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 on a medical unit tells the nurse he has a plan to end his life and has saved tablets at home. What is the priority action?

  1. AAsk him to promise he will not harm himself
  2. BEnsure constant observation and remove anything he could use to harm himself
  3. CReassure him that things usually look better in the morning after some sleep
  4. DArrange a psychiatry appointment for next week
2.Prioritization & delegationHard

A patient opens their eyes only to pain, uses inappropriate words and withdraws from pain. What is the Glasgow Coma Scale score?

  1. A7
  2. B9
  3. C11
  4. D13
3.Infection control & patient safetyMedium

An infant has had a cleft lip repair. Why are elbow restraints often used?

  1. ATo keep the infant from rolling over in the crib
  2. BTo prevent the infant from sucking a pacifier
  3. CTo hold the IV line in place during feeds and stop it being pulled out
  4. DTo stop the infant’s hands reaching the mouth while still allowing arm movement
4.Infection control & patient safetyHard

A nurse teaches a patient who has had a splenectomy. Which statement shows a need for further teaching?

  1. A“I will get medical help quickly if I get a high temperature.”
  2. B“Now that my spleen is out, a fever is nothing to worry about.”
  3. C“I will tell all of my health care providers that I have no spleen.”
  4. D“I will keep my vaccinations up to date.”
5.Lab values & electrolytesMedium

A patient with chronic kidney disease has a potassium of 5.6 mEq/L. Which food should the nurse advise the patient to limit?

  1. ACabbage
  2. BWhite rice
  3. CBananas
  4. DApples
6.Lab values & electrolytesHard

A patient with long-term heavy alcohol use is admitted with alcohol withdrawal. Which group of electrolyte problems is most common?

  1. ALow chloride, high bicarbonate and high calcium
  2. BLow magnesium, low phosphate and low potassium
  3. CHigh magnesium, high phosphate and high potassium
  4. DHigh sodium, high calcium and high glucose
7.Clinical nursingMedium

A very anxious patient breathes rapidly for a long period. Which change is expected?

  1. ARespiratory acidosis from a high PaCO2
  2. BRespiratory alkalosis from a low PaCO2
  3. CMetabolic acidosis from a low bicarbonate
  4. DMetabolic alkalosis from vomiting
8.Clinical nursingHard

A patient on a heparin infusion develops a sudden fall in platelet count five days after starting it. What should you suspect?

  1. ANormal response to heparin
  2. BHeparin-induced thrombocytopenia
  3. CVitamin K deficiency from poor intake
  4. DIron deficiency anaemia
9.Med-surg: cardiovascular & respiratoryMedium

A patient is on a short course of oral prednisolone for an asthma exacerbation. Which effect should the nurse monitor for?

  1. ARaised blood glucose
  2. BLow blood sodium
  3. CSlow heart rate
  4. DLow blood pressure
10.Med-surg: cardiovascular & respiratoryHard

A 74-year-old with atrial fibrillation, hypertension and diabetes asks why she needs an anticoagulant when she feels well. Which reply is best?

  1. AThe anticoagulant will stop the irregular heartbeat for good
  2. BIt is needed only while she has palpitations
  3. CIt is given to lower her blood pressure
  4. DHer risk of stroke is high, and an anticoagulant lowers it
11.Med-surg: neuro, endocrine & renalMedium

Why does a patient with untreated hypothyroidism need extra care when given opioids or sedatives?

  1. AThese drugs make the thyroid gland overactive
  2. BThere is no difference compared with other patients
  3. CThey break the drugs down slowly and are more sensitive to them
  4. DThey clear the drugs too fast, so higher doses are needed
12.Med-surg: neuro, endocrine & renalHard

A patient with lung cancer and SIADH has a sodium of 112 mmol/L and is having seizures. What is the most appropriate treatment?

  1. ALarge volumes of oral water to help dilute the urine
  2. BIV 5% glucose at a high rate until the seizures stop
  3. CRapid correction to 140 mmol/L within the first six hours
  4. DHypertonic saline, monitored, with a limited rate of rise
13.Med-surg: GI, perioperative & oncologyMedium

Before an anti-TNF biologic such as infliximab is started for Crohn's disease, which screening is essential?

  1. AA bone density scan
  2. BA test for coeliac disease
  3. CScreening for tuberculosis
  4. DA test of colour vision
14.Med-surg: GI, perioperative & oncologyHard

After a coughing fit, the external mark on a patient's nasogastric tube has moved 10 cm. Feed is due. What should the nurse do?

  1. APush the tube back to the original mark and start the feed
  2. BDo not use the tube until its position is confirmed by policy
  3. CStart the feed at a slow rate and watch for coughing
  4. DGive the medicines only and save the feed for later

3Solutions

1.Prioritization & delegation

Answer: B · Ensure constant observation and remove anything he could use to harm himself

Why this is the answer

A patient with a plan and means is at high risk. Safety comes first: constant observation, removal of means and urgent referral. A “no-harm promise” does not protect the patient.

