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 speaks little English, and the nurse needs to explain a new procedure. What is the best way to communicate?

  1. AUse hand gestures and hope the patient understands
  2. BUse a professional medical interpreter
  3. CAsk the patient’s 10-year-old child to translate
  4. DSpeak loudly and slowly in English
2.Prioritization & delegationHard

Using ESI, a stable adult with abdominal pain will need blood tests and a CT scan, but has a heart rate of 130/min. Which statement is correct?

  1. AThe nurse should consider level 2 because of the danger-zone vital sign
  2. BVital signs never change the ESI level
  3. CThe patient is level 4 because the blood tests and the scan count as one resource
  4. DThe patient is level 5 because the pain is not severe
3.Infection control & patient safetyMedium

A woman who is pregnant asks for the MMR vaccine because she is not immune to rubella. What is correct?

  1. AMMR is a live vaccine and is not given during pregnancy, but can be given after delivery
  2. BMMR is only given to pregnant women who work in hospitals
  3. CMMR should be given as soon as possible in the first trimester to protect the baby
  4. DMMR is safe at any stage of pregnancy
4.Infection control & patient safetyHard

A patient is admitted with acute diarrhea, and C. difficile is suspected. The test result is pending. When should contact precautions start?

  1. AOnly when the test result comes back positive
  2. BStraight away, without waiting for the test result
  3. COnly if the patient develops a fever
  4. DAfter three days of diarrhea
5.Lab values & electrolytesMedium

A patient takes valproate (valproic acid) for epilepsy. Which tests are monitored regularly?

  1. AThyroid function and serum calcium
  2. BSerum lithium and urine specific gravity
  3. CLiver function tests and platelet count
  4. DTroponin and B-type natriuretic peptide
6.Lab values & electrolytesHard

A patient on high-dose dexamethasone has a white cell count of 15 × 10³/µL, mostly mature neutrophils with no bands. They have no fever and no signs of infection. What is the most likely explanation?

  1. AA steroid effect that moves neutrophils into the circulating blood
  2. BA laboratory error, because steroids always lower the white count
  3. CCertain sepsis that needs antibiotics started without delay
  4. DA new leukemia that is confirmed by this result alone
7.Clinical nursingMedium

Which examination findings suggest a large pleural effusion on one side?

  1. ADull percussion and reduced breath sounds over the lung base
  2. BNormal breath sounds and normal percussion
  3. CA hyper-resonant chest with the trachea pulled towards that side
  4. DWheeze heard over both lungs
8.Clinical nursingHard

A patient with severe sepsis starts bleeding from cannula sites and the gums, with a low platelet count and prolonged clotting times. What is most likely?

  1. AVitamin C deficiency
  2. BDisseminated intravascular coagulation
  3. CAn allergic reaction to the cannula
  4. DHaemophilia A
9.Med-surg: cardiovascular & respiratoryMedium

A peripheral cannula site is red, warm, tender and swollen along the vein. What should the nurse do?

  1. ARemove the cannula, document and monitor the site
  2. BFlush the cannula hard to clear it
  3. CLeave it in place, as this is normal after 24 hours
  4. DCover the site and keep using it until it blocks
10.Med-surg: cardiovascular & respiratoryHard

A 25-year-old non-smoker has wheeze and cough that come and go, worse at night and after exercise. Spirometry improves markedly after a bronchodilator. Which diagnosis is most likely?

  1. AHeart failure
  2. BIdiopathic pulmonary fibrosis
  3. CCOPD
  4. DAsthma
11.Med-surg: neuro, endocrine & renalMedium

Why must Parkinson's medicines be given on time in hospital?

  1. ALate doses build up in the blood and cause an overdose
  2. BLate doses cause the patient to develop high blood glucose
  3. CLate doses can soon cause stiffness, falls and poor swallowing
  4. DGiving them on time prevents the disease from getting worse
12.Med-surg: neuro, endocrine & renalHard

A patient with DKA is improving: glucose 9 mmol/L, ketones 0.4 mmol/L, pH 7.36. They are eating and drinking. How should the IV insulin be stopped?

  1. AGive subcutaneous insulin with a meal, then stop the IV after an overlap
  2. BGive subcutaneous insulin only if glucose rises above 20 mmol/L
  3. CStop the IV insulin now and start subcutaneous insulin tomorrow
  4. DStop all insulin, as the ketoacidosis has fully resolved
13.Med-surg: GI, perioperative & oncologyMedium

Which is a recognised cause of anaphylaxis during surgery?

  1. AThe patient's own blood from cell salvage
  2. BA warmed blanket
  3. CSterile normal saline
  4. DChlorhexidine skin preparation
14.Med-surg: GI, perioperative & oncologyHard

A patient has negative pressure wound therapy. The pump alarms and the dressing has lost its seal. What is the most appropriate action?

