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 stable adult with normal vital signs has a cut on the hand that needs sutures and nothing else. Which ESI level fits?

  1. ALevel 4
  2. BLevel 3
  3. CLevel 2
  4. DLevel 5
2.Prioritization & delegationHard

A patient taking an SSRI is also given tramadol. A few hours later the patient is agitated, sweating and has a fever, jerking muscles and brisk reflexes. What is the most likely cause?

  1. ANeuroleptic malignant syndrome
  2. BOpioid withdrawal
  3. CSerotonin syndrome
  4. DAn anxiety attack
3.Infection control & patient safetyMedium

A patient receiving continuous nasogastric feeding has pulled the tube partly out. What should the nurse do first?

  1. AIncrease the feed rate to make up for the lost time
  2. BPush the tube back in and restart the feed
  3. CStop the feeding until the tube position is checked
  4. DTape the tube in its new position and continue
4.Infection control & patient safetyHard

While preparing an IV medication, a nurse sees that the syringe tip touched the medication tray after the cap came off. What should the nurse do?

  1. ADiscard the syringe and prepare the dose again with new equipment
  2. BGive the dose anyway, because the medication tray was cleaned this morning
  3. CWipe the tip with an alcohol swab and give the dose
  4. DBlow on the tip to remove any dust
5.Lab values & electrolytesMedium

A patient scheduled for surgery this morning has a potassium of 3.0 mEq/L on pre-operative tests. What should the nurse do?

  1. AReport it to the surgical team before surgery
  2. BSend the patient to surgery without comment
  3. CRepeat the test after the surgery is finished
  4. DGive an oral potassium dose without a prescription
6.Lab values & electrolytesHard

A patient with right upper abdominal pain from gallstones now has jaundice, a total bilirubin of 4.8 mg/dL (82 µmol/L) and a raised ALP. What is the most likely cause?

  1. AGilbert syndrome triggered by pain
  2. BUncomplicated gallbladder inflammation
  3. CA stone blocking the common bile duct
  4. DHemolysis caused by the gallstones
7.Clinical nursingMedium

Long-term amiodarone treatment can affect which of the following?

  1. AThe sense of smell and taste only, with no other effects
  2. BThyroid function, the lungs and the skin's sensitivity to sunlight
  3. CBlood glucose and cholesterol only
  4. DHair colour and nail growth only, with no effect on organs
8.Clinical nursingHard

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

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

A patient with stable angina is afraid nicotine patches will harm their heart. Which reply is most accurate?

  1. ANicotine replacement is much safer than smoking and is recommended
  2. BNicotine replacement only works if smoking continues
  3. CPeople with angina must stop smoking without any help
  4. DNicotine patches are much more harmful to the heart than cigarettes
10.Med-surg: cardiovascular & respiratoryHard

A nurse phones the doctor about a patient with pneumonia whose observations are worsening. Using SBAR, which statement is the clearest "recommendation"?

  1. A"I think he may have sepsis; please review him within 30 minutes."
  2. B"I am calling about the patient in bed 6."
  3. C"He is 72 and was admitted yesterday with community-acquired pneumonia."
  4. D"His heart rate is 124/min, his BP is 88/50 mmHg and he is confused."
11.Med-surg: neuro, endocrine & renalMedium

A patient with myasthenia gravis wants to plan a busy day. Which advice fits the disease?

  1. ADo demanding tasks in the morning or when the drug works best
  2. BAvoid rest periods, because rest makes the weakness worse
  3. CExercise to exhaustion so the muscles get stronger quickly
  4. DDo the hardest tasks in the evening when muscles are warmed up
12.Med-surg: neuro, endocrine & renalHard

A patient taking digoxin has a potassium of 2.9 mmol/L. Why is this especially dangerous?

  1. ADigoxin stops working when potassium is low
  2. BDigoxin raises the potassium to dangerous levels
  3. CLow potassium makes digoxin leave the body faster
  4. DLow potassium increases the risk of digoxin toxicity
13.Med-surg: GI, perioperative & oncologyMedium

In the UK National Early Warning Score (NEWS2), what does an aggregate score of 5 or more usually trigger?

  1. ARoutine observations once every 12 hours, with no other change in care
  2. BAn urgent review by a clinician skilled in acute illness
  3. CNo change unless the patient complains
  4. DDischarge planning for the next day
14.Med-surg: GI, perioperative & oncologyHard

A patient with a permanent pacemaker is booked for surgery using monopolar diathermy. Why must the team know?

  1. AThe patient cannot have any anaesthetic at all
  2. BThe pacemaker will always be removed during surgery
  3. CPacemakers stop all bleeding during surgery
  4. DDiathermy can interfere with the pacemaker's function

3Solutions

1.Prioritization & delegation

Answer: A · Level 4

Why this is the answer

For a stable patient, ESI levels 3 to 5 depend on the expected resources: two or more is level 3, one is level 4 and none is level 5. Simple suturing counts as one resource, so this is level 4.

