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 asks a nursing assistant to “assess the patient’s pain and decide if the patient needs more medication”. Which right of delegation is violated?

  1. ARight circumstance
  2. BRight person
  3. CRight task
  4. DRight supervision and evaluation
2.Prioritization & delegationHard

In an emergency department, which patient should go straight to a treatment room?

  1. AA 45-year-old asking for a repeat prescription
  2. BA 60-year-old with chest pressure, sweating and nausea for 20 minutes
  3. CA 30-year-old with a sore throat for two days and a temperature of 38.0 °C
  4. DA 25-year-old with a sprained wrist and normal vital signs
3.Infection control & patient safetyMedium

A patient with a fever and a cough arrives in a crowded clinic waiting room. What should the nurse do?

  1. ADo nothing until the patient is seen by the provider
  2. BAsk the patient to wait outside in the car park
  3. CGive the patient a mask and seat them apart from others
  4. DGive everyone else in the waiting room a mask instead
4.Infection control & patient safetyHard

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

  1. AHelping the patient bathe while wearing a gown and gloves
  2. BDeciding when the precautions can be stopped
  3. CTeaching the family how to follow the precautions
  4. DAssessing the wound for new signs of infection during the bath
5.Lab values & electrolytesMedium

In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?

  1. AAt about 24–28 weeks of pregnancy
  2. BOnly after the baby is born
  3. CAt about 6–8 weeks of pregnancy
  4. DAt about 38–40 weeks of pregnancy
6.Lab values & electrolytesHard

A 68-year-old man has fatigue, a hemoglobin of 9.8 g/dL (98 g/L), an MCV of 72 fL and a low ferritin. He eats a normal diet. What is the most important next step?

  1. ARepeat the blood count in one year
  2. BLook for a source of blood loss in the gut
  3. CStart vitamin B12 injections
  4. DGive iron and do no further tests at all
7.Clinical nursingMedium

A patient is admitted with cellulitis of the leg. Why might the nurse mark the edge of the redness on the skin?

  1. ATo help the patient find the sore area
  2. BTo show the surgeon exactly where to make the incision
  3. CTo mark the site for an injection
  4. DTo monitor whether the infection is spreading or improving
8.Clinical nursingHard

Two days after a bowel resection, a patient has rising pain, fever, tachycardia and fluid that looks like faeces in the wound drain. What is most likely?

  1. AAnastomotic leak
  2. BUrinary retention
  3. CNormal postoperative recovery
  4. DConstipation
9.Med-surg: cardiovascular & respiratoryMedium

How should a patient breathe in when using a dry powder inhaler?

  1. AQuickly and deeply, after breathing out away from the device
  2. BThrough the nose with the mouthpiece in the mouth
  3. CSeveral times, breathing out into the device between breaths
  4. DSlowly and gently over about ten seconds
10.Med-surg: cardiovascular & respiratoryHard

A patient with severe sepsis becomes increasingly breathless over 24 hours. SpO₂ stays low despite high-flow oxygen, and the chest X-ray shows bilateral infiltrates. The heart function is normal. Which condition is most likely?

  1. AAcute respiratory distress syndrome
  2. BSpontaneous pneumothorax
  3. CAn acute asthma attack
  4. DAcute left ventricular failure after an MI
11.Med-surg: neuro, endocrine & renalMedium

After pressing the plunger of an insulin pen, what should the patient do?

  1. APull the needle out at once and rub the site firmly
  2. BInject a second dose straight away to be sure
  3. CLeave the needle on the pen for the next injection
  4. DKeep the needle in the skin for about 10 seconds
12.Med-surg: neuro, endocrine & renalHard

A patient with a brain tumour on high-dose dexamethasone has a capillary glucose of 16 mmol/L (288 mg/dL). They have no history of diabetes. What is the best explanation?

  1. AA sign that the brain tumour has now spread to the pancreas
  2. BA lab error, because steroids lower blood glucose
  3. CNormal for this patient, so no action is needed
  4. DSteroid-induced hyperglycaemia, which needs monitoring and treatment
13.Med-surg: GI, perioperative & oncologyMedium

How should a patient use an incentive spirometer after surgery?

  1. AUse it once a day, just before going to sleep at night
  2. BBreathe in slowly and deeply, then hold briefly
  3. CBlow out as hard and as fast as possible
  4. DBreathe quickly in and out ten times in a row
14.Med-surg: GI, perioperative & oncologyHard

A patient has a circumferential full-thickness burn of the upper arm. Which assessment is most important over the next hours?

  1. AVisual acuity in both eyes daily
  2. BCirculation and sensation of the hand
  3. CPupil size and reaction to light
  4. DBowel sounds and abdominal girth

3Solutions

1.Prioritization & delegation

Answer: C · Right task

Why this is the answer

Assessing a patient and deciding on treatment need nursing judgement, so the task itself cannot be delegated to assistive personnel. An assistant can report what the patient says, but the RN assesses and decides.

