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

Which patient should the RN see first after receiving a report from the night nurse?

  1. ADay 4 after bowel surgery, waiting for discharge teaching
  2. BDay 1 after bowel surgery, new chest pain and heart rate 110/min
  3. CDay 2 after bowel surgery, asking to start a soft diet
  4. DDay 3 after bowel surgery, wants a shower and hair wash before breakfast
2.Prioritization & delegationHard

Four patients arrive at the emergency department at the same time. Who should be seen first?

  1. AA young adult with a swollen, painful ankle after a fall on the stairs
  2. BAn adult with kidney stone pain of 9/10 and stable vital signs
  3. CA child with a temperature of 39 °C who is alert and drinking
  4. DAn older adult with weakness on one side that began 40 minutes ago
3.Infection control & patient safetyMedium

Sterile saline is spilled on a sterile drape that lies on a non-sterile table. What does this mean?

  1. AThe field stays sterile, because saline is sterile
  2. BThe field becomes sterile again when it dries
  3. CThe field is contaminated, because moisture can carry organisms through the drape
  4. DOnly the wet part is contaminated, so items can be moved to the dry part
4.Infection control & patient safetyHard

A nurse teaches a patient about care of a surgical incision at home. Which statement shows a need for further teaching?

  1. A“I will keep the dressing clean and dry as I was shown.”
  2. B“If the wound gets red and drains pus, I will wait for my appointment next month.”
  3. C“I will call the clinic if I get a fever or more pain around the wound.”
  4. D“I will wash my hands with soap before I touch or change the dressing.”
5.Lab values & electrolytesMedium

A patient with recurrent gout starts allopurinol. Which laboratory result shows that the treatment is achieving its goal?

  1. AA falling serum potassium
  2. BA rising white cell count
  3. CA falling serum uric acid
  4. DA rising serum calcium
6.Lab values & electrolytesHard

An RN cares for a patient on a 24-hour urine collection. Which task can be delegated to unlicensed assistive personnel (UAP), such as a nursing or healthcare assistant?

  1. ADeciding whether to restart the collection after a missed sample
  2. BSaving all urine in the collection container as instructed
  3. CTeaching the patient why the 24-hour collection is needed
  4. DInterpreting the creatinine clearance result when it comes back
7.Clinical nursingMedium

How should a nurse communicate with a patient who has impaired hearing?

  1. ASpeak very quickly to save time
  2. BTalk to the patient's relative instead of to the patient directly
  3. CFace the patient, speak clearly and reduce background noise
  4. DShout loudly from the end of the bed so they can hear
8.Clinical nursingHard

A patient with central chest pain has ST elevation on the 12-lead ECG. What is the main aim of urgent treatment?

  1. AStrict bed rest for several days before deciding on treatment
  2. BStarting a cholesterol-lowering drug before any other treatment is given
  3. CWaiting for the troponin result before taking any action
  4. DRestoring blood flow through the blocked coronary artery quickly
9.Med-surg: cardiovascular & respiratoryMedium

A patient with bronchiectasis of the right lower lobe is taught postural drainage. How should they be positioned?

  1. ASitting fully upright at all times
  2. BWith the affected lobe uppermost so gravity drains it
  3. CWith the affected lobe lowest so it fills with mucus
  4. DFlat on the back with the arms raised
10.Med-surg: cardiovascular & respiratoryHard

A patient with a confirmed calf DVT has started therapeutic anticoagulation and asks whether they must stay in bed. What is the most accurate answer?

  1. AWalking is not allowed until the clot has fully dissolved
  2. BWalking as tolerated is usually encouraged once treated
  3. CStrict bed rest is needed for at least two weeks
  4. DThe leg should be massaged before each walk
11.Med-surg: neuro, endocrine & renalMedium

Which nursing action helps most to prevent and manage delirium in an older inpatient?

  1. AUse glasses and hearing aids and reorient the patient often
  2. BRestrain the patient so that they do not wander off the ward
  3. CKeep the lights on all night so the patient can see clearly
  4. DMove the patient to a different room each day for variety
12.Med-surg: neuro, endocrine & renalHard

A patient with diabetic neuropathy has a hot, red, swollen foot that is barely painful. The skin is intact, and there is no fever. What should the nurse suspect?

  1. AAn acute Charcot foot, needing urgent offloading
  2. BGout, which only needs pain relief
  3. CNormal swelling from standing too long
  4. DA sprained ankle that will settle with walking
13.Med-surg: GI, perioperative & oncologyMedium

Which statement about fatigue during radiotherapy is correct?

  1. AIt is caused by the patient becoming radioactive
  2. BIt often builds during the course and can last for weeks
  3. CIt means the radiotherapy has failed
  4. DIt occurs only after the first session and then disappears completely
14.Med-surg: GI, perioperative & oncologyHard

In recovery, an awake and anxious patient cannot lift their head, and their breaths are shallow and weak. What is the most likely cause?

  1. AA simple panic attack
  2. BOpioid overdose with pinpoint pupils
  3. CResidual neuromuscular blockade
  4. DNormal tiredness after surgery

3Solutions

1.Prioritization & delegation

Answer: B · Day 1 after bowel surgery, new chest pain and heart rate 110/min

Why this is the answer

New chest pain and tachycardia after surgery could be a myocardial infarction or pulmonary embolism. This patient needs immediate assessment; the others have routine needs.

