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 with asthma uses a peak flow meter. A reading below 50% of personal best is in the red zone. Which statement shows correct understanding?
- A“I will wait until tomorrow morning to see if the reading gets better on its own.”
- B“I will go for a short run to open up my lungs.”
- C“I will use my reliever inhaler and get emergency help straight away.”
- D“I will stop all my inhalers until the reading is back up.”
2.Prioritization & delegationHard
A patient is admitted with inhalational anthrax. Which precautions are needed?
- AStandard precautions, because it does not usually spread from person to person
- BAirborne precautions in a negative-pressure room for the whole of the hospital stay
- CFull contact and droplet precautions for all staff and visitors on the unit
- DDroplet precautions with a surgical mask for everyone who enters
3.Infection control & patient safetyMedium
A parent says, “I tell my son his medicine is candy so he takes it.” What should the nurse teach?
- AIt only matters for medicines that taste bitter or are hard to swallow
- BIt is fine as long as the medicine is kept in the fridge
- CThis is a good idea and makes giving medicine easier
- DDo not call medicine candy, because the child may take it when no one is watching
4.Infection control & patient safetyHard
A nurse teaches a patient with neutropenia about preventing infection at home. Which statement shows a need for further teaching?
- A“I can clean the cat’s litter box if I wear a face mask.”
- B“I will avoid crowds and people who have colds.”
- C“I will check my temperature and call if I have a fever.”
- D“I will wash my hands often and ask visitors to do the same.”
5.Lab values & electrolytesMedium
Before giving prescribed IV potassium chloride, which assessment is most important?
- AUrine output and kidney function
- BHearing in both ears
- CPupil size and reaction to light
- DSkin turgor on the forearm
6.Lab values & electrolytesHard
Four drug levels are reported. Which patient should the nurse assess first?
- AValproate 75 mcg/mL with no symptoms
- BDigoxin 1.0 ng/mL with a pulse of 72/min
- CLithium 1.8 mEq/L with a new coarse tremor
- DPhenytoin 15 mcg/mL with no symptoms
7.Clinical nursingMedium
A patient with heart failure has pink, frothy sputum and crackles throughout both lungs. What is happening?
- AAcute pulmonary oedema
- BUpper gastrointestinal bleeding
- CPneumothorax
- DAsthma attack
8.Clinical nursingHard
A patient with acute pancreatitis is in severe epigastric pain radiating to the back. Which nursing care is most important?
- ARestricting all fluids
- BAdequate pain relief, IV fluids and close fluid balance monitoring
- CA large fatty meal to stimulate the pancreas
- DStrict bed rest without observations
9.Med-surg: cardiovascular & respiratoryMedium
How can a patient reduce wound pain when coughing after abdominal surgery?
- AHold a pillow firmly against the wound while coughing
- BLie flat on the back with the legs straight
- CHold the breath for as long as possible
- DAvoid coughing completely until all the stitches are removed
10.Med-surg: cardiovascular & respiratoryHard
Four surgical patients need VTE prevention. For which patient is mechanical prophylaxis alone most appropriate?
- AA patient after an uncomplicated knee replacement
- BA patient with cancer having bowel surgery
- CA patient who had a brain haemorrhage two days ago
- DAn obese patient after hip surgery
11.Med-surg: neuro, endocrine & renalMedium
An 82-year-old taking apixaban fell three weeks ago. Since then their family has noticed increasing confusion and headaches. Which condition is most likely?
- ANormal ageing with mild memory loss
- BAcute extradural haematoma
- CSubarachnoid haemorrhage from an aneurysm
- DChronic subdural haematoma
12.Med-surg: neuro, endocrine & renalHard
A man with chronic urinary retention is catheterised. Over the next hours he passes very large volumes of urine. What is the main nursing concern?
- AFluid and electrolyte loss from post-obstructive diuresis
- BRupture of the bladder from the catheter
- CA rise in blood glucose from the urine
- DA urinary infection caused by the high flow of urine
13.Med-surg: GI, perioperative & oncologyMedium
How should pancreatic enzyme replacement capsules usually be taken?
- AOnce a day at bedtime
- BWith every meal and snack
- COne hour after meals, on an empty stomach
- DOnly on days with abdominal pain
14.Med-surg: GI, perioperative & oncologyHard
A patient with lung cancer develops facial swelling, distended neck veins and breathlessness that worsens when lying down. Which emergency is likely?
- ASuperior vena cava obstruction
- BMassive pulmonary embolism
- CSpinal cord compression
- DHypercalcaemia of malignancy
3Solutions
1.Prioritization & delegation
Answer: C · “I will use my reliever inhaler and get emergency help straight away.”
Why this is the answer
A red-zone reading means a severe flare. The patient uses their quick-relief inhaler as in their action plan and seeks emergency care at once.
