1Formulas and methods
Prioritization & delegation
Method
- Ask what will harm the patient soonest if nothing is done.
- Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
- Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
- Assess before you act unless it is an emergency; then choose the step the others depend on.
- 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
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Lab values & electrolytes
Method
- Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
- Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
- Link the value to its typical signs and to the drugs and conditions that cause it.
- Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
- 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
- Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
- Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
- Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
- Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
- Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
- Check the glucose in every patient with new confusion, weakness or a seizure.
- Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
- For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
- For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
- For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
- Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
- Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
- For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
- For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
- 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
During START triage, a non-walking adult breathes 22 times a minute, has a radial pulse and follows simple commands, but has an obvious leg fracture. Which category is the victim given?
- ABlack (expectant)
- BRed (immediate)
- CGreen (minor)
- DYellow (delayed)
2.Prioritization & delegationHard
A marathon runner is confused, with a temperature of 41 °C and hot skin. What is the priority?
- ARapid cooling while supporting airway and circulation
- BWrapping the runner in a blanket to prevent shivering
- CAsking the runner to rest in the shade and drink slowly
- DGiving an antipyretic tablet and waiting for it to work
3.Infection control & patient safetyMedium
A nurse is preparing medications for two patients. What is the safest approach?
- AAsk one patient to pass the medications to the other
- BPut both patients’ medications in one cup and sort them at the bedside
- CPrepare both patients’ medications together to save time
- DPrepare and give medications for one patient at a time
4.Infection control & patient safetyHard
A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?
- AHelping the patient bathe while wearing a gown and gloves
- BTeaching the family how to follow the precautions
- CAssessing the wound for new signs of infection during the bath
- DDeciding when the precautions can be stopped
5.Lab values & electrolytesMedium
When should a blood specimen tube be labeled?
- AIn the laboratory, by the staff who receive the unlabeled sample
- BAt the bedside, in the patient's presence, using two identifiers
- CBefore entering the room, so tubes are ready for the next patients
- DAt the nurses' station, after all samples for the shift are drawn
6.Lab values & electrolytesHard
A patient with sepsis has the following new results. Which set best shows organ dysfunction?
- AHemoglobin 12.5 g/dL, sodium 138 mEq/L, glucose 105 mg/dL
- BWBC 11.5 × 10³/µL, potassium 4.2 mEq/L, albumin 3.8 g/dL
- CCalcium 9.4 mg/dL, phosphate 3.5 mg/dL, magnesium 1.9 mEq/L
- DPlatelets 70 × 10³/µL, creatinine doubled, bilirubin raised
7.Clinical nursingMedium
Why is continuous bladder irrigation used after a transurethral resection of the prostate (TURP)?
- ATo stretch the bladder back to its normal size
- BTo give antibiotics directly into the kidneys
- CTo stop blood clots from blocking the catheter
- DTo measure the patient's kidney function
8.Clinical nursingHard
Which nursing measure helps reduce raised intracranial pressure?
- ALying the patient flat with the neck flexed forward on two pillows
- BTilting the patient head-down
- CRaising the head of the bed to about 30° with the head kept midline
- DFrequent suctioning and encouraging strong coughing
9.Med-surg: cardiovascular & respiratoryMedium
Septic shock belongs to which category of shock?
- AHypovolaemic shock
- BDistributive shock
- CObstructive shock
- DCardiogenic shock
10.Med-surg: cardiovascular & respiratoryHard
A patient with severe aortic stenosis is prescribed glyceryl trinitrate (nitroglycerin) for chest pain. Why should the nurse use particular caution?
- AGTN raises the blood pressure dangerously in aortic stenosis
- BVasodilators can cause a severe fall in BP with a fixed outflow obstruction
- CGTN makes the narrowed aortic valve tighten further within a few minutes
- DThere is no reason for caution, because GTN acts only on the coronary arteries
11.Med-surg: neuro, endocrine & renalMedium
A patient with gout has recurrent uric acid kidney stones. Which treatment helps prevent them?
- AVitamin C supplements and a high-meat diet
- BRestricting fluids in the evening only
- CCalcium tablets and a low-fluid diet
- DAllopurinol and making the urine less acidic
12.Med-surg: neuro, endocrine & renalHard
A patient with CKD has a haemoglobin of 92 g/L and starts an erythropoiesis-stimulating agent (ESA). What should the nurse monitor?
- ABlood pressure and haemoglobin, as overshoot raises clot risk
- BHearing, because ESAs can damage the inner ear
- CLiver enzymes, because ESAs are toxic to the liver
- DBlood glucose, because ESAs often cause hypoglycaemia
13.Med-surg: GI, perioperative & oncologyMedium
What is the most important safety point about misoprostol?
- AIt causes severe constipation in most patients
- BIt can cause miscarriage and must not be used in pregnancy
- CIt must be given only by deep intramuscular injection
- DIt strongly raises blood glucose in people with diabetes
14.Med-surg: GI, perioperative & oncologyHard
The skin around a patient's ileostomy is red, raw and weeping, and the pouch leaks often. What is the most likely cause?
