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

After a hip replacement using a posterior approach, which statement shows a need for further teaching?

  1. A“I will keep a pillow between my knees when I lie on my side in bed.”
  2. B“I will not bend my hip past 90 degrees.”
  3. C“I will use a raised toilet seat at home.”
  4. D“I will cross my legs when I sit, so I am more comfortable.”
2.Prioritization & delegationHard

During START triage, a non-walking adult breathes 24 times a minute, has a radial pulse, but cannot follow simple commands. Which category is the victim given?

  1. ABlack (expectant)
  2. BRed (immediate)
  3. CGreen (minor)
  4. DYellow (delayed)
3.Infection control & patient safetyMedium

A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?

  1. AMake the child vomit, using a finger at the back of the throat
  2. BGive syrup of ipecac from the medicine cabinet
  3. CContact the local poison advice service now for specific advice
  4. DWait to see whether any symptoms develop over the next day
4.Infection control & patient safetyHard

A nurse cannot find a confused patient who was in their room 15 minutes ago. What should the nurse do first?

  1. ACall the family to ask whether the patient has gone home on their own
  2. BDocument the absence at the end of the shift
  3. CAlert staff and security at once, following the missing-patient procedure
  4. DWait an hour in case the patient comes back
5.Lab values & electrolytesMedium

How does normal pregnancy usually affect serum creatinine?

  1. AIt stays exactly the same
  2. BIt rises with every week
  3. CIt falls, because GFR rises
  4. DIt rises, because GFR falls
6.Lab values & electrolytesHard

A patient with blood pressure that is hard to control has a potassium of 2.9 mEq/L, a sodium of 144 mEq/L and a raised serum bicarbonate, without taking a diuretic. Which condition is most likely?

  1. ACentral diabetes insipidus
  2. BPrimary adrenal insufficiency
  3. CSyndrome of inappropriate ADH
  4. DPrimary hyperaldosteronism
7.Clinical nursingMedium

A patient receives IV furosemide for fluid overload. Which findings show the treatment is working?

  1. AFalling urine output, new ankle swelling and a rise in weight
  2. BIncreased urine output, less breathlessness and a falling weight
  3. CA rise in blood pressure and a new cough
  4. DA rise in weight and more lung crackles
8.Clinical nursingHard

A patient with a confirmed pulmonary embolism is started on anticoagulation. Which statement best explains its purpose?

  1. AIt thins the blood so that the lungs absorb more oxygen
  2. BIt stops the clot growing and prevents new clots while the body breaks it down
  3. CIt dissolves the clot completely within minutes of the first dose being given
  4. DIt is mainly given to lower the blood pressure
9.Med-surg: cardiovascular & respiratoryMedium

Why is a raised serum lactate concerning in a patient with shock?

  1. AIt means the kidneys are working harder than normal to clear fluid
  2. BIt confirms a bacterial infection is present
  3. CIt shows only that the patient has eaten a large meal in the past hour
  4. DIt suggests tissues are short of oxygen and using anaerobic metabolism
10.Med-surg: cardiovascular & respiratoryHard

During a severe asthma attack, a patient's PaCO₂ rises from low to normal while they look exhausted. What does this mean?

  1. AThe sample is probably venous and can be ignored
  2. BThe patient is hyperventilating because of anxiety
  3. CThe attack is resolving and treatment can be reduced
  4. DThe patient is tiring and respiratory failure may follow
11.Med-surg: neuro, endocrine & renalMedium

Before surgery for a phaeochromocytoma, why is an alpha-blocker started before any beta-blocker?

  1. ABeta-blockers given first would make the tumour grow faster
  2. BThe order of the two drugs makes no difference
  3. CA beta-blocker alone can cause a dangerous rise in BP
  4. DAlpha-blockers lower the blood glucose before surgery
12.Med-surg: neuro, endocrine & renalHard

A nurse teaches a patient with Hashimoto's thyroiditis about levothyroxine. Which statement shows a need for further teaching?

  1. A"I will report palpitations or chest pain."
  2. B"I will have regular blood tests to check my dose."
  3. C"I will take the tablets at the same time each day."
  4. D"I can stop the tablets once I feel back to normal."
13.Med-surg: GI, perioperative & oncologyMedium

Which electrolyte abnormality can contribute to a postoperative ileus?

  1. AHypokalaemia
  2. BHyperphosphataemia
  3. CHypernatraemia
  4. DHyperkalaemia
14.Med-surg: GI, perioperative & oncologyHard

Hours after an oesophageal dilatation, a patient has chest pain, fever and crackling swelling under the skin of the neck. What should the nurse suspect?

  1. AOesophageal perforation
  2. BNormal discomfort after the procedure
  3. CSimple reflux after the dilatation
  4. DAn allergic reaction to the sedative

3Solutions

1.Prioritization & delegation

Answer: D · “I will cross my legs when I sit, so I am more comfortable.”

