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 with a head injury is being monitored. Which set of findings suggests rising intracranial pressure?

  1. ALow temperature, fast breathing and a strong appetite
  2. BRising systolic pressure, slow pulse and irregular breathing
  3. CNormal blood pressure, normal pulse and clear speech
  4. DFalling blood pressure, a fast pulse and warm, flushed dry skin
2.Prioritization & delegationHard

A patient is admitted with suspected meningococcal meningitis. Which precautions are needed until treatment has been given for long enough?

  1. AContact precautions only
  2. BStandard precautions only
  3. CDroplet precautions
  4. DAirborne precautions
3.Infection control & patient safetyMedium

Two patients infected with the same organism are admitted, and no single room is available. What is an accepted option?

  1. APlacing them in the corridor
  2. BPlacing each with a patient who has a weakened immune system
  3. CCohorting them in the same room, according to infection control advice
  4. DStopping contact precautions
4.Infection control & patient safetyHard

A nurse has given a medication to the wrong patient. The patient seems well. What is the first priority?

  1. ASay nothing to the patient, in order to avoid worrying them
  2. BAssess the patient and monitor for effects of the drug
  3. CComplete the incident report before anything else
  4. DWait until the end of the shift to tell anyone
5.Lab values & electrolytesMedium

Which technique is recommended for a capillary blood glucose test on an adult's finger?

  1. APrick the center of the fingertip
  2. BSqueeze the finger very hard
  3. CUse the same finger every time
  4. DPrick the side of the fingertip
6.Lab values & electrolytesHard

A patient with kidney stones and fatigue has a calcium of 11.6 mg/dL (2.9 mmol/L), a high parathyroid hormone (PTH) and a low phosphate. Which condition is most likely?

  1. APrimary hyperparathyroidism
  2. BHypoparathyroidism
  3. CCancer-related hypercalcemia
  4. DVitamin D deficiency
7.Clinical nursingMedium

A new colostomy stoma appears dark purple to black on the second postoperative day. What does this indicate?

  1. AA normal healthy stoma
  2. BPossible ischaemia of the stoma, which needs urgent review
  3. CNormal postoperative bruising of the stoma that needs no action
  4. DConstipation
8.Clinical nursingHard

A patient on an unfractionated heparin infusion is also started on warfarin. Which tests are used to monitor each drug?

  1. AINR for heparin and APTT for warfarin
  2. BAPTT for heparin and INR for warfarin
  3. CD-dimer for both drugs
  4. DPlatelet count for both drugs
9.Med-surg: cardiovascular & respiratoryMedium

Which statement about a spacer for a metered-dose inhaler is correct?

  1. ALess coordination is needed, and more drug reaches the lungs
  2. BIt makes each puff of the drug stronger than usual
  3. CIt is designed to be used with dry-powder inhalers
  4. DIt means the steroid preventer inhaler can be stopped altogether
10.Med-surg: cardiovascular & respiratoryHard

A patient with asthma needs their reliever every three hours and their peak flow is falling well below their personal best. What does their action plan most likely advise?

  1. AStop the preventer inhaler for a few days to rest the lungs
  2. BFollow the worsening-asthma steps and get a same-day review
  3. CWait two weeks to see whether it improves without any change
  4. DDo extra exercise to open the airways
11.Med-surg: neuro, endocrine & renalMedium

Which finding most suggests fluid overload in a patient with chronic kidney disease?

  1. AA weight gain of 2 kg (4.4 lb) in two days with ankle swelling
  2. BA weight loss of 1 kg (2.2 lb) after a hot day
  3. CA dry mouth and a low blood pressure when standing
  4. DDark yellow urine and thirst
12.Med-surg: neuro, endocrine & renalHard

A patient with Addison's disease has been vomiting for a day. They are confused, with BP 78/40 mmHg, sodium 126 mmol/L and potassium 6.0 mmol/L. What is the priority?

  1. AIV potassium to correct the electrolytes
  2. BOral hydrocortisone and an antiemetic by mouth
  3. CIV hydrocortisone straight away, plus IV fluids
  4. DA fluid restriction for the low sodium
13.Med-surg: GI, perioperative & oncologyMedium

Which statement about moist wound healing is correct?

  1. AA moist, not wet, wound bed helps cells move and heal faster
  2. BWounds heal fastest when left to dry out and form a scab
  3. CWounds should be soaked in water for hours every day
  4. DA wet wound bed always prevents infection
14.Med-surg: GI, perioperative & oncologyHard

A patient has had a large terminal ileum resection for Crohn's disease. Which long-term problems should the nurse anticipate?

  1. AIron overload and constipation
  2. BExcess vitamin D and calcium kidney stones in the first year
  3. CInsulin deficiency and high blood glucose from loss of the islets
  4. DVitamin B12 deficiency and bile-acid diarrhoea

3Solutions

1.Prioritization & delegation

Answer: B · Rising systolic pressure, slow pulse and irregular breathing

Why this is the answer

Cushing’s triad (high systolic pressure with a widening pulse pressure, bradycardia and irregular respirations) is a late sign of raised intracranial pressure and needs urgent escalation.