C · “I will use my reliever inhaler and get emergency help straight away.”
2.Prioritization & delegation
Answer: A · Standard precautions, because it does not usually spread from person to person
Why this is the answer
Inhalational anthrax is not spread from person to person, so standard precautions are used. Contact precautions may be added for skin (cutaneous) anthrax with draining lesions.
A · Standard precautions, because it does not usually spread from person to person
3.Infection control & patient safety
Answer: D · Do not call medicine candy, because the child may take it when no one is watching
Why this is the answer
Calling medicine candy encourages children to look for it and swallow it, which can lead to poisoning. Parents are taught to call medicine medicine and keep it locked away.
D · Do not call medicine candy, because the child may take it when no one is watching
4.Infection control & patient safety
Answer: A · “I can clean the cat’s litter box if I wear a face mask.”
Why this is the answer
Immunocompromised patients should avoid cleaning litter boxes and other animal waste, because of organisms such as Toxoplasma. Another person should do it. The other statements are correct.
A · “I can clean the cat’s litter box if I wear a face mask.”
5.Lab values & electrolytes
Answer: A · Urine output and kidney function
Why this is the answer
The kidneys excrete potassium, so poor urine output or kidney failure can lead to dangerous hyperkalemia during replacement. IV potassium is always diluted and given by infusion pump, never as an IV push.Checked against: High potassium level · MedlinePlus (NIH) (2025)
A · Urine output and kidney function
6.Lab values & electrolytes
Answer: C · Lithium 1.8 mEq/L with a new coarse tremor
Why this is the answer
A lithium level of 1.8 mEq/L with a coarse tremor suggests toxicity, which can progress to confusion and seizures. The digoxin, phenytoin and valproate levels are within commonly cited ranges and the patients are stable.
C · Lithium 1.8 mEq/L with a new coarse tremor
7.Clinical nursing
Answer: A · Acute pulmonary oedema
Why this is the answer
Acute pulmonary oedema causes severe breathlessness, crackles and frothy sputum. Sit the patient up, give oxygen and call urgently for medical help; diuretics are commonly given.
A · Acute pulmonary oedema
8.Clinical nursing
Answer: B · Adequate pain relief, IV fluids and close fluid balance monitoring
Why this is the answer
Acute pancreatitis can cause large fluid losses and organ failure. Care focuses on fluid resuscitation, analgesia, monitoring urine output, glucose and early nutrition when possible.
B · Adequate pain relief, IV fluids and close fluid balance monitoring
9.Med-surg: cardiovascular & respiratory
Answer: A · Hold a pillow firmly against the wound while coughing
Why this is the answer
Splinting the incision with a pillow or folded towel supports the wound, reduces pain and makes effective coughing easier. Combined with good analgesia and deep breathing, this helps clear secretions and prevents atelectasis and pneumonia.
A · Hold a pillow firmly against the wound while coughing
10.Med-surg: cardiovascular & respiratory
Answer: C · A patient who had a brain haemorrhage two days ago
Why this is the answer
When bleeding risk is high, such as after recent intracranial haemorrhage, mechanical methods (intermittent pneumatic compression) are used instead of anticoagulants until it is safe. The other patients are at high VTE risk and would usually receive pharmacological prophylaxis unless contraindicated.
C · A patient who had a brain haemorrhage two days ago
11.Med-surg: neuro, endocrine & renal
Answer: D · Chronic subdural haematoma
Why this is the answer
Older people have brain atrophy that stretches the bridging veins, and anticoagulants increase bleeding. A slow venous bleed can cause gradual confusion, headache or weakness over weeks. A CT scan is needed.
D · Chronic subdural haematoma
12.Med-surg: neuro, endocrine & renal
Answer: A · Fluid and electrolyte loss from post-obstructive diuresis
Why this is the answer
After relief of chronic obstruction, the kidneys may pass large volumes of urine and salt. Hypovolaemia and electrolyte problems can follow. Strict fluid balance, blood pressure checks and electrolyte monitoring are needed.
A · Fluid and electrolyte loss from post-obstructive diuresis
13.Med-surg: GI, perioperative & oncology
Answer: B · With every meal and snack
Why this is the answer
Pancreatic enzymes digest fat, protein and carbohydrate, so they are taken with meals and snacks. The dose is adjusted to reduce steatorrhoea and support weight gain.
B · With every meal and snack
14.Med-surg: GI, perioperative & oncology
Answer: A · Superior vena cava obstruction
Why this is the answer
A tumour can compress or invade the superior vena cava, causing facial and arm swelling, dilated chest veins, headache and breathlessness. The patient is sat up and urgently reviewed; treatment includes steroids, stenting and radiotherapy or chemotherapy.
A · Superior vena cava obstruction
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