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 registered nurse tells a nursing assistant, “Check on the patient in room 12.” Which right of delegation is missing?

  1. ARight task for the setting
  2. BRight person for the task
  3. CRight directions and communication
  4. DRight circumstance
2.Prioritization & delegationHard

A patient with diabetes takes propranolol. Which sign of hypoglycemia is most likely to still appear?

  1. ATremor
  2. BSweating
  3. CTachycardia
  4. DPalpitations
3.Infection control & patient safetyMedium

A patient with diabetes will use lancets and insulin needles at home. Which teaching about disposal is correct?

  1. APut them in a puncture-resistant container with a lid and follow local disposal rules
  2. BPut them loose in the household trash bag, as long as the bag is tied shut
  3. CFlush the used lancets and needles down the toilet
  4. DRecap each needle with two hands before putting it in the kitchen trash
4.Infection control & patient safetyHard

Which action by a nurse shows that the five moments of hand hygiene are being followed?

  1. AShe cleans her hands only at the start and end of the shift
  2. BShe wears the same gloves between two patients
  3. CShe cleans her hands only when they look dirty
  4. DShe cleans her hands after touching the bed rail
5.Lab values & electrolytesMedium

Which change in clotting tests is normal in late pregnancy?

  1. APlatelets rise above 600 × 10³/µL
  2. BaPTT doubles from baseline
  3. CINR rises to about 3.0
  4. DFibrinogen and D-dimer rise
6.Lab values & electrolytesHard

Which set of results is most typical of iron-deficiency anemia?

  1. AHigh hemoglobin and high hematocrit
  2. BLow hemoglobin, large red cells (high MCV) and high ferritin
  3. CLow hemoglobin, small red cells (low MCV) and low ferritin
  4. DNormal hemoglobin with a high platelet count only
7.Clinical nursingMedium

Before giving a beta-blocker, which observation is most important to check?

  1. ABlood glucose only
  2. BTemperature only
  3. CBowel movements
  4. DHeart rate and blood pressure
8.Clinical nursingHard

Which feature suggests moisture-associated skin damage rather than a pressure ulcer?

  1. ANon-blanching redness directly over the hip bone after lying on one side
  2. BA round area of necrosis over the heel
  3. CDiffuse, superficial redness in a skin fold, not over a bony prominence
  4. DA deep wound over the sacrum with exposed bone and a dark base
9.Med-surg: cardiovascular & respiratoryMedium

Two days after a myocardial infarction, a patient develops sudden breathlessness, crackles and a new loud systolic murmur. Which complication should be suspected?

  1. APapillary muscle rupture with acute mitral regurgitation
  2. BPost-infarction pericarditis causing a pericardial friction rub
  3. CA pulmonary embolism caused by prolonged bed rest
  4. DA new episode of stable angina brought on by stress
10.Med-surg: cardiovascular & respiratoryHard

A patient with severe COPD has increasing ankle oedema and a raised JVP, but no crackles and a normal left ventricle on echocardiography. Which condition is most likely?

  1. AAortic stenosis
  2. BCor pulmonale
  3. CLeft ventricular failure
  4. DDeep vein thrombosis
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 the patient's urine
  3. CIt contains air that keeps the line open
  4. DIt contains a strong antibiotic that must be kept
12.Med-surg: neuro, endocrine & renalHard

A patient's glucose is 6.2 mmol/L (112 mg/dL) at 03:00 and 12 mmol/L (216 mg/dL) before breakfast. No hypoglycaemia occurred overnight. What is the most likely explanation?

  1. AA large snack eaten in the night by mistake
  2. BThe Somogyi effect from a night-time hypo
  3. CThe meter is faulty and should be replaced
  4. DThe dawn phenomenon from early-morning hormones
13.Med-surg: GI, perioperative & oncologyMedium

Which practice is correct when giving parenteral nutrition through a central line?

  1. AUse a dedicated lumen and strict aseptic technique
  2. BDisconnect and reconnect the line without cleaning the hub
  3. CLet the bag hang at room temperature for several days
  4. DGive other IV drugs through the same lumen to save time
14.Med-surg: GI, perioperative & oncologyHard

Two days after starting chemotherapy for a high-grade lymphoma, a patient's urine output falls; potassium is 6.4 mmol/L, phosphate high and calcium low. What should the nurse suspect and do?

  1. AAn allergic reaction: give an antihistamine and continue as normal
  2. BExpected chemotherapy side effects: no action needed until the next cycle
  3. CTumour lysis syndrome: escalate, start cardiac monitoring and expect IV fluids
  4. DSimple dehydration: encourage oral fluids and recheck bloods next week

3Solutions

1.Prioritization & delegation

Answer: C · Right directions and communication

Why this is the answer

“Check on” does not say what to measure, when, or which findings to report. A clear instruction would be, for example, “Measure his blood pressure and pulse at 10:00 and tell me at once if the systolic is below 100.”