Answer

B · Rising systolic pressure, slow pulse and irregular breathing
2.Prioritization & delegation

Answer: C · Droplet precautions

Why this is the answer

Neisseria meningitidis spreads by respiratory droplets, so a surgical mask is worn within close range. Droplet precautions continue until the patient has received effective antibiotics for about 24 hours.

Answer

C · Droplet precautions
3.Infection control & patient safety

Answer: C · Cohorting them in the same room, according to infection control advice

Why this is the answer

When single rooms are short, patients with the same organism (and no other infections) can share a room (cohorting), with precautions continued. Infection control staff advise on this.

Answer

C · Cohorting them in the same room, according to infection control advice
4.Infection control & patient safety

Answer: B · Assess the patient and monitor for effects of the drug

Why this is the answer

The first priority is the patient’s safety: assess, monitor and inform the prescriber, who decides on any treatment. The error is then reported through the hospital’s system and the patient is told according to policy.

Answer

B · Assess the patient and monitor for effects of the drug
5.Lab values & electrolytes

Answer: D · Prick the side of the fingertip

Why this is the answer

The sides of the fingertips are less sensitive than the pads, so they are used for capillary sampling. Rotating sites reduces soreness, and hard squeezing can add tissue fluid that gives inaccurate results.

Answer

D · Prick the side of the fingertip
6.Lab values & electrolytes

Answer: A · Primary hyperparathyroidism

Why this is the answer

In primary hyperparathyroidism, usually from an adenoma, PTH is high despite high calcium, and phosphate is low because PTH increases its excretion. Cancer-related hypercalcemia typically has a suppressed PTH.Checked against: Parathyroid Hormone (PTH) Test · MedlinePlus (NIH) (2023); Hyperparathyroidism · MedlinePlus (NIH) (2026)

Answer

A · Primary hyperparathyroidism
7.Clinical nursing

Answer: B · Possible ischaemia of the stoma, which needs urgent review

Why this is the answer

A dusky or black stoma suggests poor blood supply and possible necrosis, and must be reported promptly to the surgical team.

Answer

B · Possible ischaemia of the stoma, which needs urgent review
8.Clinical nursing

Answer: B · APTT for heparin and INR for warfarin

Why this is the answer

The APTT reflects the intrinsic pathway and is used to adjust heparin infusions. Warfarin is monitored by the INR, a standardised prothrombin time. Platelets are also checked on heparin to detect HIT.

Answer

B · APTT for heparin and INR for warfarin
9.Med-surg: cardiovascular & respiratory

Answer: A · Less coordination is needed, and more drug reaches the lungs

Why this is the answer

A spacer slows the aerosol and holds it so the patient can inhale it with slow breaths. More drug reaches the lungs and less is deposited in the mouth. It is used with pressurised metered-dose inhalers, not dry-powder devices.

Answer

A · Less coordination is needed, and more drug reaches the lungs
10.Med-surg: cardiovascular & respiratory

Answer: B · Follow the worsening-asthma steps and get a same-day review

Why this is the answer

Personal asthma action plans set steps based on symptoms and peak flow compared with the personal best. Increasing reliever need and a falling peak flow mean worsening asthma: treatment is increased as the plan says (sometimes with oral steroids) and urgent review is sought. Severe signs need emergency care.

Answer

B · Follow the worsening-asthma steps and get a same-day review
11.Med-surg: neuro, endocrine & renal

Answer: A · A weight gain of 2 kg (4.4 lb) in two days with ankle swelling

Why this is the answer

Rapid weight gain reflects fluid retention. Oedema, breathlessness, crackles in the lungs and a raised blood pressure are other signs. Daily weights are a simple and reliable way to track fluid balance.

Answer

A · A weight gain of 2 kg (4.4 lb) in two days with ankle swelling
12.Med-surg: neuro, endocrine & renal

Answer: C · IV hydrocortisone straight away, plus IV fluids

Why this is the answer

An adrenal crisis is life-threatening. IV or IM hydrocortisone is given immediately, without waiting for tests, together with IV saline and checks of glucose and electrolytes. Vomiting prevents tablets from being absorbed.

Answer

C · IV hydrocortisone straight away, plus IV fluids
13.Med-surg: GI, perioperative & oncology

Answer: A · A moist, not wet, wound bed helps cells move and heal faster

Why this is the answer

A moist environment supports cell migration, autolytic debridement and less pain. Too much moisture causes maceration, so dressings are chosen to balance exudate.

Answer

A · A moist, not wet, wound bed helps cells move and heal faster
14.Med-surg: GI, perioperative & oncology

Answer: D · Vitamin B12 deficiency and bile-acid diarrhoea

Why this is the answer

The terminal ileum absorbs vitamin B12 and bile acids. After resection, B12 replacement may be needed, and unabsorbed bile acids reaching the colon cause diarrhoea.

Answer

D · Vitamin B12 deficiency and bile-acid diarrhoea

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