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

During an IV antibiotic infusion, a patient develops hives, wheezing and a hoarse voice. What does the nurse do first?

  1. AStop the infusion
  2. BDocument the reaction in the chart
  3. CSlow the infusion to half the rate
  4. DGive oral diphenhydramine
2.Prioritization & delegationHard

In a disaster with very limited resources, a victim with severe burns over almost the whole body is tagged black. Which principle explains this decision?

  1. ATreating the youngest victims first
  2. BTreating victims in the order in which they arrive
  3. CDoing the greatest good for the greatest number
  4. DTreating the most severely injured person first
3.Infection control & patient safetyMedium

Where should the dispersive (grounding) pad for electrosurgery be placed?

  1. AOn skin that is wet with antiseptic prep
  2. BOver a bony prominence such as the hip bone
  3. COver an area with scar tissue or a tattoo, so that the pad does not slip
  4. DOn clean, dry skin over a well-perfused muscle, close to the surgical site
4.Infection control & patient safetyHard

During bedside handoff, the patient says, “I’m allergic to sulfa drugs,” but no allergy is recorded. What should the nurse do?

  1. AIgnore it, because the electronic record is more reliable than the patient’s memory
  2. BTell the patient that sulfa drugs are always safe
  3. CClarify the reaction, update the allergy record and tell the prescriber
  4. DWait until the patient is discharged to update the record
5.Lab values & electrolytesMedium

A patient has a platelet count of 18 × 10³/µL. Which nursing measure is appropriate?

  1. AGive the prescribed aspirin when the patient has a headache
  2. BSoft toothbrush, electric razor and no intramuscular injections
  3. CTake temperatures rectally every four hours for accuracy
  4. DEncourage flossing twice daily and shaving with a sharp razor blade
6.Lab values & electrolytesHard

A patient with a calcium of 6.8 mg/dL (1.7 mmol/L) suddenly develops noisy breathing and a hoarse voice. What does this suggest?

  1. AAnxiety about the blood results, which needs calm reassurance
  2. BLaryngospasm, an emergency needing urgent help and IV calcium
  3. CA common cold that started this morning
  4. DA normal response that will pass without treatment
7.Clinical nursingMedium

A patient's seizure has lasted more than five minutes. What does this mean?

  1. ARestrain the limbs to stop the movements
  2. BPlace something in the mouth to prevent tongue biting
  3. CIt should be treated as status epilepticus and emergency medication given
  4. DIt is normal and needs no treatment
8.Clinical nursingHard

A patient with diabetes is found confused with slurred speech and weakness on one side. What should the nurse check first?

  1. ASerum cholesterol
  2. BUrine output for the last day
  3. CCapillary blood glucose
  4. DBody mass index
9.Med-surg: cardiovascular & respiratoryMedium

Which skin changes around the ankles are typical of chronic venous insufficiency?

  1. AA sharply defined red patch with fever
  2. BBrown staining, swelling and dry, itchy skin
  3. CPale, shiny, hairless skin with weak pulses
  4. DA cold, white foot with no pulse
10.Med-surg: cardiovascular & respiratoryHard

After intubation, breath sounds are heard on the right side of the chest but not the left. What is the most likely cause?

  1. AThe left lung has completely filled with fluid
  2. BThe tube has entered the right main bronchus
  3. CThe tube has entered the oesophagus
  4. DThe tube cuff has burst during insertion
11.Med-surg: neuro, endocrine & renalMedium

Which statement about storing insulin is correct?

  1. AInsulin should be kept on a sunny windowsill to stay warm
  2. BAll insulin must be stored in the freezer to keep it stable
  3. CUnopened insulin goes in the fridge and must never be frozen
  4. DInsulin that has been frozen can be used once it has thawed
12.Med-surg: neuro, endocrine & renalHard

A day after a total thyroidectomy, a patient has tingling lips, a positive Chvostek's sign and a corrected calcium of 1.85 mmol/L (about 7.4 mg/dL). What does the nurse expect?

  1. AIV calcium gluconate and monitoring for laryngospasm
  2. BIV potassium chloride and a fluid restriction
  3. COral levothyroxine, with a recheck of the calcium in a month
  4. DA loop diuretic to remove the extra calcium
13.Med-surg: GI, perioperative & oncologyMedium

What are anticipatory ("just in case") medicines at the end of life usually prescribed for?

  1. APain, nausea, agitation and respiratory secretions
  2. BHigh blood pressure, high cholesterol and diabetes
  3. CWeight gain and appetite stimulation
  4. DInfection prevention and vaccination
14.Med-surg: GI, perioperative & oncologyHard

Which patient has the highest risk of postoperative nausea and vomiting?

  1. AA non-smoking woman with motion sickness who will need opioids
  2. BA male smoker having a short procedure without opioids
  3. CA smoker who has never had nausea after surgery
  4. DA man with no history of nausea having local anaesthetic only

3Solutions

1.Prioritization & delegation

Answer: A · Stop the infusion

Why this is the answer

Stopping the drug stops further exposure to the allergen. The nurse then calls for help and prepares epinephrine as prescribed for anaphylaxis. Slowing the infusion still gives more of the drug, and documentation comes later.