Answer

A · Level 4
2.Prioritization & delegation

Answer: C · Serotonin syndrome

Why this is the answer

SSRIs and tramadol both raise serotonin. Agitation, fever, clonus and hyperreflexia that start quickly suggest serotonin syndrome; neuroleptic malignant syndrome follows antipsychotics and causes rigid muscles with slow reflexes.

Answer

C · Serotonin syndrome
3.Infection control & patient safety

Answer: C · Stop the feeding until the tube position is checked

Why this is the answer

A displaced tube may now sit in the esophagus or airway. The feeding is stopped and the tube is not pushed back blindly. Its position is checked according to policy, or it is replaced.

Answer

C · Stop the feeding until the tube position is checked
4.Infection control & patient safety

Answer: A · Discard the syringe and prepare the dose again with new equipment

Why this is the answer

In aseptic non-touch technique, key parts such as syringe tips and IV hubs must not touch any non-sterile surface. A contaminated key part is not cleaned and reused. It is replaced.

Answer

A · Discard the syringe and prepare the dose again with new equipment
5.Lab values & electrolytes

Answer: A · Report it to the surgical team before surgery

Why this is the answer

Hypokalemia increases the risk of arrhythmias during anesthesia and can prolong muscle weakness. Abnormal pre-operative results are reported to the surgeon and anesthetist, who decide whether to correct it or delay surgery.Checked against: Hypokalemia · StatPearls (NCBI Bookshelf) (2025)

Answer

A · Report it to the surgical team before surgery
6.Lab values & electrolytes

Answer: C · A stone blocking the common bile duct

Why this is the answer

A gallstone in the common bile duct (choledocholithiasis) obstructs bile flow, raising conjugated bilirubin and ALP. Fever with jaundice and pain suggests cholangitis, an emergency. Simple cholecystitis usually causes only mild liver test changes.Checked against: Choledocholithiasis · MedlinePlus (NIH) (2025); Cholangitis · MedlinePlus (NIH) (2026)

Answer

C · A stone blocking the common bile duct
7.Clinical nursing

Answer: B · Thyroid function, the lungs and the skin's sensitivity to sunlight

Why this is the answer

Amiodarone can cause hypo- or hyperthyroidism, pulmonary fibrosis, liver problems and photosensitivity. Regular monitoring of thyroid and liver function is needed.

Answer

B · Thyroid function, the lungs and the skin's sensitivity to sunlight
8.Clinical nursing

Answer: A · 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

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

Answer: A · Nicotine replacement is much safer than smoking and is recommended

Why this is the answer

Nicotine replacement delivers nicotine without carbon monoxide, tar and other toxins and is considered safe in stable heart disease. Combining a patch with a short-acting form and behavioural support gives the best chance of quitting.

Answer

A · Nicotine replacement is much safer than smoking and is recommended
10.Med-surg: cardiovascular & respiratory

Answer: A · "I think he may have sepsis; please review him within 30 minutes."

Why this is the answer

In SBAR, the recommendation states clearly what the nurse needs and how quickly, such as a review within a set time. The other statements belong to situation, background and assessment. Structured communication reduces delays in escalation.

Answer

A · "I think he may have sepsis; please review him within 30 minutes."
11.Med-surg: neuro, endocrine & renal

Answer: A · Do demanding tasks in the morning or when the drug works best

Why this is the answer

In myasthenia gravis, muscles tire with use and recover with rest, so weakness is often worse later in the day. Planning demanding tasks for times of peak strength and building in rest helps.

Answer

A · Do demanding tasks in the morning or when the drug works best
12.Med-surg: neuro, endocrine & renal

Answer: D · Low potassium increases the risk of digoxin toxicity

Why this is the answer

Digoxin binds to the sodium–potassium pump, and low potassium increases this binding. Hypokalaemia therefore raises the risk of toxicity and arrhythmias, even with a normal digoxin level. The potassium is corrected and the patient monitored.

Answer

D · Low potassium increases the risk of digoxin toxicity
13.Med-surg: GI, perioperative & oncology

Answer: B · An urgent review by a clinician skilled in acute illness

Why this is the answer

NEWS2 scores respiratory rate, SpO₂, oxygen use, BP, pulse, consciousness or new confusion, and temperature. A score of 5–6 needs an urgent response, and 7 or more an emergency response.

Answer

B · An urgent review by a clinician skilled in acute illness
14.Med-surg: GI, perioperative & oncology

Answer: D · Diathermy can interfere with the pacemaker's function

Why this is the answer

Electrical interference from monopolar diathermy can inhibit or reprogram pacemakers and defibrillators. The team plans ahead, for example using bipolar diathermy, placing the plate carefully or having the device checked.

Answer

D · Diathermy can interfere with the pacemaker's function

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