Answer

C · Right task
2.Prioritization & delegation

Answer: B · A 60-year-old with chest pressure, sweating and nausea for 20 minutes

Why this is the answer

Chest pressure with sweating and nausea may be a heart attack, so the patient needs an ECG within minutes. The other patients are stable and can safely wait.

Answer

B · A 60-year-old with chest pressure, sweating and nausea for 20 minutes
3.Infection control & patient safety

Answer: C · Give the patient a mask and seat them apart from others

Why this is the answer

Offering a mask to people with respiratory symptoms and separating them from others reduces the spread of droplets. Tissues, hand hygiene products and waste bins are also provided.

Answer

C · Give the patient a mask and seat them apart from others
4.Infection control & patient safety

Answer: A · Helping the patient bathe while wearing a gown and gloves

Why this is the answer

Assistive personnel can carry out routine care for a stable patient, using the correct PPE. Assessment, teaching and clinical judgement, such as deciding when to stop precautions, cannot be delegated to them.

Answer

A · Helping the patient bathe while wearing a gown and gloves
5.Lab values & electrolytes

Answer: A · At about 24–28 weeks of pregnancy

Why this is the answer

Placental hormones increase insulin resistance in the second half of pregnancy, so US guidance recommends screening all women at 24–28 weeks, with earlier testing for those with risk factors. In the UK, NICE recommends an oral glucose tolerance test at 24–28 weeks only for women with risk factors.Checked against: Glucose screening tests during pregnancy · MedlinePlus (NIH) (2026); Gestational diabetes · MedlinePlus (NIH) (2026)

Answer

A · At about 24–28 weeks of pregnancy
6.Lab values & electrolytes

Answer: B · Look for a source of blood loss in the gut

Why this is the answer

Iron deficiency in an older man or a postmenopausal woman suggests chronic blood loss, often from the gastrointestinal tract, including colorectal cancer. Iron is started, but endoscopy or colonoscopy is needed to find the cause.

Answer

B · Look for a source of blood loss in the gut
7.Clinical nursing

Answer: D · To monitor whether the infection is spreading or improving

Why this is the answer

Marking the margin helps staff see whether the redness is spreading despite treatment, which may mean antibiotics need review. The limb is also elevated and observations monitored.

Answer

D · To monitor whether the infection is spreading or improving
8.Clinical nursing

Answer: A · Anastomotic leak

Why this is the answer

An anastomotic leak lets bowel contents into the abdomen, causing peritonitis and sepsis. It is a surgical emergency that needs urgent review.

Answer

A · Anastomotic leak
9.Med-surg: cardiovascular & respiratory

Answer: A · Quickly and deeply, after breathing out away from the device

Why this is the answer

Dry powder inhalers have no propellant, so a fast, deep inhalation is needed to disperse the powder. The patient breathes out away from the device first, because moist breath can clump the powder. Very weak or breathless patients may not manage this.

Answer

A · Quickly and deeply, after breathing out away from the device
10.Med-surg: cardiovascular & respiratory

Answer: A · Acute respiratory distress syndrome

Why this is the answer

ARDS is acute, non-cardiogenic pulmonary oedema caused by widespread inflammation, triggered by sepsis, pneumonia, trauma or pancreatitis. It causes severe hypoxaemia that responds poorly to oxygen, with bilateral infiltrates not explained by heart failure. Treatment includes lung-protective ventilation and often prone positioning.

Answer

A · Acute respiratory distress syndrome
11.Med-surg: neuro, endocrine & renal

Answer: D · Keep the needle in the skin for about 10 seconds

Why this is the answer

Holding the needle in place for around 10 seconds (or as the manufacturer advises) lets the full dose be delivered. A new needle is used for each injection, and the site should not be massaged.

Answer

D · Keep the needle in the skin for about 10 seconds
12.Med-surg: neuro, endocrine & renal

Answer: D · Steroid-induced hyperglycaemia, which needs monitoring and treatment

Why this is the answer

Glucocorticoids increase glucose production and insulin resistance, so hyperglycaemia is common, often later in the day after a morning dose. Glucose is monitored regularly, and treatment may be needed. Other steroid effects include mood change and gastric irritation.

Answer

D · Steroid-induced hyperglycaemia, which needs monitoring and treatment
13.Med-surg: GI, perioperative & oncology

Answer: B · Breathe in slowly and deeply, then hold briefly

Why this is the answer

Slow, deep inspiration with a short hold expands the alveoli and helps prevent atelectasis. It is repeated regularly while awake, together with coughing and good pain control.

Answer

B · Breathe in slowly and deeply, then hold briefly
14.Med-surg: GI, perioperative & oncology

Answer: B · Circulation and sensation of the hand

Why this is the answer

Full-thickness eschar is inelastic. As oedema develops, pressure rises and can compromise circulation (or breathing with a chest burn). Regular checks of pulses, colour, capillary refill, pain and sensation detect this early; an escharotomy may be needed.

Answer

B · Circulation and sensation of the hand

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