Answer

A · Stop the infusion
2.Prioritization & delegation

Answer: C · Doing the greatest good for the greatest number

Why this is the answer

In a mass-casualty event, resources are used where they save the most lives. A victim who is unlikely to survive even with full treatment is given comfort care, while staff treat salvageable victims. In everyday triage, the sickest patient is usually seen first.

Answer

C · Doing the greatest good for the greatest number
3.Infection control & patient safety

Answer: D · On clean, dry skin over a well-perfused muscle, close to the surgical site

Why this is the answer

The pad returns the current safely. Good contact over a well-perfused muscle prevents burns, while bony areas, scars, hair and moisture reduce contact and can cause burns at the pad site.

Answer

D · On clean, dry skin over a well-perfused muscle, close to the surgical site
4.Infection control & patient safety

Answer: C · Clarify the reaction, update the allergy record and tell the prescriber

Why this is the answer

Bedside handoff lets patients correct errors. The nurse asks about the reaction, updates the record and alerts the prescriber and pharmacy so current and future orders can be checked.

Answer

C · Clarify the reaction, update the allergy record and tell the prescriber
5.Lab values & electrolytes

Answer: B · Soft toothbrush, electric razor and no intramuscular injections

Why this is the answer

Severe thrombocytopenia causes bleeding from minor trauma. Bleeding precautions include soft toothbrushes, electric razors, no IM injections or rectal procedures, and avoiding aspirin and NSAIDs.Checked against: Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment · National Cancer Institute (NIH) (2022); Platelet Tests · MedlinePlus (NIH) (2024)

Answer

B · Soft toothbrush, electric razor and no intramuscular injections
6.Lab values & electrolytes

Answer: B · Laryngospasm, an emergency needing urgent help and IV calcium

Why this is the answer

Severe hypocalcemia can cause spasm of the larynx, which blocks the airway. The nurse calls for urgent help, supports the airway and prepares IV calcium gluconate as prescribed, with cardiac monitoring.Checked against: Hypocalcemia (StatPearls) · StatPearls (NCBI Bookshelf) (2026)

Answer

B · Laryngospasm, an emergency needing urgent help and IV calcium
7.Clinical nursing

Answer: C · It should be treated as status epilepticus and emergency medication given

Why this is the answer

A seizure lasting five minutes or longer, or repeated seizures without recovery, is treated as status epilepticus. Protect from injury, give oxygen and give emergency anticonvulsants as prescribed.

Answer

C · It should be treated as status epilepticus and emergency medication given
8.Clinical nursing

Answer: C · Capillary blood glucose

Why this is the answer

Hypoglycaemia can cause focal neurological signs that mimic stroke. A bedside glucose check is quick and should be done in any patient with sudden neurological symptoms.

Answer

C · Capillary blood glucose
9.Med-surg: cardiovascular & respiratory

Answer: B · Brown staining, swelling and dry, itchy skin

Why this is the answer

High venous pressure causes oedema and leakage of red cells, depositing haemosiderin (brown staining), with venous eczema and lipodermatosclerosis. Pale, shiny, hairless skin suggests arterial disease. Venous ulcers often form above the medial malleolus.

Answer

B · Brown staining, swelling and dry, itchy skin
10.Med-surg: cardiovascular & respiratory

Answer: B · The tube has entered the right main bronchus

Why this is the answer

The right main bronchus is more in line with the trachea, so a tube pushed too far usually enters it and only the right lung is ventilated. The tube is withdrawn slightly by the team and position is rechecked. Oesophageal intubation gives no breath sounds and gastric gurgling.

Answer

B · The tube has entered the right main bronchus
11.Med-surg: neuro, endocrine & renal

Answer: C · Unopened insulin goes in the fridge and must never be frozen

Why this is the answer

Unopened insulin is kept in a fridge at about 2–8 °C. Freezing or heat destroys it, so frozen insulin must be thrown away. In-use pens can usually be kept at room temperature for the time stated by the manufacturer.

Answer

C · Unopened insulin goes in the fridge and must never be frozen
12.Med-surg: neuro, endocrine & renal

Answer: A · IV calcium gluconate and monitoring for laryngospasm

Why this is the answer

Symptomatic hypocalcaemia is treated with IV calcium gluconate, followed by oral calcium and often vitamin D. Severe hypocalcaemia can cause laryngospasm, seizures and arrhythmias, so the airway and ECG are monitored.

Answer

A · IV calcium gluconate and monitoring for laryngospasm
13.Med-surg: GI, perioperative & oncology

Answer: A · Pain, nausea, agitation and respiratory secretions

Why this is the answer

Anticipatory medicines are prescribed in advance, usually for subcutaneous use, so that common end-of-life symptoms can be treated quickly without delay, especially at home.

Answer

A · Pain, nausea, agitation and respiratory secretions
14.Med-surg: GI, perioperative & oncology

Answer: A · A non-smoking woman with motion sickness who will need opioids

Why this is the answer

Apfel risk factors are female sex, non-smoking status, a history of PONV or motion sickness, and postoperative opioids. Patients with more factors receive more preventive antiemetics.

Answer

A · A non-smoking woman with motion sickness who will need opioids

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