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 nurse teaches a patient about storing insulin at home. Which statement shows a need for further teaching?

  1. A“I will not leave my insulin in a hot car.”
  2. B“I will keep my spare insulin in the freezer so it lasts longer.”
  3. C“I will check the expiry date on the label before I use the vial.”
  4. D“I will keep unopened insulin in the fridge.”
2.Prioritization & delegationHard

A medical-unit nurse is floated to intensive care and given a patient on a ventilator, which the nurse has never managed. What is the best response?

  1. ALeave the intensive care unit and go back to the medical unit without telling anyone
  2. BRefuse to work and go home, because the assignment is unsafe
  3. CAccept the full assignment without comment to avoid conflict
  4. DTell the charge nurse about the gap, accept tasks within competence and ask for support
3.Infection control & patient safetyMedium

A family member will visit a patient on contact precautions. What should the nurse do?

  1. ATell them visits are not allowed at all
  2. BTell them precautions only apply to staff
  3. CShow them how to use the gown and gloves and how to clean their hands
  4. DAsk them to wear an N95 respirator only, with no gown or gloves
4.Infection control & patient safetyHard

During a urinary catheter insertion with sterile technique, the catheter tip touches the patient’s thigh. What should the nurse do?

  1. AWipe the tip with an antiseptic and continue
  2. BContinue, because the thigh was cleaned
  3. CRinse the tip with sterile water and then continue
  4. DDiscard the catheter and use a new sterile one
5.Lab values & electrolytesMedium

A stool test for Clostridioides difficile is ordered. Which sample is appropriate?

  1. AA rectal swab from a patient with constipation
  2. BAny stool after a laxative dose
  3. CA formed, hard stool sample
  4. DAn unformed (liquid or soft) stool
6.Lab values & electrolytesHard

Which patient should the nurse assess first?

  1. AStable angina with a total cholesterol of 245 mg/dL (6.3 mmol/L)
  2. BChest pain with troponin rising from the first to the second sample
  3. CHeart failure with a BNP lower than the result on admission
  4. DHypertension with a potassium of 3.6 mEq/L on a thiazide
7.Clinical nursingMedium

An arterial blood gas shows a low pH, a high PaCO2 and a normal bicarbonate. What does this show?

  1. AMetabolic acidosis
  2. BRespiratory acidosis
  3. CRespiratory alkalosis
  4. DMetabolic alkalosis
8.Clinical nursingHard

Which action is correct when caring for a chest drain with an underwater seal?

  1. AKeep the drainage bottle below the level of the chest
  2. BRemove the water from the bottle to prevent spills
  3. CLift the bottle above the patient to empty it
  4. DClamp the tube routinely during every transfer or bed move
9.Med-surg: cardiovascular & respiratoryMedium

After a permanent pacemaker is inserted, which instruction is commonly given for the first few weeks?

  1. AAvoid raising the arm on that side above shoulder height
  2. BMassage the wound firmly twice a day
  3. CDo not shower or wash at all for six weeks
  4. DKeep the arm completely still in a sling for six months or more
10.Med-surg: cardiovascular & respiratoryHard

During a thrombolytic infusion for an MI, the patient develops a sudden severe headache, vomiting and new confusion. What should the nurse do first?

  1. AGive a second dose to finish the treatment
  2. BSlow the infusion and give an antiemetic
  3. CStop the infusion and call for urgent medical help
  4. DContinue the infusion, as headache is a common side effect
11.Med-surg: neuro, endocrine & renalMedium

A patient taking sodium valproate becomes tired and is vomiting, and the nurse notices yellowing of the eyes. What is the main concern?

  1. ADehydration from drinking too little
  2. BLiver toxicity from valproate
  3. CA sign that the dose is too low
  4. DA normal adjustment reaction to the drug
12.Med-surg: neuro, endocrine & renalHard

A patient with multiple sclerosis has had worse leg weakness for one day, together with a fever and burning on passing urine. What is the most likely explanation?

  1. AA change to progressive MS
  2. BA pseudo-relapse caused by infection
  3. CA side effect of physiotherapy
  4. DA true relapse that needs high-dose steroids
13.Med-surg: GI, perioperative & oncologyMedium

Which treatment often relieves pain from a bone metastasis?

  1. AA diet low in calcium and vitamin D
  2. BIron supplements by mouth for several months
  3. CPalliative radiotherapy to the area
  4. DComplete bed rest for a month
14.Med-surg: GI, perioperative & oncologyHard

A patient with advanced cancer who has capacity decides to stop chemotherapy. The family insists that treatment must continue. What should the nurse do?

  1. AAsk the family to sign a new consent form
  2. BTell the patient that stopping is not allowed
  3. CSupport the patient's decision and help the team talk with the family
  4. DContinue treatment because the family has asked for it

3Solutions

1.Prioritization & delegation

Answer: B · “I will keep my spare insulin in the freezer so it lasts longer.”

