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 stable adult has abdominal pain and normal vital signs. They will need blood tests and a CT scan. Which ESI level fits?

  1. ALevel 3
  2. BLevel 5
  3. CLevel 4
  4. DLevel 1
2.Prioritization & delegationHard

A patient is admitted with inhalational anthrax. Which precautions are needed?

  1. AAirborne precautions in a negative-pressure room for the whole of the hospital stay
  2. BFull contact and droplet precautions for all staff and visitors on the unit
  3. CStandard precautions, because it does not usually spread from person to person
  4. DDroplet precautions with a surgical mask for everyone who enters
3.Infection control & patient safetyMedium

A nurse pours sterile saline into a bowl on a sterile field. Which technique is correct?

  1. APour from below the level of the field to reduce splashing
  2. BReach across the field to fill the bowl at the far side
  3. CRest the lip of the bottle on the edge of the bowl so that the saline does not splash
  4. DHold the bottle with the label in the palm and pour without touching the bowl
4.Infection control & patient safetyHard

A patient restrained because of violent behavior is now calm, oriented and following instructions. What should the nurse do?

  1. ARemove the restraints, because the reason for them has ended
  2. BRemove one restraint each day to test the patient’s behavior
  3. CKeep the restraints until the next provider visit
  4. DKeep the restraints until the order expires
5.Lab values & electrolytesMedium

Why must a low total calcium be interpreted with care in a patient with a low serum albumin?

  1. AMuch calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
  2. BAlbumin and calcium are measured with the same chemical reaction, so they always fall together
  3. CLow albumin makes every calcium test inaccurate and useless
  4. DLow albumin always causes true, symptomatic hypocalcemia
6.Lab values & electrolytesHard

A patient has fever, confusion, a platelet count of 15 × 10³/µL, anemia with fragmented red cells (schistocytes) and a raised creatinine. Clotting times are normal. Which condition should be suspected?

  1. AVitamin K deficiency with bleeding
  2. BDisseminated intravascular coagulation
  3. CThrombotic thrombocytopenic purpura (TTP)
  4. DImmune thrombocytopenia (ITP)
7.Clinical nursingMedium

A patient receiving warfarin has an INR far above the target range and bruising. Which drug may be prescribed to reverse the effect?

  1. AVitamin K
  2. BAspirin
  3. CProtamine sulfate
  4. DNaloxone
8.Clinical nursingHard

A patient's hypoglycaemia was caused by a sulfonylurea such as gliclazide or glipizide. Why might they need monitoring for longer than usual?

  1. ASulfonylureas act for a long time, so hypoglycaemia can recur
  2. BSulfonylureas only work at night
  3. CThe drug makes glucose tablets and drinks ineffective
  4. DThe drug causes rebound hyperglycaemia later the same day
9.Med-surg: cardiovascular & respiratoryMedium

A patient with diabetes is starting a beta-blocker. What should the nurse teach about hypoglycaemia?

  1. AInsulin should be stopped while taking a beta-blocker
  2. BThe beta-blocker will prevent all episodes of hypoglycaemia
  3. CHypoglycaemia will always cause a very slow and weak pulse
  4. DSome warning signs, such as a fast heartbeat, may be masked
10.Med-surg: cardiovascular & respiratoryHard

A one-way speaking valve is fitted to a patient's tracheostomy tube while the cuff is still inflated. What is the danger?

  1. AThere is no danger, as the valve works with any cuff
  2. BThe valve will humidify the air too much
  3. CThe patient cannot breathe out and may suffocate
  4. DThe patient will speak too loudly
11.Med-surg: neuro, endocrine & renalMedium

A patient with primary adrenal insufficiency has a fever. What is the usual sick-day advice for steroid replacement?

  1. AIncrease the glucocorticoid dose, often doubling it
  2. BKeep the usual dose and avoid drinking extra fluids for now
  3. CHalve the dose to reduce the side effects
  4. DStop the steroid until the fever has settled
12.Med-surg: neuro, endocrine & renalHard

A haemodialysis patient asks why fluid between sessions must be limited. Which explanation is correct?

  1. AExtra fluid weakens the fistula wall and makes it more likely to burst
  2. BDrinking water makes the dialysis remove too much potassium from the blood
  3. CFluid restriction is mainly to shorten the time spent on the machine
  4. DExcess fluid builds up, raising BP and causing breathlessness and cramps on dialysis
13.Med-surg: GI, perioperative & oncologyMedium

Which task for a stable patient with an established ileostomy can usually be delegated to a trained healthcare assistant (nursing assistant)?

  1. AAssessing the stoma for signs of necrosis
  2. BDeciding whether IV fluids are needed
  3. CTeaching the patient about high-output risks
  4. DEmptying the pouch and measuring the output
14.Med-surg: GI, perioperative & oncologyHard

In week 5 of radiotherapy, the skin in the treatment field is broken, moist and painful. What should the nurse do?

  1. AReport it, keep it clean and use a non-adherent dressing
  2. BApply adhesive tape directly over the area to protect it from clothing
  3. CScrub the area with soap to prevent infection
  4. DUse a heat pad to speed healing

3Solutions

1.Prioritization & delegation

Answer: A · Level 3

Why this is the answer

Blood tests (one resource) plus a CT scan (a second resource) make two resources, which is ESI level 3 when the vital signs are acceptable.

