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

A patient on a medical unit tells the nurse he has a plan to end his life and has saved tablets at home. What is the priority action?

  1. AAsk him to promise he will not harm himself
  2. BArrange a psychiatry appointment for next week
  3. CReassure him that things usually look better in the morning after some sleep
  4. DEnsure constant observation and remove anything he could use to harm himself
2.Prioritization & delegationHard

During START triage, a non-walking adult breathes 24 times a minute, has a radial pulse, but cannot follow simple commands. Which category is the victim given?

  1. ARed (immediate)
  2. BGreen (minor)
  3. CYellow (delayed)
  4. DBlack (expectant)
3.Infection control & patient safetyMedium

The laboratory calls with a critical lab result by phone. What should the nurse do?

  1. ATell the patient the result first and then call the provider
  2. BWait for the printed report to arrive before telling the provider about it
  3. CRemember the value and enter it in the chart at the end of the shift
  4. DWrite it down, read it back to confirm and report it to the provider promptly
4.Infection control & patient safetyHard

A nurse finds an unknown liquid leaking from a container in the utility room, with a strong smell. What should the nurse do first?

  1. APour water over it to dilute it
  2. BMop it up with paper towels
  3. CMove closer and smell it carefully to identify what the substance is
  4. DLeave the area, keep others out and alert the trained response team
5.Lab values & electrolytesMedium

A week after a splenectomy, a patient's platelet count is 650 × 10³/µL. What is the best interpretation?

  1. AA laboratory error, because platelets fall after splenectomy
  2. BAn expected rise after splenectomy that increases clot risk
  3. CA sign of new leukemia that needs immediate chemotherapy
  4. DA sign of iron overload from the surgery and transfusion
6.Lab values & electrolytesHard

A patient with a new deep vein thrombosis is on a heparin infusion, and warfarin has just been started. Why is the heparin continued for several days?

  1. AWarfarin takes several days to reach its full anticoagulant effect
  2. BHeparin increases the absorption of warfarin from the gut
  3. CHeparin prevents the side effects of warfarin
  4. DWarfarin only works when heparin is given at the same time
7.Clinical nursingMedium

A patient started on an ACE inhibitor develops a persistent dry cough. What is the likely cause?

  1. AA recognised side effect of the ACE inhibitor
  2. BAn allergic reaction to a recently given penicillin
  3. CAsthma caused by a beta-blocker
  4. DPulmonary embolism
8.Clinical nursingHard

A patient with poorly controlled hyperthyroidism develops a high fever, very fast heart rate, agitation and vomiting during an infection. What is likely?

  1. AThyroid storm
  2. BAddisonian crisis
  3. CHypoglycaemia
  4. DMyxoedema coma
9.Med-surg: cardiovascular & respiratoryMedium

Which position is usually best for the legs of a patient with chronic venous insufficiency and ankle swelling?

  1. ARaised above the level of the heart when resting
  2. BCrossed at the knees while sitting
  3. CHanging down over the side of the bed
  4. DKept still in a standing position for long periods
10.Med-surg: cardiovascular & respiratoryHard

A patient with a valid, documented do-not-attempt-CPR decision (DNACPR in the UK, DNR or DNAR in the US) is found in cardiac arrest. What should the nurse do?

  1. AStart full CPR because the patient's family is not present
  2. BNot start CPR, call for support, and provide dignity and comfort
  3. CCall the arrest team and let them decide whether to resuscitate
  4. DStart CPR but use only chest compressions
11.Med-surg: neuro, endocrine & renalMedium

Which statement about long-acting basal insulin such as glargine is correct?

  1. AIn type 1 diabetes it is continued even when the patient is not eating
  2. BIt has a sharp peak in action about 30 minutes after injection
  3. CIt is given only after large meals to cover the carbohydrate
  4. DIt is mixed with rapid-acting insulin in the same syringe
12.Med-surg: neuro, endocrine & renalHard

A patient with Parkinson's disease is nil by mouth after abdominal surgery. Their levodopa is due. What is the best action?

  1. AGive double the dose once eating restarts
  2. BOmit the dose until the patient can swallow again
  3. CContact the prescriber or pharmacist about another route
  4. DGive the tablets with a sip of water anyway
13.Med-surg: GI, perioperative & oncologyMedium

How should a patient use an incentive spirometer after surgery?

  1. ABreathe quickly in and out ten times in a row
  2. BBreathe in slowly and deeply, then hold briefly
  3. CUse it once a day, just before going to sleep at night
  4. DBlow out as hard and as fast as possible
14.Med-surg: GI, perioperative & oncologyHard

Which history should most alert the nurse to a possible latex allergy before surgery?

  1. AA rash after taking amoxicillin as a child, with a family history of asthma
  2. BHay fever every spring since childhood
  3. CFeeling sick after eating shellfish once
  4. DItching with bananas, avocado and kiwi, and many operations

3Solutions

1.Prioritization & delegation

Answer: D · Ensure constant observation and remove anything he could use to harm himself

Why this is the answer

A patient with a plan and means is at high risk. Safety comes first: constant observation, removal of means and urgent referral. A “no-harm promise” does not protect the patient.