Answer

B · Day 1 after bowel surgery, new chest pain and heart rate 110/min
2.Prioritization & delegation

Answer: D · An older adult with weakness on one side that began 40 minutes ago

Why this is the answer

Sudden one-sided weakness suggests a stroke, and treatment depends on how quickly it starts. Severe kidney stone pain needs prompt pain relief, but the patient is stable.

Answer

D · An older adult with weakness on one side that began 40 minutes ago
3.Infection control & patient safety

Answer: C · The field is contaminated, because moisture can carry organisms through the drape

Why this is the answer

Liquid soaking through a drape can carry organisms up from the non-sterile surface below. The field is considered contaminated and is set up again.

Answer

C · The field is contaminated, because moisture can carry organisms through the drape
4.Infection control & patient safety

Answer: B · “If the wound gets red and drains pus, I will wait for my appointment next month.”

Why this is the answer

Increasing redness, purulent drainage, fever and worsening pain are signs of surgical site infection and should be reported promptly. Waiting a month could allow the infection to spread.

Answer

B · “If the wound gets red and drains pus, I will wait for my appointment next month.”
5.Lab values & electrolytes

Answer: C · A falling serum uric acid

Why this is the answer

Allopurinol reduces uric acid production by blocking xanthine oxidase. Over time, a lower serum uric acid reduces gout attacks and dissolves urate crystals. Kidney function is checked, and a rash must be reported because of rare severe skin reactions.Checked against: Gout · StatPearls (NCBI Bookshelf) (2026)

Answer

C · A falling serum uric acid
6.Lab values & electrolytes

Answer: B · Saving all urine in the collection container as instructed

Why this is the answer

UAP can help with routine, standard tasks such as saving urine and keeping the container cool as instructed. Teaching, clinical decisions and interpreting results require nursing judgment and stay with the RN.Checked against: 24-Hour Urine Collection and Analysis · StatPearls (NCBI Bookshelf) (2024)

Answer

B · Saving all urine in the collection container as instructed
7.Clinical nursing

Answer: C · Face the patient, speak clearly and reduce background noise

Why this is the answer

Facing the patient in good light, speaking clearly at a normal pace, checking hearing aids and reducing noise improves communication. Written information can also help.

Answer

C · Face the patient, speak clearly and reduce background noise
8.Clinical nursing

Answer: D · Restoring blood flow through the blocked coronary artery quickly

Why this is the answer

ST-elevation myocardial infarction means a coronary artery is usually completely blocked. Urgent reperfusion by primary PCI, or thrombolysis if PCI is not available in time, limits the amount of heart muscle that dies.

Answer

D · Restoring blood flow through the blocked coronary artery quickly
9.Med-surg: cardiovascular & respiratory

Answer: B · With the affected lobe uppermost so gravity drains it

Why this is the answer

Postural drainage places the patient so the affected segment is above the main bronchus, letting gravity move secretions towards the larger airways to be coughed up. It is combined with breathing techniques. Head-down positions are avoided in patients with reflux, recent surgery or breathlessness.

Answer

B · With the affected lobe uppermost so gravity drains it
10.Med-surg: cardiovascular & respiratory

Answer: B · Walking as tolerated is usually encouraged once treated

Why this is the answer

Early mobilisation with effective anticoagulation does not increase the risk of pulmonary embolism and may reduce pain, swelling and post-thrombotic syndrome. Routine bed rest is no longer recommended. Massage of the affected leg should be avoided.

Answer

B · Walking as tolerated is usually encouraged once treated
11.Med-surg: neuro, endocrine & renal

Answer: A · Use glasses and hearing aids and reorient the patient often

Why this is the answer

Non-drug measures are the mainstay of delirium care: glasses and hearing aids, clocks and calendars, familiar faces, good sleep, hydration, mobility and treating the cause. Restraints and frequent moves make delirium worse.

Answer

A · Use glasses and hearing aids and reorient the patient often
12.Med-surg: neuro, endocrine & renal

Answer: A · An acute Charcot foot, needing urgent offloading

Why this is the answer

Acute Charcot neuroarthropathy causes inflammation and destruction of bones and joints in a foot without protective sensation. It can look like cellulitis. Early immobilisation and offloading prevent permanent deformity.

Answer

A · An acute Charcot foot, needing urgent offloading
13.Med-surg: GI, perioperative & oncology

Answer: B · It often builds during the course and can last for weeks

Why this is the answer

Radiotherapy fatigue usually increases as treatment continues and may persist for weeks or months afterwards. Pacing, light exercise and good sleep and nutrition help.

Answer

B · It often builds during the course and can last for weeks
14.Med-surg: GI, perioperative & oncology

Answer: C · Residual neuromuscular blockade

Why this is the answer

Remaining muscle relaxant causes weakness, poor head lift and shallow breathing in an awake patient. The nurse supports breathing, gives oxygen and calls the anaesthetist, who may give a reversal agent.

Answer

C · Residual neuromuscular blockade

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