fistula
  4. DWeighing the patient before they go to dialysis
13.Med-surg: GI, perioperative & oncologyMedium

A patient on enteral feeding develops diarrhoea. What should the nurse review first?

  1. AThe patient's mobility aids and walking distance
  2. BThe patient's eye drops and skin creams
  3. CThe colour of the feeding bag label
  4. DThe medicine chart, including laxatives and antibiotics
14.Med-surg: GI, perioperative & oncologyHard

Four patients are on a surgical ward. Which patient should the nurse assess first?

  1. ADay 3 after surgery: asking for a laxative for constipation
  2. BStable ileostomy: asking for help to change the pouch
  3. CNeutropenic: temperature normal one hour ago, feels well
  4. DFour hours after bowel surgery: pulse 118/min, BP 90/55 mmHg

3Solutions

1.Prioritization & delegation

Answer: A · A patient with stable cellulitis on scheduled IV antibiotics

Why this is the answer

A newly oriented nurse is best given stable patients with predictable care. The other patients have changing or high-risk conditions that need more experience and close monitoring.

Answer

A · A patient with stable cellulitis on scheduled IV antibiotics
2.Prioritization & delegation

Answer: B · Protecting the airway, preparing for early airway support

Why this is the answer

Singed nasal hair and hoarseness suggest inhalation injury. The upper airway can swell and close within hours, so it is protected early. Fluids, pain relief and wound care follow.

Answer

B · Protecting the airway, preparing for early airway support
3.Infection control & patient safety

Answer: B · Using a new sterile needle and syringe every time a vial is entered

Why this is the answer

Needles and syringes are single-use. A syringe that has been used can contaminate a vial, and outbreaks of hepatitis have been linked to syringe reuse. Single-dose vials are used for one patient, and multi-dose vials are dedicated to one patient when possible.

Answer

B · Using a new sterile needle and syringe every time a vial is entered
4.Infection control & patient safety

Answer: D · Notify the infection prevention team and place affected patients on contact precautions

Why this is the answer

Early reporting lets infection prevention organize testing, cohorting, closing of the ward if needed, cleaning with suitable agents and soap-and-water hand hygiene. Moving patients around can spread the outbreak.

Answer

D · Notify the infection prevention team and place affected patients on contact precautions
5.Lab values & electrolytes

Answer: C · Serum calcium

Why this is the answer

The parathyroid glands can be injured or removed during thyroidectomy, so parathyroid hormone falls and hypocalcemia can follow. The nurse monitors calcium and checks for tingling around the mouth, muscle cramps and Chvostek or Trousseau signs.Checked against: Hypoparathyroidism · MedlinePlus (NIH) (2026)

Answer

C · Serum calcium
6.Lab values & electrolytes

Answer: D · Secondary (central) hypothyroidism from pituitary failure

Why this is the answer

In primary hypothyroidism, a low T4 causes a high TSH. A low T4 with a low or inappropriately normal TSH means the pituitary (or hypothalamus) is not producing enough TSH, so the TSH cannot be used alone to monitor treatment.Checked against: Thyroxine (T4) Test · MedlinePlus (NIH) (2024); Hypothyroidism · MedlinePlus (NIH) (2024)

Answer

D · Secondary (central) hypothyroidism from pituitary failure
7.Clinical nursing

Answer: D · Moist but not wet

Why this is the answer

A moist wound environment speeds epithelial cell migration and healing. Too much moisture causes maceration, so dressings are chosen to manage exudate.

Answer

D · Moist but not wet
8.Clinical nursing

Answer: A · Medicines reconciliation against reliable sources, such as primary care records

Why this is the answer

Medicines reconciliation compares several sources to produce an accurate medication list. It finds omissions, duplications and errors, and is especially important in older people with polypharmacy.

Answer

A · Medicines reconciliation against reliable sources, such as primary care records
9.Med-surg: cardiovascular & respiratory

Answer: D · It causes sodium and water retention and vasoconstriction

Why this is the answer

Reduced cardiac output activates RAAS and the sympathetic system. Angiotensin II constricts vessels (raising afterload) and aldosterone retains sodium and water (raising preload and congestion). ACE inhibitors, ARBs, mineralocorticoid antagonists and beta-blockers block these harmful loops.

Answer

D · It causes sodium and water retention and vasoconstriction
10.Med-surg: cardiovascular & respiratory

Answer: C · A vasovagal reaction

Why this is the answer

Vasovagal reactions cause bradycardia, pallor, sweating and fainting, and resolve quickly when lying flat. Anaphylaxis usually causes tachycardia, airway or breathing problems and often skin changes, and does not settle on its own. If in doubt, treat as anaphylaxis.

Answer

C · A vasovagal reaction
11.Med-surg: neuro, endocrine & renal

Answer: C · Below 0.5 mL/kg/h for 6 hours or more

Why this is the answer

KDIGO defines AKI as a creatinine rise of ≥26.5 µmol/L (0.3 mg/dL) within 48 hours, a rise to ≥1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours. Accurate fluid balance charts are therefore essential.

Answer

C · Below 0.5 mL/kg/h for 6 hours or more
12.Med-surg: neuro, endocrine & renal

Answer: D · Weighing the patient before they go to dialysis

Why this is the answer

Weighing a patient is a routine task suitable for a trained assistant. Assessing the access, making medication decisions and teaching require the registered nurse's knowledge and judgement.

Answer

D · Weighing the patient before they go to dialysis
13.Med-surg: GI, perioperative & oncology

Answer: D · The medicine chart, including laxatives and antibiotics

Why this is the answer

Diarrhoea on enteral feeds is often caused by drugs such as antibiotics, laxatives and liquid medicines containing sorbitol, or by infection such as C. difficile. The feed is not stopped automatically; the cause is investigated.

Answer

D · The medicine chart, including laxatives and antibiotics
14.Med-surg: GI, perioperative & oncology

Answer: D · Four hours after bowel surgery: pulse 118/min, BP 90/55 mmHg

Why this is the answer

Tachycardia with hypotension early after surgery suggests haemorrhage or sepsis and needs immediate assessment and escalation. The other patients are stable at present, although the neutropenic patient still needs regular monitoring.

Answer

D · Four hours after bowel surgery: pulse 118/min, BP 90/55 mmHg

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