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 parent calls to say their toddler has just swallowed drain cleaner. What should the nurse advise?

  1. AMake the child vomit straight away to bring up the chemical
  2. BDo not make the child vomit; call poison control or emergency services now
  3. CGive a large glass of fizzy drink or milk to dilute the cleaner before calling anyone
  4. DWait to see whether the child develops any symptoms first
2.Prioritization & delegationHard

A patient with a head injury has a pupil on one side that is now large and does not react to light. What should the nurse do?

  1. ADocument it, because pupils often differ slightly after a head injury
  2. BRecheck it at the next routine observation in four hours
  3. CReport it at once, as it may mean the brain is being compressed
  4. DDim the room lights so the pupil can get smaller
3.Infection control & patient safetyMedium

Which nurse should not be assigned to a patient with a sealed radioactive implant?

  1. AA nurse trained in radiation safety
  2. BA nurse wearing a dosimeter badge
  3. CA nurse who has worked on the unit for two years
  4. DA nurse who is pregnant
4.Infection control & patient safetyHard

A patient on chemotherapy develops shingles over several areas on both sides of the body. Which precautions are needed?

  1. AAirborne and contact precautions until all lesions are crusted
  2. BStandard precautions only, with the lesions covered
  3. CDroplet precautions until the pain settles
  4. DContact precautions only, with gloves for dressing changes
5.Lab values & electrolytesMedium

An older adult with chronic kidney disease starts trimethoprim-sulfamethoxazole for a urinary tract infection. Which electrolyte should be monitored closely?

  1. AChloride, because the drug causes chloride loss
  2. BSodium, because the drug causes heavy sodium retention
  3. CPotassium, because trimethoprim can raise it
  4. DCalcium, because the drug binds calcium in the gut
6.Lab values & electrolytesHard

The nurse teaches a patient with severe neutropenia after chemotherapy. Which statement shows a need for further teaching?

  1. A"I'll avoid people who have a cold or the flu"
  2. B"I'll wash my hands before eating and after the toilet"
  3. C"I'll call the clinic if my temperature rises"
  4. D"I'll check my temperature rectally to be accurate"
7.Clinical nursingMedium

Which group of features is typical of nephrotic syndrome?

  1. ASevere loin pain and fever
  2. BHeavy proteinuria, low serum albumin and oedema
  3. CPolyuria, thirst and weight loss
  4. DBlood in the urine, high blood pressure and reduced urine output only
8.Clinical nursingHard

A patient suddenly develops a painful red eye with blurred vision, haloes around lights and vomiting. What should be suspected?

  1. AA stye
  2. BDry eye syndrome
  3. CAcute angle-closure glaucoma
  4. DSimple conjunctivitis from a viral infection
9.Med-surg: cardiovascular & respiratoryMedium

A patient on theophylline develops nausea, vomiting, a fast heart rate and restlessness. What should the nurse suspect?

  1. ATheophylline toxicity
  2. BAn expected sign that the drug is working
  3. CA theophylline allergy causing a rash
  4. DHypoglycaemia caused by the drug
10.Med-surg: cardiovascular & respiratoryHard

A patient on three blood pressure drugs still has high readings at every visit. What should the nurse check first?

  1. AWhether the readings should be ignored
  2. BWhether the patient is taking the medicines as prescribed
  3. CWhether a fourth drug can be added at today's appointment
  4. DWhether the patient needs surgery on the renal arteries
11.Med-surg: neuro, endocrine & renalMedium

Before a haemodialysis catheter is used, why is the lock solution withdrawn from each lumen?

  1. AIt contains concentrated anticoagulant
  2. BIt contains a strong antibiotic that must be kept
  3. CIt contains air that keeps the line open
  4. DIt contains the patient's urine
12.Med-surg: neuro, endocrine & renalHard

A patient with myasthenia gravis is admitted with pneumonia. Which newly prescribed antibiotic should the nurse question?

  1. ABenzylpenicillin
  2. BCeftriaxone
  3. CAmoxicillin
  4. DGentamicin
13.Med-surg: GI, perioperative & oncologyMedium

During the first infusion of a monoclonal antibody such as rituximab, which problem is most important to watch for?

  1. AA rise in platelet count above normal
  2. BSevere constipation within the first hour of starting the infusion
  3. CAn infusion reaction, such as fever, rigors or breathlessness
  4. DSudden hair loss during the infusion
14.Med-surg: GI, perioperative & oncologyHard

On day 3 after hip surgery, an older patient becomes acutely confused, with fluctuating attention and agitation. What should the nurse do first?

  1. ALook for causes such as hypoxia, infection, pain or drugs, and escalate
  2. BAssume that it is dementia and continue the care plan unchanged
  3. CAsk the family to take the patient home so that they can settle
  4. DRestrain the patient and give a large dose of sedative straight away

3Solutions

1.Prioritization & delegation

Answer: B · Do not make the child vomit; call poison control or emergency services now

Why this is the answer

Inducing vomiting after a corrosive is swallowed causes more burns to the throat and risks aspiration. The parent should get expert advice and emergency help at once.