Answer

B · Ensure constant observation and remove anything he could use to harm himself
2.Prioritization & delegation

Answer: B · 9

Why this is the answer

Eyes open to pain scores 2, inappropriate words score 3 and withdrawal from pain scores 4, giving 9. A score of 8 or less often means the patient cannot protect their airway.

Answer

B · 9
3.Infection control & patient safety

Answer: D · To stop the infant’s hands reaching the mouth while still allowing arm movement

Why this is the answer

Elbow restraints keep the elbows straight so the infant cannot touch the suture line. They are removed regularly, one at a time, for skin checks and movement under supervision.

Answer

D · To stop the infant’s hands reaching the mouth while still allowing arm movement
4.Infection control & patient safety

Answer: B · “Now that my spleen is out, a fever is nothing to worry about.”

Why this is the answer

People without a spleen are at risk of overwhelming infection, especially from encapsulated bacteria. Fever needs prompt medical assessment, and vaccines are kept up to date.

Answer

B · “Now that my spleen is out, a fever is nothing to worry about.”
5.Lab values & electrolytes

Answer: C · Bananas

Why this is the answer

Bananas, oranges, potatoes, tomatoes, dried fruit and beans are high in potassium. Apples, white rice and cabbage are lower-potassium choices that are commonly allowed on a potassium-restricted diet.Checked against: Potassium in diet · MedlinePlus (NIH) (2026); Chronic kidney disease · MedlinePlus (NIH) (2025)

Answer

C · Bananas
6.Lab values & electrolytes

Answer: B · Low magnesium, low phosphate and low potassium

Why this is the answer

Poor diet, vomiting, diarrhea and alcohol's effect on the kidneys commonly cause low magnesium, phosphate and potassium. These worsen arrhythmia and seizure risk, so they are checked and replaced, together with thiamine.

Answer

B · Low magnesium, low phosphate and low potassium
7.Clinical nursing

Answer: B · Respiratory alkalosis from a low PaCO2

Why this is the answer

Hyperventilation blows off CO2, raising the pH. Symptoms can include tingling of the lips and fingers and lightheadedness.

Answer

B · Respiratory alkalosis from a low PaCO2
8.Clinical nursing

Answer: B · Heparin-induced thrombocytopenia

Why this is the answer

HIT typically appears 5–10 days after starting heparin, with a platelet drop of more than 50% and a risk of thrombosis. Heparin is stopped and a non-heparin anticoagulant used.

Answer

B · Heparin-induced thrombocytopenia
9.Med-surg: cardiovascular & respiratory

Answer: A · Raised blood glucose

Why this is the answer

Corticosteroids raise blood glucose, which matters especially in diabetes. Short courses can also cause mood changes, insomnia, indigestion and fluid retention. Long-term use adds osteoporosis, adrenal suppression and infection risk.

Answer

A · Raised blood glucose
10.Med-surg: cardiovascular & respiratory

Answer: D · Her risk of stroke is high, and an anticoagulant lowers it

Why this is the answer

In AF, blood stasis in the left atrium causes clots that can travel to the brain. Scores such as CHA₂DS₂-VASc (age, hypertension, diabetes, female sex and others) estimate stroke risk; her score is high. Anticoagulation reduces stroke risk but does not change the rhythm.

Answer

D · Her risk of stroke is high, and an anticoagulant lowers it
11.Med-surg: neuro, endocrine & renal

Answer: C · They break the drugs down slowly and are more sensitive to them

Why this is the answer

In hypothyroidism, drug metabolism is slowed, and patients are more sensitive to sedatives and opioids. These drugs can cause respiratory depression and may even trigger myxoedema coma, so they are used with caution.

Answer

C · They break the drugs down slowly and are more sensitive to them
12.Med-surg: neuro, endocrine & renal

Answer: D · Hypertonic saline, monitored, with a limited rate of rise

Why this is the answer

Severe symptomatic hyponatraemia is treated with small boluses of hypertonic saline to raise sodium by a few mmol/L and stop seizures. Overall correction is limited (often to no more than about 8–10 mmol/L in 24 hours) to avoid osmotic demyelination syndrome. Sodium is checked frequently.

Answer

D · Hypertonic saline, monitored, with a limited rate of rise
13.Med-surg: GI, perioperative & oncology

Answer: C · Screening for tuberculosis

Why this is the answer

Anti-TNF drugs suppress immunity and can reactivate latent tuberculosis. Patients are screened for TB and hepatitis B before starting and are taught to report signs of infection.

Answer

C · Screening for tuberculosis
14.Med-surg: GI, perioperative & oncology

Answer: B · Do not use the tube until its position is confirmed by policy

Why this is the answer

A change in external length means the tube may have moved. Pushing it back blindly is unsafe. It is not used until placement is confirmed by pH or X-ray, or it is replaced.

Answer

B · Do not use the tube until its position is confirmed by policy

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