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
A nurse needs to give report on a patient to a colleague. Which information is the most important to include?
- APersonal opinions about the patient’s family members and their visiting habits
- BDetails of the nurse’s own break times that shift
- CThe patient’s favorite television programs and hobbies
- DThe patient’s current condition, recent changes and pending tasks
2.Prioritization & delegationHard
A child who had a tonsillectomy this morning is swallowing again and again while asleep. What should the nurse suspect?
- ANormal swallowing during sleep
- BBleeding from the operation site
- CHunger after fasting for surgery
- DA sore throat from the breathing tube
3.Infection control & patient safetyMedium
When should the transparent dressing over a peripheral IV site be changed?
- AWhen it is damp, loose or visibly soiled
- BOnly when the IV catheter is removed, whatever its state
- COnly when the patient asks for a new dressing
- DEvery hour, so the site can be cleaned again
4.Infection control & patient safetyHard
A nurse teaches new parents about safe infant sleep. Which statement shows a need for further teaching?
- A“We will keep the crib in our room, next to our bed, for the first months.”
- B“We will lay the baby on the back for every sleep, including naps.”
- C“We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”
- D“We will not smoke near the baby.”
5.Lab values & electrolytesMedium
Which technique is recommended for a capillary blood glucose test on an adult's finger?
- AUse the same finger every time
- BSqueeze the finger very hard
- CPrick the center of the fingertip
- DPrick the side of the fingertip
6.Lab values & electrolytesHard
The nurse teaches a patient with thrombocytopenia (platelets 25 × 10³/µL) about home safety. Which statement shows a need for further teaching?
- A"I'll take aspirin if I get a headache"
- B"I'll use an electric razor to shave"
- C"I'll blow my nose gently, not forcefully"
- D"I'll use a soft-bristled toothbrush"
7.Clinical nursingMedium
A patient's low potassium does not improve despite potassium replacement. Which other electrolyte should be checked?
- APhosphate
- BSodium
- CChloride
- DMagnesium
8.Clinical nursingHard
A patient rescued from a house fire has soot around the mouth, singed nasal hairs and a hoarse voice. What is the main concern?
- AHypothermia from the fire service water
- BDehydration from sweating
- CAirway swelling from inhalation injury
- DA minor throat infection
9.Med-surg: cardiovascular & respiratoryMedium
What is the ejection fraction?
- AThe volume of blood pumped out with each heartbeat
- BThe percentage of ventricular blood ejected with each beat
- CThe pressure in the left ventricle at the end of diastolic filling
- DThe volume of blood the heart pumps out every minute
10.Med-surg: cardiovascular & respiratoryHard
A patient with small-cell lung cancer becomes confused. Sodium is 122 mmol/L (122 mEq/L) with concentrated urine, and there are no signs of dehydration. What is the most likely cause?
- ACranial diabetes insipidus from brain metastases
- BSevere dehydration from poor oral intake
- CExcess salt in the diet over several weeks
- DSyndrome of inappropriate ADH secretion
11.Med-surg: neuro, endocrine & renalMedium
What is the dexamethasone suppression test used for?
- ATo help diagnose Cushing's syndrome
- BTo measure kidney function
- CTo check thyroid function
- DTo diagnose diabetes insipidus
12.Med-surg: neuro, endocrine & renalHard
The nurse has four patients. Which one needs to be seen first?
- AA patient with Parkinson's disease whose next dose is due in two hours
- BA patient with stable CKD waiting for a renal diet review
- CA patient with hypothyroidism asking when to take levothyroxine
- DA patient on insulin for DKA whose potassium is now 2.9 mmol/L
13.Med-surg: GI, perioperative & oncologyMedium
Which lifestyle change most improves the course of Crohn's disease?
- AStopping smoking
- BEating more red meat
- CAvoiding all exercise
- DDrinking more coffee
14.Med-surg: GI, perioperative & oncologyHard
A patient with an ileostomy has had no output for 6 hours, with cramping pain, distension, nausea and a swollen stoma. What should the nurse suspect?
- AA minor skin rash around the stoma
- BNormal quiet period for a new ileostomy
- CA stoma blockage, often from food, needing review
- DDehydration from very high ileostomy output
3Solutions
1.Prioritization & delegation
Answer: D · The patient’s current condition, recent changes and pending tasks
Why this is the answer
Effective handover covers the current status, changes, risks and outstanding tasks, often using a structure such as SBAR. Opinions and unrelated details distract from what matters.