Answer

B · Do not make the child vomit; call poison control or emergency services now
2.Prioritization & delegation

Answer: C · Report it at once, as it may mean the brain is being compressed

Why this is the answer

A newly fixed, dilated pupil suggests pressure on the third cranial nerve from rising intracranial pressure or a bleed. It is a neurological emergency that needs immediate escalation.

Answer

C · Report it at once, as it may mean the brain is being compressed
3.Infection control & patient safety

Answer: D · A nurse who is pregnant

Why this is the answer

Pregnant staff and visitors are not assigned to patients with radioactive implants. Other staff limit the time spent with the patient, keep their distance, use shielding and wear a dosimeter.

Answer

D · A nurse who is pregnant
4.Infection control & patient safety

Answer: A · Airborne and contact precautions until all lesions are crusted

Why this is the answer

Lesions over several areas on both sides mean disseminated zoster, which can spread through the air like chickenpox. Airborne and contact precautions are used until all lesions are dry and crusted. Localized zoster in an immunocompromised patient also needs airborne and contact precautions, but only until dissemination is ruled out.

Answer

A · Airborne and contact precautions until all lesions are crusted
5.Lab values & electrolytes

Answer: C · Potassium, because trimethoprim can raise it

Why this is the answer

Trimethoprim blocks sodium channels in the collecting duct, reducing potassium excretion, much like amiloride. Hyperkalemia is more likely in older adults, with kidney disease, or with ACE inhibitors, ARBs or spironolactone.Checked against: Trimethoprim-Sulfamethoxazole · StatPearls (NCBI Bookshelf) (2026); Trimethoprim is a potassium-sparing diuretic like amiloride and causes hyperkalemia in high-risk patients (abstract) · PubMed (NLM) / Am J Ther (1997)

Answer

C · Potassium, because trimethoprim can raise it
6.Lab values & electrolytes

Answer: D · "I'll check my temperature rectally to be accurate"

Why this is the answer

Rectal temperatures, suppositories and enemas are avoided in neutropenia, because injury to the rectal mucosa can let bacteria into the blood. Prompt reporting of fever, hand hygiene and avoiding sick contacts are correct.

Answer

D · "I'll check my temperature rectally to be accurate"
7.Clinical nursing

Answer: B · Heavy proteinuria, low serum albumin and oedema

Why this is the answer

In nephrotic syndrome, damaged glomeruli leak protein, so albumin falls and fluid moves into tissues, causing oedema. Cholesterol is often raised too.

Answer

B · Heavy proteinuria, low serum albumin and oedema
8.Clinical nursing

Answer: C · Acute angle-closure glaucoma

Why this is the answer

Acute angle-closure glaucoma causes a rapid rise in eye pressure, with pain, visual disturbance, haloes and vomiting. It is an emergency that can cause permanent sight loss without urgent treatment.

Answer

C · Acute angle-closure glaucoma
9.Med-surg: cardiovascular & respiratory

Answer: A · Theophylline toxicity

Why this is the answer

Theophylline has a narrow therapeutic window. Toxicity causes nausea, vomiting, tachycardia, arrhythmias, agitation and seizures. Levels are monitored, and many drugs and smoking status change its clearance. The nurse should hold the dose and report.

Answer

A · Theophylline toxicity
10.Med-surg: cardiovascular & respiratory

Answer: B · Whether the patient is taking the medicines as prescribed

Why this is the answer

Before labelling hypertension as resistant, adherence, measurement technique, white-coat effect and interacting substances (NSAIDs, decongestants, alcohol, liquorice) should be checked. Side effects, cost and complex regimens are common reasons for missed doses.

Answer

B · Whether the patient is taking the medicines as prescribed
11.Med-surg: neuro, endocrine & renal

Answer: A · It contains concentrated anticoagulant

Why this is the answer

Dialysis catheter lumens are filled with a concentrated heparin or citrate lock. If it is flushed into the patient, it can cause bleeding or other effects. Catheters are usually accessed only by trained staff.

Answer

A · It contains concentrated anticoagulant
12.Med-surg: neuro, endocrine & renal

Answer: D · Gentamicin

Why this is the answer

Aminoglycosides such as gentamicin can impair neuromuscular transmission and trigger a myasthenic crisis. Fluoroquinolones, magnesium and some other drugs carry similar warnings. The nurse checks with the prescriber before giving it.

Answer

D · Gentamicin
13.Med-surg: GI, perioperative & oncology

Answer: C · An infusion reaction, such as fever, rigors or breathlessness

Why this is the answer

Infusion-related reactions are most common with the first dose. Premedication, a slow starting rate, close monitoring and readiness to stop the infusion and treat anaphylaxis are standard.

Answer

C · An infusion reaction, such as fever, rigors or breathlessness
14.Med-surg: GI, perioperative & oncology

Answer: A · Look for causes such as hypoxia, infection, pain or drugs, and escalate

Why this is the answer

Acute confusion with fluctuating attention suggests delirium. It is a medical emergency with many possible causes, such as hypoxia, sepsis, pain, drugs (including opioids and anticholinergics), urinary retention, constipation, dehydration and electrolyte problems. Treat the cause, use non-drug measures, and use sedation only as a last resort.

Answer

A · Look for causes such as hypoxia, infection, pain or drugs, and escalate

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