Why this is the answer

After a posterior hip replacement, crossing the legs, bending the hip beyond 90 degrees and turning the leg inwards can cause dislocation. Raised seats and a pillow between the knees help prevent it.

Answer

D · “I will cross my legs when I sit, so I am more comfortable.”
2.Prioritization & delegation

Answer: B · Red (immediate)

Why this is the answer

A victim who fails the mental status check (cannot follow simple commands) is immediate, even when breathing and perfusion are acceptable. This may signal a head injury or shock.

Answer

B · Red (immediate)
3.Infection control & patient safety

Answer: C · Contact the local poison advice service now for specific advice

Why this is the answer

A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.

Answer

C · Contact the local poison advice service now for specific advice
4.Infection control & patient safety

Answer: C · Alert staff and security at once, following the missing-patient procedure

Why this is the answer

A missing vulnerable patient is an emergency. The nurse immediately activates the facility’s missing-patient procedure so a search starts, and the provider and family are informed per policy.

Answer

C · Alert staff and security at once, following the missing-patient procedure
5.Lab values & electrolytes

Answer: C · It falls, because GFR rises

Why this is the answer

In pregnancy, kidney blood flow and GFR rise by about 50%, so creatinine falls below non-pregnant values. A creatinine that looks "normal" for a non-pregnant adult may indicate reduced kidney function in pregnancy.

Answer

C · It falls, because GFR rises
6.Lab values & electrolytes

Answer: D · Primary hyperaldosteronism

Why this is the answer

Excess aldosterone causes sodium and water retention (hypertension), potassium loss (hypokalemia) and hydrogen ion loss (metabolic alkalosis). Adrenal insufficiency causes the opposite pattern, with low sodium and high potassium.Checked against: Primary and secondary hyperaldosteronism · MedlinePlus (NIH) (2025); Alkalosis · StatPearls (NCBI Bookshelf) (2024)

Answer

D · Primary hyperaldosteronism
7.Clinical nursing

Answer: B · Increased urine output, less breathlessness and a falling weight

Why this is the answer

Effective diuresis increases urine output and reduces congestion, so breathing improves and weight falls. Electrolytes, renal function and blood pressure are also monitored.

Answer

B · Increased urine output, less breathlessness and a falling weight
8.Clinical nursing

Answer: B · It stops the clot growing and prevents new clots while the body breaks it down

Why this is the answer

Anticoagulants prevent clot extension and new clots; the body's own fibrinolysis gradually breaks down the existing clot. Thrombolysis, which actively dissolves clots, is reserved for massive PE with shock.

Answer

B · It stops the clot growing and prevents new clots while the body breaks it down
9.Med-surg: cardiovascular & respiratory

Answer: D · It suggests tissues are short of oxygen and using anaerobic metabolism

Why this is the answer

When tissues are poorly perfused, cells switch to anaerobic metabolism and produce lactate. A raised lactate is a marker of tissue hypoperfusion and severity in sepsis and shock. Repeated measurements show whether treatment is working.

Answer

D · It suggests tissues are short of oxygen and using anaerobic metabolism
10.Med-surg: cardiovascular & respiratory

Answer: D · The patient is tiring and respiratory failure may follow

Why this is the answer

Early in an attack, hyperventilation lowers PaCO₂. A normal or rising PaCO₂ in a breathless, tiring patient means ventilation is failing and is a life-threatening feature. Urgent senior and critical care review is needed.

Answer

D · The patient is tiring and respiratory failure may follow
11.Med-surg: neuro, endocrine & renal

Answer: C · A beta-blocker alone can cause a dangerous rise in BP

Why this is the answer

Blocking beta receptors alone leaves catecholamines acting on alpha receptors, causing severe vasoconstriction and a hypertensive crisis. Alpha blockade, such as with phenoxybenzamine, comes first, and a beta-blocker may be added later for tachycardia.

Answer

C · A beta-blocker alone can cause a dangerous rise in BP
12.Med-surg: neuro, endocrine & renal

Answer: D · "I can stop the tablets once I feel back to normal."

Why this is the answer

In Hashimoto's thyroiditis the gland is permanently damaged, so levothyroxine is usually lifelong. Feeling well shows that the dose is right, not that the disease is cured. Stopping causes symptoms to return.

Answer

D · "I can stop the tablets once I feel back to normal."
13.Med-surg: GI, perioperative & oncology

Answer: A · Hypokalaemia

Why this is the answer

Low potassium impairs smooth muscle contraction and is a common correctable contributor to ileus. Magnesium and other electrolytes are also checked and corrected.

Answer

A · Hypokalaemia
14.Med-surg: GI, perioperative & oncology

Answer: A · Oesophageal perforation

Why this is the answer

Chest pain, fever and surgical (subcutaneous) emphysema after instrumentation suggest oesophageal perforation, which can cause mediastinitis. The patient is kept nil by mouth and reviewed urgently; CT confirms it.

Answer

A · Oesophageal perforation

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