- AAn allergy to the stool itself, which needs steroids
- BOutput on the skin, often from a poorly fitting appliance
- CIschaemia of the stoma, which needs urgent surgery
- DA normal reaction that needs no change in care
3Solutions
1.Prioritization & delegation
Answer: D · Yellow (delayed)
Why this is the answer
A victim who cannot walk but passes the breathing, perfusion and mental status checks is delayed (yellow). A serious injury alone does not make a victim immediate.
2.Prioritization & delegation
Answer: A · Rapid cooling while supporting airway and circulation
Why this is the answer
Heat stroke is an emergency in which body temperature rises and the brain is affected. Rapid cooling, for example with cold water or ice, is the priority; antipyretics do not work for heat stroke.
A · Rapid cooling while supporting airway and circulation
3.Infection control & patient safety
Answer: D · Prepare and give medications for one patient at a time
Why this is the answer
Preparing, checking and giving medications for one patient at a time, at the bedside, reduces wrong-patient errors. Mixing medicines makes errors more likely.
D · Prepare and give medications for one patient at a time
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.
A · Helping the patient bathe while wearing a gown and gloves
5.Lab values & electrolytes
Answer: B · At the bedside, in the patient's presence, using two identifiers
Why this is the answer
Specimens are labeled immediately after collection, at the bedside, after checking two patient identifiers such as name and date of birth. Pre-labeling or labeling away from the patient can put the wrong patient's name on the sample, which can lead to harmful decisions.
B · At the bedside, in the patient's presence, using two identifiers
6.Lab values & electrolytes
Answer: D · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised
Why this is the answer
In sepsis, falling platelets (coagulation), a rising creatinine (kidney) and a raised bilirubin (liver) show organ dysfunction, which indicates severe disease. The other sets are normal or near normal.Checked against: Bacterial Sepsis · StatPearls (NCBI Bookshelf) (2023); Laboratory Evaluation of Sepsis · StatPearls (NCBI Bookshelf) (2023)
D · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised
7.Clinical nursing
Answer: C · To stop blood clots from blocking the catheter
Why this is the answer
Irrigation dilutes blood and flushes out clots so the catheter does not block. Output must be measured carefully and urine output calculated by subtracting the irrigation volume.
C · To stop blood clots from blocking the catheter
8.Clinical nursing
Answer: C · Raising the head of the bed to about 30° with the head kept midline
Why this is the answer
Head elevation and a midline neck position help venous drainage from the brain. Neck flexion, tight tube ties, coughing, straining and unnecessary suctioning can all raise intracranial pressure.
C · Raising the head of the bed to about 30° with the head kept midline
9.Med-surg: cardiovascular & respiratory
Answer: B · Distributive shock
Why this is the answer
In distributive shock (septic, anaphylactic, neurogenic), vessels dilate and leak, so blood is maldistributed and pressure falls. Obstructive shock includes PE, tamponade and tension pneumothorax; cardiogenic shock is pump failure; hypovolaemic shock is volume loss.
10.Med-surg: cardiovascular & respiratory
Answer: B · Vasodilators can cause a severe fall in BP with a fixed outflow obstruction
Why this is the answer
In severe aortic stenosis, cardiac output is fixed by the narrow valve. Vasodilators lower preload and afterload, and the heart cannot compensate, so the blood pressure can fall sharply and cause syncope. They are used with care and close monitoring.
B · Vasodilators can cause a severe fall in BP with a fixed outflow obstruction
11.Med-surg: neuro, endocrine & renal
Answer: D · Allopurinol and making the urine less acidic
Why this is the answer
Uric acid stones form when urine is acidic and rich in uric acid. High fluid intake, alkalinising the urine (for example with potassium citrate) and allopurinol reduce the risk. Purine-rich foods are limited.
D · Allopurinol and making the urine less acidic
12.Med-surg: neuro, endocrine & renal
Answer: A · Blood pressure and haemoglobin, as overshoot raises clot risk
Why this is the answer
ESAs can cause hypertension and, when haemoglobin is pushed too high, increase the risk of thrombosis and stroke. Haemoglobin is targeted to a moderate range (commonly about 100–120 g/L). Iron stores are checked because iron deficiency limits the response.
A · Blood pressure and haemoglobin, as overshoot raises clot risk
13.Med-surg: GI, perioperative & oncology
Answer: B · It can cause miscarriage and must not be used in pregnancy
Why this is the answer
Misoprostol protects the stomach lining against NSAID damage, but it stimulates uterine contraction and can cause miscarriage. Diarrhoea is its most common side effect.
B · It can cause miscarriage and must not be used in pregnancy
14.Med-surg: GI, perioperative & oncology
Answer: B · Output on the skin, often from a poorly fitting appliance
Why this is the answer
Irritant dermatitis from leaking effluent is the commonest peristomal skin problem, particularly with ileostomies. The stoma is remeasured, the aperture and appliance (for example a convex base or seal) adjusted and skin protection used, ideally with stoma nurse input. Raw skin also makes the appliance stick less, worsening leaks.
B · Output on the skin, often from a poorly fitting appliance
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