Why this is the answer

Freezing damages insulin, and frozen insulin should not be used. Unopened insulin is kept in the fridge, and heat and expired products are avoided.

Answer

B · “I will keep my spare insulin in the freezer so it lasts longer.”
2.Prioritization & delegation

Answer: D · Tell the charge nurse about the gap, accept tasks within competence and ask for support

Why this is the answer

A nurse should clearly state the limits of their competence and ask for an assignment or support that keeps patients safe. Leaving without handover would be patient abandonment.

Answer

D · Tell the charge nurse about the gap, accept tasks within competence and ask for support
3.Infection control & patient safety

Answer: C · Show them how to use the gown and gloves and how to clean their hands

Why this is the answer

Visitors are taught how to put on and remove PPE as required by the policy and how to perform hand hygiene, so they protect themselves and other patients.

Answer

C · Show them how to use the gown and gloves and how to clean their hands
4.Infection control & patient safety

Answer: D · Discard the catheter and use a new sterile one

Why this is the answer

Once a sterile item touches a non-sterile surface, it is contaminated and is replaced. Inserting a contaminated catheter brings bacteria into the bladder and increases the risk of urinary tract infection.

Answer

D · Discard the catheter and use a new sterile one
5.Lab values & electrolytes

Answer: D · An unformed (liquid or soft) stool

Why this is the answer

C. difficile testing is done on unformed stool from patients with diarrhea, because many people carry the organism without disease. Testing formed stool, or stool after laxatives, can lead to misdiagnosis.Checked against: C. diff Testing · MedlinePlus (NIH) (2026)

Answer

D · An unformed (liquid or soft) stool
6.Lab values & electrolytes

Answer: B · Chest pain with troponin rising from the first to the second sample

Why this is the answer

A rising troponin with chest pain indicates acute myocardial injury, possibly infarction, which needs urgent assessment and treatment. High cholesterol is a long-term risk, a falling BNP shows improvement, and a potassium of 3.6 mEq/L is normal.Checked against: Troponin Test · MedlinePlus (NIH) (2023)

Answer

B · Chest pain with troponin rising from the first to the second sample
7.Clinical nursing

Answer: B · Respiratory acidosis

Why this is the answer

A raised PaCO2 with a low pH means the lungs are not removing enough CO2, for example from hypoventilation. A normal bicarbonate suggests it is acute.

Answer

B · Respiratory acidosis
8.Clinical nursing

Answer: A · Keep the drainage bottle below the level of the chest

Why this is the answer

The bottle stays below chest level so fluid and air cannot return to the pleural space. Routine clamping can cause a tension pneumothorax.

Answer

A · Keep the drainage bottle below the level of the chest
9.Med-surg: cardiovascular & respiratory

Answer: A · Avoid raising the arm on that side above shoulder height

Why this is the answer

Limiting arm movement on the device side for a few weeks reduces the risk of lead displacement. Patients are also taught to watch the wound for infection, carry their device card and follow advice on magnets and certain medical scans.

Answer

A · Avoid raising the arm on that side above shoulder height
10.Med-surg: cardiovascular & respiratory

Answer: C · Stop the infusion and call for urgent medical help

Why this is the answer

Sudden neurological change during or after thrombolysis suggests intracranial haemorrhage. The infusion is stopped immediately, help is called, and urgent CT and reversal are considered. Neurological observations continue.

Answer

C · Stop the infusion and call for urgent medical help
11.Med-surg: neuro, endocrine & renal

Answer: B · Liver toxicity from valproate

Why this is the answer

Valproate can cause serious liver injury, especially early in treatment. Jaundice, vomiting, lethargy or abdominal pain need urgent review and liver function tests. Pancreatitis is another rare but serious effect.

Answer

B · Liver toxicity from valproate
12.Med-surg: neuro, endocrine & renal

Answer: B · A pseudo-relapse caused by infection

Why this is the answer

Infection and fever can temporarily worsen existing MS symptoms without new damage (a pseudo-relapse). The infection, here probably a UTI, is treated first. Steroids for a true relapse are considered only if the infection is excluded.

Answer

B · A pseudo-relapse caused by infection
13.Med-surg: GI, perioperative & oncology

Answer: C · Palliative radiotherapy to the area

Why this is the answer

A single fraction or short course of radiotherapy relieves pain from bone metastases in many patients. Analgesia, including NSAIDs where suitable, and bone-targeted drugs are also used.

Answer

C · Palliative radiotherapy to the area
14.Med-surg: GI, perioperative & oncology

Answer: C · Support the patient's decision and help the team talk with the family

Why this is the answer

A competent adult can refuse treatment. The nurse advocates for the patient, supports communication with the family and team, and helps plan symptom control and palliative care.

Answer

C · Support the patient's decision and help the team talk with the family

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