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 has a serum potassium of 6.8 mEq/L. Which action comes first?

  1. APlace the patient on a cardiac monitor
  2. BGive the patient’s scheduled potassium supplement
  3. CRecheck the level next week
  4. DEncourage foods high in potassium
2.Prioritization & delegationHard

Which child should the nurse see first?

  1. AA toddler with a temperature of 38.4 °C who is playing with toys
  2. BA school-aged child with a leg cast who is asking for a drink
  3. CA teenager with asthma whose peak flow is 90% of their personal best
  4. DAn infant with RSV who has nasal flaring, chest retractions and an SpO₂ of 89%
3.Infection control & patient safetyMedium

A patient wishes to refuse a prescribed medicine. What should the nurse do?

  1. AGive it anyway, because it was prescribed
  2. BRecord the dose as given to avoid questions from the team
  3. CHide the medicine in the patient’s food or drink to make sure it is taken
  4. DExplore the reason, explain, respect a competent choice and document
4.Infection control & patient safetyHard

Which pairing of an organism with its transmission-based precautions is correct?

  1. AC. difficile – airborne
  2. BMeasles – contact only
  3. CMumps – droplet
  4. DInfluenza – airborne only
5.Lab values & electrolytesMedium

A patient’s white cell count is 16 × 10³/µL with a high proportion of immature neutrophils (bands). What does this most likely indicate?

  1. AAn acute bacterial infection
  2. BA chronic viral illness only
  3. CA normal result
  4. DIron-deficiency anemia
6.Lab values & electrolytesHard

Which cerebrospinal fluid (CSF) pattern most strongly suggests bacterial meningitis?

  1. AClear fluid, high glucose, low protein, many red cells
  2. BClear fluid, normal glucose, normal protein, no white cells
  3. CCloudy fluid, low glucose, high protein, many neutrophils
  4. DClear fluid, normal glucose, mildly raised protein, lymphocytes
7.Clinical nursingMedium

Why are alternate sutures sometimes removed first when taking out stitches?

  1. ATo reduce the cost of dressings
  2. BTo check the wound stays closed before removing the rest
  3. CBecause the remaining sutures dissolve on their own within a day
  4. DTo make the procedure faster
8.Clinical nursingHard

Why must severe chronic hyponatraemia be corrected slowly?

  1. ASodium given quickly causes immediate cardiac arrest
  2. BFast correction makes the kidneys stop producing urine
  3. CToo-rapid correction can cause osmotic demyelination in the brain
  4. DFast correction causes severe hypoglycaemia and seizures in most patients
9.Med-surg: cardiovascular & respiratoryMedium

A patient has exercise-induced asthma. Which advice is most appropriate?

  1. AExercise only in cold, dry air to toughen the airways
  2. BAvoid all forms of exercise permanently to prevent attacks
  3. CTake a beta-blocker before exercise
  4. DUse the reliever inhaler shortly before exercise and warm up
10.Med-surg: cardiovascular & respiratoryHard

A patient's chest drain tubing disconnects from the drainage unit. What should the nurse do first?

  1. ARemove the drain from the chest and cover the site
  2. BClamp the tube for several hours and recheck the patient later
  3. CLeave it open to air until the doctor arrives to review it
  4. DReconnect it, or put the tube end in sterile water, then assess
11.Med-surg: neuro, endocrine & renalMedium

Fifteen minutes after treatment with glucose tablets, a patient's glucose has risen from 3.2 to 5.1 mmol/L. Their next meal is in two hours. What should happen next?

  1. AGive the usual dose of rapid-acting insulin straight away
  2. BGive a longer-acting carbohydrate snack, such as a sandwich
  3. CNo further action is needed until the next meal is served later
  4. DGive another dose of glucose tablets to push it higher
12.Med-surg: neuro, endocrine & renalHard

A patient has frothy urine and marked leg swelling. Serum albumin is 18 g/L (1.8 g/dL), and BP is normal. The urine shows heavy protein but little blood. What is most likely?

  1. AAcute pyelonephritis
  2. BNephrotic syndrome
  3. CNephritic syndrome
  4. DA urethral stricture
13.Med-surg: GI, perioperative & oncologyMedium

Dysphagia that started with solids and now includes liquids, with weight loss, most suggests which cause?

  1. ANormal ageing of the swallowing muscles
  2. BA narrowing such as an oesophageal tumour
  3. CA dry mouth from drinking too little water
  4. DSimple anxiety about swallowing tablets
14.Med-surg: GI, perioperative & oncologyHard

After signing the consent form, a patient tells the nurse, "I don't really understand what they are going to do." What should the nurse do?

  1. AIgnore the comment because the form is already signed
  2. BReassure the patient that the surgeon knows best
  3. CInform the surgeon so that the procedure can be explained again
  4. DExplain the surgical risks in detail without involving the surgeon

3Solutions

1.Prioritization & delegation

Answer: A · Place the patient on a cardiac monitor

Why this is the answer

Severe hyperkalemia can cause dangerous arrhythmias, so continuous cardiac monitoring comes first while the provider is informed and treatment is prepared.