Answer

A · Level 3
2.Prioritization & delegation

Answer: C · 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.

Answer

C · Standard precautions, because it does not usually spread from person to person
3.Infection control & patient safety

Answer: D · Hold the bottle with the label in the palm and pour without touching the bowl

Why this is the answer

The nurse pours from a little height without touching the sterile bowl, avoiding splashes that would wet the field. Holding the label in the palm keeps it readable and free of drips.

Answer

D · Hold the bottle with the label in the palm and pour without touching the bowl
4.Infection control & patient safety

Answer: A · Remove the restraints, because the reason for them has ended

Why this is the answer

Restraints are used only as long as needed to keep people safe. Once the patient no longer presents a danger, the restraints are removed, even if the order has not yet expired.

Answer

A · Remove the restraints, because the reason for them has ended
5.Lab values & electrolytes

Answer: A · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal

Why this is the answer

About 40–45% of calcium is bound to plasma proteins, mainly albumin. When albumin is low, total calcium falls although ionized calcium may be normal. A corrected calcium or a measured ionized calcium gives the true picture.Checked against: Hypocalcemia (StatPearls) · StatPearls (NCBI Bookshelf) (2026)

Answer

A · Much calcium is bound to albumin, so total calcium falls even if ionized calcium is normal
6.Lab values & electrolytes

Answer: C · Thrombotic thrombocytopenic purpura (TTP)

Why this is the answer

TTP causes small clots that consume platelets, break red cells (microangiopathic hemolysis) and damage the brain and kidneys, while clotting times usually stay normal. It is an emergency treated with plasma exchange; platelet transfusion is generally avoided.Checked against: Thrombotic thrombocytopenic purpura · MedlinePlus (NIH) (2025)

Answer

C · Thrombotic thrombocytopenic purpura (TTP)
7.Clinical nursing

Answer: A · Vitamin K

Why this is the answer

Warfarin inhibits vitamin K-dependent clotting factors. Vitamin K, and for major bleeding prothrombin complex concentrate, reverse it. Protamine reverses heparin.

Answer

A · Vitamin K
8.Clinical nursing

Answer: A · Sulfonylureas act for a long time, so hypoglycaemia can recur

Why this is the answer

Sulfonylureas stimulate insulin release and have a long duration of action. Hypoglycaemia can be prolonged or recur, so glucose is monitored closely after treatment.

Answer

A · Sulfonylureas act for a long time, so hypoglycaemia can recur
9.Med-surg: cardiovascular & respiratory

Answer: D · Some warning signs, such as a fast heartbeat, may be masked

Why this is the answer

Beta-blockers can blunt adrenergic symptoms of hypoglycaemia such as palpitations and tremor. Sweating usually remains. Patients should check their glucose if they feel unwell and know their other warning signs.

Answer

D · Some warning signs, such as a fast heartbeat, may be masked
10.Med-surg: cardiovascular & respiratory

Answer: C · The patient cannot breathe out and may suffocate

Why this is the answer

A speaking valve opens on inspiration and closes on expiration, so exhaled air must pass around the tube and up through the larynx. If the cuff is inflated, air cannot escape, causing air trapping and respiratory arrest. The cuff must be fully deflated first.

Answer

C · The patient cannot breathe out and may suffocate
11.Med-surg: neuro, endocrine & renal

Answer: A · Increase the glucocorticoid dose, often doubling it

Why this is the answer

During illness, people on steroid replacement need more glucocorticoid. Sick-day rules usually advise doubling the dose during fever and using emergency injectable hydrocortisone or seeking urgent care if they vomit and cannot keep tablets down, to prevent adrenal crisis.

Answer

A · Increase the glucocorticoid dose, often doubling it
12.Med-surg: neuro, endocrine & renal

Answer: D · Excess fluid builds up, raising BP and causing breathlessness and cramps on dialysis

Why this is the answer

Patients with little residual urine output accumulate fluid between sessions. Large gains cause hypertension, pulmonary oedema and heart strain, and removing large volumes quickly during dialysis causes hypotension and cramps. Restricting fluid and salt (which drives thirst) keeps gains manageable.

Answer

D · Excess fluid builds up, raising BP and causing breathlessness and cramps on dialysis
13.Med-surg: GI, perioperative & oncology

Answer: D · Emptying the pouch and measuring the output

Why this is the answer

Emptying and measuring output is a routine task. Assessment of the stoma, teaching and decisions about treatment remain with the registered nurse, who reviews the recorded output.

Answer

D · Emptying the pouch and measuring the output
14.Med-surg: GI, perioperative & oncology

Answer: A · Report it, keep it clean and use a non-adherent dressing

Why this is the answer

Moist desquamation is a more severe radiation skin reaction. The radiotherapy team is informed; the area is kept clean and covered with non-adherent dressings, avoiding adhesive on the skin, and analgesia is given. Infection is watched for.

Answer

A · Report it, keep it clean and use a non-adherent dressing

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