Answer

C · Right directions and communication
2.Prioritization & delegation

Answer: B · Sweating

Why this is the answer

Beta-blockers can hide tachycardia, palpitations and tremor during hypoglycemia. Sweating is mainly cholinergic, so it usually remains, and patients are taught to check glucose when they sweat.

Answer

B · Sweating
3.Infection control & patient safety

Answer: A · Put them in a puncture-resistant container with a lid and follow local disposal rules

Why this is the answer

Home sharps go into a puncture-resistant container, such as an approved sharps container or a rigid plastic bottle if local rules allow, which is closed and disposed of according to local guidance.

Answer

A · Put them in a puncture-resistant container with a lid and follow local disposal rules
4.Infection control & patient safety

Answer: D · She cleans her hands after touching the bed rail

Why this is the answer

Touching the patient’s surroundings, such as rails and tables, contaminates the hands, so hand hygiene is needed afterwards. Gloves are changed between patients, and hand hygiene is needed whether or not the hands look dirty.

Answer

D · She cleans her hands after touching the bed rail
5.Lab values & electrolytes

Answer: D · Fibrinogen and D-dimer rise

Why this is the answer

Pregnancy increases clotting factors and fibrinogen and raises the D-dimer, which helps prevent bleeding at delivery but raises the risk of clots. Because D-dimer is normally raised, it is less useful for excluding DVT in pregnancy.Checked against: D-dimer Test · MedlinePlus (NIH) (2024)

Answer

D · Fibrinogen and D-dimer rise
6.Lab values & electrolytes

Answer: C · Low hemoglobin, small red cells (low MCV) and low ferritin

Why this is the answer

Iron deficiency causes a microcytic anemia (low MCV) with low iron stores (low ferritin). Large red cells suggest vitamin B12 or folate deficiency.Checked against: Ferritin Blood Test · MedlinePlus (NIH) (2025); RBC indices · MedlinePlus (NIH) (2026)

Answer

C · Low hemoglobin, small red cells (low MCV) and low ferritin
7.Clinical nursing

Answer: D · Heart rate and blood pressure

Why this is the answer

Beta-blockers lower heart rate and blood pressure, so bradycardia or hypotension may require withholding the dose and informing the prescriber.

Answer

D · Heart rate and blood pressure
8.Clinical nursing

Answer: C · Diffuse, superficial redness in a skin fold, not over a bony prominence

Why this is the answer

Moisture lesions are superficial, irregular and often in skin folds or areas exposed to incontinence. Pressure ulcers usually occur over bony prominences or under devices and may be deeper.

Answer

C · Diffuse, superficial redness in a skin fold, not over a bony prominence
9.Med-surg: cardiovascular & respiratory

Answer: A · Papillary muscle rupture with acute mitral regurgitation

Why this is the answer

Rupture of a papillary muscle (or of the ventricular septum) after MI produces a new murmur and sudden heart failure or shock. This is a surgical emergency. Pericarditis causes pleuritic chest pain and a friction rub rather than acute pulmonary oedema with a new murmur.

Answer

A · Papillary muscle rupture with acute mitral regurgitation
10.Med-surg: cardiovascular & respiratory

Answer: B · Cor pulmonale

Why this is the answer

Chronic hypoxia in COPD causes pulmonary hypertension, which strains the right ventricle and leads to right heart failure with oedema and raised JVP. Management includes treating hypoxia (long-term oxygen if eligible), diuretics for oedema and optimising COPD treatment.

Answer

B · Cor pulmonale
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 · The dawn phenomenon from early-morning hormones

Why this is the answer

In the dawn phenomenon, cortisol and growth hormone rise in the early morning and push glucose up without a preceding hypo. A night-time hypo followed by rebound hyperglycaemia would suggest the Somogyi effect. The prescriber can adjust the insulin regimen.

Answer

D · The dawn phenomenon from early-morning hormones
13.Med-surg: GI, perioperative & oncology

Answer: A · Use a dedicated lumen and strict aseptic technique

Why this is the answer

PN is rich in nutrients that bacteria can use. A dedicated lumen, aseptic non-touch technique and hanging limits reduce catheter-related bloodstream infection.

Answer

A · Use a dedicated lumen and strict aseptic technique
14.Med-surg: GI, perioperative & oncology

Answer: C · Tumour lysis syndrome: escalate, start cardiac monitoring and expect IV fluids

Why this is the answer

High potassium and phosphate, low calcium and falling urine output after starting treatment for a fast-growing cancer point to tumour lysis syndrome with AKI. It needs urgent review, cardiac monitoring, IV fluids, treatment of hyperkalaemia, rasburicase as prescribed and possibly dialysis.

Answer

C · Tumour lysis syndrome: escalate, start cardiac monitoring and expect IV fluids

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