D · The patient’s current condition, recent changes and pending tasks
2.Prioritization & delegation
Answer: B · Bleeding from the operation site
Why this is the answer
Frequent swallowing after tonsillectomy is a classic sign of bleeding. The nurse checks the throat with a light, looks at vital signs and reports at once.
B · Bleeding from the operation site
3.Infection control & patient safety
Answer: A · When it is damp, loose or visibly soiled
Why this is the answer
A dressing that is wet, loose or dirty no longer protects the insertion site and is changed using aseptic technique. Otherwise, it is changed according to policy.
A · When it is damp, loose or visibly soiled
4.Infection control & patient safety
Answer: C · “We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”
Why this is the answer
Soft bedding, bumpers and loose blankets increase the risk of suffocation and sudden infant death. The crib should hold only a firm mattress with a fitted sheet.
C · “We will put a soft bumper pad and a blanket in the crib so the baby is cozy.”
5.Lab values & electrolytes
Answer: D · Prick the side of the fingertip
Why this is the answer
The sides of the fingertips are less sensitive than the pads, so they are used for capillary sampling. Rotating sites reduces soreness, and hard squeezing can add tissue fluid that gives inaccurate results.
D · Prick the side of the fingertip
6.Lab values & electrolytes
Answer: A · "I'll take aspirin if I get a headache"
Why this is the answer
Aspirin irreversibly inhibits platelet function and raises the bleeding risk further in thrombocytopenia, so it and other NSAIDs are avoided unless prescribed. An electric razor, gentle nose blowing and a soft toothbrush reduce minor bleeding.Checked against: Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment · National Cancer Institute (NIH) (2022); Aspirin · MedlinePlus (NIH) (2025)
A · "I'll take aspirin if I get a headache"
7.Clinical nursing
Answer: D · Magnesium
Why this is the answer
Hypomagnesaemia increases renal potassium loss and makes hypokalaemia hard to correct. Magnesium must be replaced as well.
8.Clinical nursing
Answer: C · Airway swelling from inhalation injury
Why this is the answer
These signs suggest inhalation injury, which can cause rapid airway swelling and obstruction. Early senior anaesthetic review is needed, as early intubation may be required. Carbon monoxide poisoning must also be considered.
C · Airway swelling from inhalation injury
9.Med-surg: cardiovascular & respiratory
Answer: B · The percentage of ventricular blood ejected with each beat
Why this is the answer
Ejection fraction = stroke volume ÷ end-diastolic volume, normally about 50–70%. Heart failure with reduced ejection fraction is usually defined as 40% or less. Cardiac output is the volume per minute and stroke volume the volume per beat.
B · The percentage of ventricular blood ejected with each beat
10.Med-surg: cardiovascular & respiratory
Answer: D · Syndrome of inappropriate ADH secretion
Why this is the answer
Small-cell lung cancer can secrete ADH, causing water retention and dilutional hyponatraemia (normal sodium about 135–145 mmol/L). Urine is inappropriately concentrated and the patient is not dry. Fluid restriction and treating the cancer are the main measures; sodium is corrected slowly to avoid osmotic demyelination.
D · Syndrome of inappropriate ADH secretion
11.Med-surg: neuro, endocrine & renal
Answer: A · To help diagnose Cushing's syndrome
Why this is the answer
A dose of dexamethasone normally suppresses ACTH and cortisol. In Cushing's syndrome, cortisol stays high. The test is part of the work-up for cortisol excess.
A · To help diagnose Cushing's syndrome
12.Med-surg: neuro, endocrine & renal
Answer: D · A patient on insulin for DKA whose potassium is now 2.9 mmol/L
Why this is the answer
Insulin drives potassium into cells, and a potassium of 2.9 mmol/L during DKA treatment can cause life-threatening arrhythmias. The insulin rate and potassium replacement need urgent review under the protocol. The other patients are stable.
D · A patient on insulin for DKA whose potassium is now 2.9 mmol/L
13.Med-surg: GI, perioperative & oncology
Answer: A · Stopping smoking
Why this is the answer
Smoking worsens Crohn's disease, increasing flares, complications and the need for surgery. Stopping smoking is one of the most effective changes a patient can make.
14.Med-surg: GI, perioperative & oncology
Answer: C · A stoma blockage, often from food, needing review
Why this is the answer
Absent output with cramps, distension, nausea or vomiting and a swollen stoma suggests obstruction, often from fibrous food. The patient needs assessment; fluids may be given and specialist advice sought. Laxatives are not given without medical advice.
C · A stoma blockage, often from food, needing review
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