Answer

D · Ensure constant observation and remove anything he could use to harm himself
2.Prioritization & delegation

Answer: A · Red (immediate)

Why this is the answer

A victim who fails the mental status check (cannot follow simple commands) is immediate, even when breathing and perfusion are acceptable. This may signal a head injury or shock.

Answer

A · Red (immediate)
3.Infection control & patient safety

Answer: D · Write it down, read it back to confirm and report it to the provider promptly

Why this is the answer

Writing down and reading back critical results confirms they were heard correctly. The nurse then reports them promptly to the responsible provider and documents who was told and when.

Answer

D · Write it down, read it back to confirm and report it to the provider promptly
4.Infection control & patient safety

Answer: D · Leave the area, keep others out and alert the trained response team

Why this is the answer

An unknown chemical spill may be toxic or flammable. The nurse moves people away, prevents entry and calls the designated hazardous materials team, who check the Safety Data Sheet and use the right equipment.

Answer

D · Leave the area, keep others out and alert the trained response team
5.Lab values & electrolytes

Answer: B · An expected rise after splenectomy that increases clot risk

Why this is the answer

The spleen stores about a third of the platelets. After splenectomy, the count often rises (reactive thrombocytosis), which can increase the risk of thrombosis. The count is monitored, and the patient is assessed for signs of clots.Checked against: Platelet count · MedlinePlus (NIH) (2025); Platelet Tests · MedlinePlus (NIH) (2024)

Answer

B · An expected rise after splenectomy that increases clot risk
6.Lab values & electrolytes

Answer: A · Warfarin takes several days to reach its full anticoagulant effect

Why this is the answer

Warfarin blocks the making of new vitamin K–dependent clotting factors, but existing factors last for days. Heparin is therefore overlapped until the INR has been in the target range, typically for at least 24 hours and after a minimum of about 5 days.

Answer

A · Warfarin takes several days to reach its full anticoagulant effect
7.Clinical nursing

Answer: A · A recognised side effect of the ACE inhibitor

Why this is the answer

Dry cough is a common side effect of ACE inhibitors such as ramipril. An angiotensin II receptor blocker is often substituted.

Answer

A · A recognised side effect of the ACE inhibitor
8.Clinical nursing

Answer: A · Thyroid storm

Why this is the answer

Thyroid storm is a life-threatening worsening of hyperthyroidism, often triggered by infection or surgery. It needs urgent treatment with cooling, beta-blockade and antithyroid drugs.

Answer

A · Thyroid storm
9.Med-surg: cardiovascular & respiratory

Answer: A · Raised above the level of the heart when resting

Why this is the answer

Elevating the legs above heart level reduces venous pressure and oedema. Compression therapy, walking and avoiding long periods of standing also help. By contrast, patients with arterial disease often find that lowering the legs eases pain.

Answer

A · Raised above the level of the heart when resting
10.Med-surg: cardiovascular & respiratory

Answer: B · Not start CPR, call for support, and provide dignity and comfort

Why this is the answer

A valid do-not-attempt-CPR decision means CPR is not attempted. Other appropriate care continues, the senior team and family are informed and the patient is cared for with dignity. Nurses should check that the decision is valid and applies to the situation.

Answer

B · Not start CPR, call for support, and provide dignity and comfort
11.Med-surg: neuro, endocrine & renal

Answer: A · In type 1 diabetes it is continued even when the patient is not eating

Why this is the answer

Basal insulin covers background needs and has a flat profile. In type 1 diabetes it must continue during illness or fasting (the dose may be adjusted) to prevent DKA. Glargine must not be mixed with other insulins.

Answer

A · In type 1 diabetes it is continued even when the patient is not eating
12.Med-surg: neuro, endocrine & renal

Answer: C · Contact the prescriber or pharmacist about another route

Why this is the answer

Omitting Parkinson's medication can cause severe rigidity, swallowing failure and, rarely, a life-threatening withdrawal syndrome. Alternatives such as giving it by nasogastric tube or a dopamine agonist patch should be arranged urgently.

Answer

C · Contact the prescriber or pharmacist about another route
13.Med-surg: GI, perioperative & oncology

Answer: B · Breathe in slowly and deeply, then hold briefly

Why this is the answer

Slow, deep inspiration with a short hold expands the alveoli and helps prevent atelectasis. It is repeated regularly while awake, together with coughing and good pain control.

Answer

B · Breathe in slowly and deeply, then hold briefly
14.Med-surg: GI, perioperative & oncology

Answer: D · Itching with bananas, avocado and kiwi, and many operations

Why this is the answer

Latex–fruit syndrome links latex allergy with foods such as banana, avocado, kiwi and chestnut. Repeated exposure, for example through many operations or catheters, also increases risk.

Answer

D · Itching with bananas, avocado and kiwi, and many operations

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