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 a spinal cord injury at T4 suddenly has a severe headache, flushing above the injury and a blood pressure of 200/110 mmHg. What does the nurse do first?
- AApply extra blankets to keep the patient warm and calm
- BGive a warm drink and recheck the blood pressure in an hour
- CSit the patient upright with the legs lowered
- DLay the patient flat with the legs raised
2.Prioritization & delegationHard
A patient in labor is receiving oxytocin, and the fetal monitor shows repeated late decelerations. What should the nurse do first?
- APlace the patient flat on her back
- BEncourage the patient to start pushing
- CStop the oxytocin infusion
- DIncrease the oxytocin rate
3.Infection control & patient safetyMedium
A patient has leftover opioid tablets after surgery. Which advice about disposal is best?
- ALeave them in the bathroom cabinet indefinitely
- BKeep them in an unlocked drawer at home in case of future pain
- CReturn them to a pharmacy or an approved take-back site
- DGive them to a friend or relative who has back pain
4.Infection control & patient safetyHard
A visitor is receiving an electric shock from a faulty lamp and is still touching it. What should the nurse do first?
- ASwitch off the power or unplug the lamp without touching the person
- BThrow water over the lamp to stop the current
- CPull the visitor away from the lamp by the arm as quickly as possible
- DStart chest compressions straight away
5.Lab values & electrolytesMedium
A patient with pneumonia had a CRP of 180 mg/L on admission and 40 mg/L after 4 days of antibiotics. What does this most likely show?
- AThe antibiotic is causing liver damage
- BThe infection has spread to another organ
- CThe inflammation is settling with treatment
- DThe patient has developed a new infection
6.Lab values & electrolytesHard
The nurse prepares a patient for a 2-hour oral glucose tolerance test tomorrow morning. Which statement shows a need for further teaching?
- A"I'll stay seated during the test if I can"
- B"I'll avoid smoking until the test is over"
- C"I can have a light breakfast before the test"
- D"I'll fast overnight but can drink plain water"
7.Clinical nursingMedium
Which blood results are typical of Addison's disease (primary adrenal insufficiency)?
- AHigh sodium and low potassium
- BLow haemoglobin and high platelets
- CHigh glucose and high calcium
- DLow sodium and high potassium
8.Clinical nursingHard
A patient has had nausea and vomiting for three days and is taking furosemide. Which electrolyte problem is most likely?
- AHypokalaemia
- BHyperkalaemia
- CHypernatraemia only
- DHypercalcaemia
9.Med-surg: cardiovascular & respiratoryMedium
Why are patients with mitral stenosis at high risk of atrial fibrillation?
- AThe right ventricle shrinks and stops contracting properly over time
- BThe left atrium enlarges as it pushes blood through the narrow valve
- CThe coronary arteries become blocked by the valve
- DThe narrow valve presses on the sinus node and slows it down directly
10.Med-surg: cardiovascular & respiratoryHard
A patient has sudden severe chest pain spreading to the back between the shoulder blades. Which finding most supports aortic dissection rather than myocardial infarction?
- AA heart rate of 104/min and a respiratory rate of 22/min
- BA large difference in blood pressure between the arms
- CSweating, nausea and pallor that started with the pain
- DPain that started at rest
11.Med-surg: neuro, endocrine & renalMedium
Which statement about giving IV potassium is correct?
- AIt needs no monitoring at all once the infusion is running
- BIt is safest given through a small vein in the hand at a fast rate
- CIt is diluted and given through an infusion pump, never as a bolus
- DIt can be given quickly as a push to correct the level fast
12.Med-surg: neuro, endocrine & renalHard
At bedtime, a patient was given their rapid-acting insulin by mistake instead of their long-acting insulin. What should the nurse do?
- ATell the prescriber and check glucose often overnight
- BGive the long-acting dose as well and check glucose at breakfast
- CGive glucagon now, before the glucose has fallen
- DSay nothing, because the patient is asleep and seems fine
13.Med-surg: GI, perioperative & oncologyMedium
Why are antibody levels checked after a healthcare worker receives the hepatitis B vaccine?
- ATo check whether they caught hepatitis B from the vaccine
- BTo measure liver damage caused by the vaccine
- CTo decide whether they need a liver biopsy
- DTo confirm that the vaccine produced immunity
14.Med-surg: GI, perioperative & oncologyHard
A patient with a leg ulcer has an ABPI of 0.5. The doctor's plan mentions starting strong compression bandages. What should the nurse do?
- AApply the strongest compression to speed healing
- BWithhold strong compression and discuss urgent vascular referral
- CApply compression but only at night
- DApply compression and elevate the leg above the heart all day
3Solutions
1.Prioritization & delegation
Answer: C · Sit the patient upright with the legs lowered
Why this is the answer
Autonomic dysreflexia is an emergency in injuries at T6 or above. Sitting the patient up lowers the blood pressure; the nurse then looks for the trigger, most often a full bladder or constipation.