  1. APack the wound with dry gauze over the foam and tape it tightly
  2. BTurn the suction up to its maximum setting to pull the seal back
  3. CRestore the seal; if that fails in time, change to a moist dressing
  4. DLeave the foam in the wound without suction for several days until review

3Solutions

1.Prioritization & delegation

Answer: B · Use a professional medical interpreter

Why this is the answer

Professional interpreters give accurate, confidential translation of medical information. Family members, especially children, may leave things out and should not be used for important explanations.

Answer

B · Use a professional medical interpreter
2.Prioritization & delegation

Answer: A · The nurse should consider level 2 because of the danger-zone vital sign

Why this is the answer

In ESI, a patient who needs two or more resources is level 3, but danger-zone vital signs such as a very fast heart rate should make the nurse consider level 2.

Answer

A · The nurse should consider level 2 because of the danger-zone vital sign
3.Infection control & patient safety

Answer: A · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery

Why this is the answer

Live vaccines such as MMR and varicella are not given during pregnancy. A non-immune woman is vaccinated after delivery, and pregnancy is avoided for a period after vaccination.

Answer

A · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery
4.Infection control & patient safety

Answer: B · Straight away, without waiting for the test result

Why this is the answer

Precautions start on suspicion, because the patient can spread spores while the test is pending. The patient is placed in a single room with contact precautions, and soap-and-water hand washing is used.

Answer

B · Straight away, without waiting for the test result
5.Lab values & electrolytes

Answer: C · Liver function tests and platelet count

Why this is the answer

Valproate can cause liver toxicity and thrombocytopenia, so liver tests and the platelet count are monitored. It can also raise ammonia; confusion or vomiting should prompt an ammonia level.Checked against: Valproic Acid · StatPearls (NCBI Bookshelf) (2024)

Answer

C · Liver function tests and platelet count
6.Lab values & electrolytes

Answer: A · A steroid effect that moves neutrophils into the circulating blood

Why this is the answer

Corticosteroids raise the neutrophil count by releasing marginated neutrophils and slowing their exit from the blood, usually without a left shift. The nurse still assesses carefully, because steroids can also hide the usual signs of infection.

Answer

A · A steroid effect that moves neutrophils into the circulating blood
7.Clinical nursing

Answer: A · Dull percussion and reduced breath sounds over the lung base

Why this is the answer

Fluid in the pleural space muffles breath sounds and makes percussion stony dull. A large effusion may push the trachea away from the affected side.

Answer

A · Dull percussion and reduced breath sounds over the lung base
8.Clinical nursing

Answer: B · Disseminated intravascular coagulation

Why this is the answer

In DIC, widespread activation of clotting consumes platelets and clotting factors, causing both small clots and bleeding. Treating the underlying cause and replacing blood products as needed are key.

Answer

B · Disseminated intravascular coagulation
9.Med-surg: cardiovascular & respiratory

Answer: A · Remove the cannula, document and monitor the site

Why this is the answer

Redness, pain, warmth and swelling along the vein indicate phlebitis. The cannula is removed, the site is observed for infection and the event is documented. Regular visual phlebitis scoring and removing cannulas that are no longer needed reduce the risk.

Answer

A · Remove the cannula, document and monitor the site
10.Med-surg: cardiovascular & respiratory

Answer: D · Asthma

Why this is the answer

Asthma typically causes variable symptoms with reversible airflow obstruction. COPD usually affects older people with a smoking history and causes persistent, poorly reversible obstruction. Fibrosis gives a restrictive pattern.

Answer

D · Asthma
11.Med-surg: neuro, endocrine & renal

Answer: C · Late doses can soon cause stiffness, falls and poor swallowing

Why this is the answer

People with Parkinson's disease often take doses at exact times. A delay of even 30 minutes or so can cause rigidity, immobility, falls and unsafe swallowing. Many hospitals treat these drugs as time-critical.

Answer

C · Late doses can soon cause stiffness, falls and poor swallowing
12.Med-surg: neuro, endocrine & renal

Answer: A · Give subcutaneous insulin with a meal, then stop the IV after an overlap

Why this is the answer

IV insulin has a very short half-life. Stopping it before subcutaneous insulin starts working leads to rebound ketosis. Subcutaneous insulin is given and the infusion continued for a set overlap (often 30–60 minutes after rapid-acting insulin with a meal). Basal insulin is often continued during the infusion in modern protocols.

Answer

A · Give subcutaneous insulin with a meal, then stop the IV after an overlap
13.Med-surg: GI, perioperative & oncology

Answer: D · Chlorhexidine skin preparation

Why this is the answer

Common causes of perioperative anaphylaxis include neuromuscular blockers, antibiotics, chlorhexidine and latex. Allergies are documented, and suspected reactions are investigated afterwards.

Answer

D · Chlorhexidine skin preparation
14.Med-surg: GI, perioperative & oncology

Answer: C · Restore the seal; if that fails in time, change to a moist dressing

Why this is the answer

NPWT needs an airtight seal. If the seal or suction is lost and cannot be restored promptly (many guidelines say within about 2 hours), the foam is removed and replaced with a standard dressing to reduce infection risk. Manufacturer and local guidance define the safe interval.

Answer

C · Restore the seal; if that fails in time, change to a moist dressing

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