Answer

A · Place the patient on a cardiac monitor
2.Prioritization & delegation

Answer: D · An infant with RSV who has nasal flaring, chest retractions and an SpO₂ of 89%

Why this is the answer

Nasal flaring, retractions and low SpO₂ show respiratory distress, and infants can deteriorate very quickly. A playing child with fever, a thirsty child and a teenager with near-normal peak flow are stable.

Answer

D · An infant with RSV who has nasal flaring, chest retractions and an SpO₂ of 89%
3.Infection control & patient safety

Answer: D · Explore the reason, explain, respect a competent choice and document

Why this is the answer

The right to refuse is one of the rights of medication administration. The nurse finds out why and gives information, but a competent patient’s decision is respected. Covert administration without a legal process, or false documentation, is unacceptable.

Answer

D · Explore the reason, explain, respect a competent choice and document
4.Infection control & patient safety

Answer: C · Mumps – droplet

Why this is the answer

Mumps spreads by respiratory droplets, so droplet precautions are used. Measles is airborne, C. difficile needs contact precautions, and influenza needs droplet precautions.

Answer

C · Mumps – droplet
5.Lab values & electrolytes

Answer: A · An acute bacterial infection

Why this is the answer

A raised white count with more bands (a “left shift”) suggests that the marrow is responding to an acute bacterial infection or severe inflammation. The result is read together with the patient’s signs, such as fever.Checked against: Blood Differential · MedlinePlus (NIH) (2024)

Answer

A · An acute bacterial infection
6.Lab values & electrolytes

Answer: C · Cloudy fluid, low glucose, high protein, many neutrophils

Why this is the answer

Bacterial meningitis typically gives cloudy CSF with many neutrophils, high protein and low glucose, because bacteria and white cells use glucose. Viral meningitis usually shows lymphocytes with a normal glucose; option C is normal CSF.Checked against: CSF glucose test · MedlinePlus (NIH) (2025); CSF cell count · MedlinePlus (NIH) (2025); CSF total protein · MedlinePlus (NIH) (2025)

Answer

C · Cloudy fluid, low glucose, high protein, many neutrophils
7.Clinical nursing

Answer: B · To check the wound stays closed before removing the rest

Why this is the answer

Removing alternate sutures allows the nurse to see whether the wound edges stay together. If they begin to separate, the remaining sutures can be left and the team informed.

Answer

B · To check the wound stays closed before removing the rest
8.Clinical nursing

Answer: C · Too-rapid correction can cause osmotic demyelination in the brain

Why this is the answer

In chronic hyponatraemia brain cells adapt to the low tonicity. A rapid rise in sodium draws water out too fast and can cause osmotic demyelination, so the correction rate is limited and sodium is checked often.

Answer

C · Too-rapid correction can cause osmotic demyelination in the brain
9.Med-surg: cardiovascular & respiratory

Answer: D · Use the reliever inhaler shortly before exercise and warm up

Why this is the answer

A short-acting bronchodilator taken shortly before exercise, a gradual warm-up and covering the mouth in cold air help prevent symptoms. Frequent exercise symptoms may mean asthma is poorly controlled and preventer treatment needs review.

Answer

D · Use the reliever inhaler shortly before exercise and warm up
10.Med-surg: cardiovascular & respiratory

Answer: D · Reconnect it, or put the tube end in sterile water, then assess

Why this is the answer

A disconnected tube lets atmospheric air enter the pleural space. Reconnecting quickly, or submerging the tube end 2–3 cm in sterile water as a temporary seal, restores the one-way valve. Then assess for respiratory distress and inform the team. Prolonged clamping risks tension pneumothorax.

Answer

D · Reconnect it, or put the tube end in sterile water, then assess
11.Med-surg: neuro, endocrine & renal

Answer: B · Give a longer-acting carbohydrate snack, such as a sandwich

Why this is the answer

Once glucose is above 4 mmol/L, a longer-acting carbohydrate (or the next meal if it is due) prevents a recurrence. The cause of the hypoglycaemia should be identified and documented, and the treatment plan reviewed if episodes recur.

Answer

B · Give a longer-acting carbohydrate snack, such as a sandwich
12.Med-surg: neuro, endocrine & renal

Answer: B · Nephrotic syndrome

Why this is the answer

Heavy proteinuria, very low albumin and oedema point to nephrotic syndrome. Nephritic syndrome is mainly haematuria with hypertension and reduced urine output. The cause is investigated, often with a biopsy.

Answer

B · Nephrotic syndrome
13.Med-surg: GI, perioperative & oncology

Answer: B · A narrowing such as an oesophageal tumour

Why this is the answer

Progressive dysphagia, solids first then liquids, with weight loss, is typical of a mechanical obstruction such as oesophageal cancer or a stricture. It needs an urgent referral for endoscopy.

Answer

B · A narrowing such as an oesophageal tumour
14.Med-surg: GI, perioperative & oncology

Answer: C · Inform the surgeon so that the procedure can be explained again

Why this is the answer

Valid consent requires understanding. The nurse advocates for the patient and asks the surgeon (who obtains consent) to explain again before surgery goes ahead. The conversation is documented.

Answer

C · Inform the surgeon so that the procedure can be explained again

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