C · Sit the patient upright with the legs lowered
2.Prioritization & delegation
Answer: C · Stop the oxytocin infusion
Why this is the answer
Late decelerations point to reduced blood flow through the placenta. Stopping oxytocin reduces contractions; the nurse then turns the patient onto her side, gives IV fluids as prescribed and informs the provider.
C · Stop the oxytocin infusion
3.Infection control & patient safety
Answer: C · Return them to a pharmacy or an approved take-back site
Why this is the answer
Returning unused opioids to a pharmacy or an approved take-back site is the preferred way to dispose of them. Leftover opioids at home can be misused or taken by children or pets.
C · Return them to a pharmacy or an approved take-back site
4.Infection control & patient safety
Answer: A · Switch off the power or unplug the lamp without touching the person
Why this is the answer
The rescuer must not touch someone still in contact with live current. The power is switched off or the plug pulled first, then the person is assessed and resuscitation is started if needed.
A · Switch off the power or unplug the lamp without touching the person
5.Lab values & electrolytes
Answer: C · The inflammation is settling with treatment
Why this is the answer
CRP has a short half-life of about 19 hours, so it falls within days when inflammation is controlled. A falling CRP, together with clinical improvement, supports a response to treatment; a CRP that stays high or rises again needs review.Checked against: C-reactive protein · MedlinePlus (NIH) (2025)
C · The inflammation is settling with treatment
6.Lab values & electrolytes
Answer: C · "I can have a light breakfast before the test"
Why this is the answer
The OGTT is done after an overnight fast of at least 8 hours; water is allowed. Eating before the test makes the results invalid. Patients rest during the test and avoid smoking, which can affect glucose.Checked against: Blood Glucose Test · MedlinePlus (NIH) (2024); Glucose tolerance test - non-pregnant · MedlinePlus (NIH) (2025)
C · "I can have a light breakfast before the test"
7.Clinical nursing
Answer: D · Low sodium and high potassium
Why this is the answer
Without aldosterone, the kidneys lose sodium and retain potassium. Patients may also have low blood pressure, low glucose and increased skin pigmentation.
D · Low sodium and high potassium
8.Clinical nursing
Answer: A · Hypokalaemia
Why this is the answer
Vomiting and loop diuretics both cause potassium loss. Hypokalaemia causes weakness, cramps and arrhythmias and needs monitoring and replacement.
9.Med-surg: cardiovascular & respiratory
Answer: B · The left atrium enlarges as it pushes blood through the narrow valve
Why this is the answer
A narrowed mitral valve raises pressure in the left atrium, which dilates. A stretched atrium is prone to atrial fibrillation, and blood stasis there carries a high risk of clots and stroke. Anticoagulation is therefore essential in mitral stenosis with AF.
B · The left atrium enlarges as it pushes blood through the narrow valve
10.Med-surg: cardiovascular & respiratory
Answer: B · A large difference in blood pressure between the arms
Why this is the answer
A difference of more than about 20 mmHg in systolic pressure between the arms, a pulse deficit or a new aortic regurgitation murmur suggests dissection. Sweating, tachycardia and rest pain also occur in MI. Thrombolysis and anticoagulants could be disastrous in dissection, so the distinction matters.
B · A large difference in blood pressure between the arms
11.Med-surg: neuro, endocrine & renal
Answer: C · It is diluted and given through an infusion pump, never as a bolus
Why this is the answer
Concentrated potassium given quickly can cause fatal arrhythmias. IV potassium is given in a diluted, ready-made solution through an infusion pump at a controlled rate, with monitoring of potassium and, at higher rates, the ECG.
C · It is diluted and given through an infusion pump, never as a bolus
12.Med-surg: neuro, endocrine & renal
Answer: A · Tell the prescriber and check glucose often overnight
Why this is the answer
Rapid-acting insulin without a meal can cause hypoglycaemia. The nurse informs the prescriber, monitors glucose closely, offers carbohydrate, follows advice about the missed basal dose and reports the incident.
A · Tell the prescriber and check glucose often overnight
13.Med-surg: GI, perioperative & oncology
Answer: D · To confirm that the vaccine produced immunity
Why this is the answer
Some people do not develop protective anti-HBs antibodies after vaccination. Testing identifies non-responders, who may need further doses and advice after exposures.
D · To confirm that the vaccine produced immunity
14.Med-surg: GI, perioperative & oncology
Answer: B · Withhold strong compression and discuss urgent vascular referral
Why this is the answer
An ABPI of 0.5 suggests severe arterial disease, and strong compression could cause limb ischaemia. The nurse raises the concern and the patient is referred to vascular specialists.
B · Withhold strong compression and discuss urgent vascular referral
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