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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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

A nurse is caring for four patients. Who can be safely assigned to the nursing assistant for routine care?

  1. AA patient five days after a stroke who needs help with bathing and has stable vital signs
  2. BA patient with a new chest tube placed an hour ago
  3. CA patient returning from surgery who needs the first postoperative assessment
  4. DA patient with a blood glucose of 52 mg/dL (2.9 mmol/L) who is sweating
3.Infection control & patient safetyMedium

A patient has highly contagious viral conjunctivitis. Which teaching is most important?

  1. AWash hands often and do not share towels, pillows or eye drops
  2. BRub the eyes gently to remove the discharge
  3. CWear a surgical mask whenever someone else is in the room
  4. DKeep using the same contact lenses to protect the eyes
4.Infection control & patient safetyHard

Patients contaminated with radioactive dust arrive at the hospital. Which step removes most of the external contamination?

  1. AScrubbing the skin until it is red
  2. BRemoving the patient’s clothing
  3. CWrapping the patient in a blanket
  4. DGiving the patient potassium iodide
5.Lab values & electrolytesMedium

A patient with ventricular arrhythmia shows a twisting pattern (torsades de pointes) on the monitor. Which electrolyte is commonly given IV as treatment?

  1. ASodium bicarbonate
  2. BMagnesium sulfate
  3. CCalcium carbonate
  4. DPotassium phosphate
6.Lab values & electrolytesHard

A patient's AST is about twice the ALT, both moderately raised, and the GGT is high. Which cause is most likely?

  1. AAlcohol-related liver disease
  2. BGallstone blocking the bile duct
  3. CAcute viral hepatitis A
  4. DAcute myocardial infarction
7.Clinical nursingMedium

A patient with hyponatraemia should be especially monitored for:

  1. AConfusion, headache and seizures
  2. BHearing loss
  3. CIncreased hair growth
  4. DBright red rash
8.Clinical nursingHard

A patient with severe sepsis starts bleeding from cannula sites and the gums, with a low platelet count and prolonged clotting times. What is most likely?

  1. AAn allergic reaction to the cannula
  2. BHaemophilia A
  3. CVitamin C deficiency
  4. DDisseminated intravascular coagulation
9.Med-surg: cardiovascular & respiratoryMedium

A patient with heart failure takes furosemide once a day. When is the best time to take it?

  1. AAt bedtime, so the effect lasts through the night
  2. BWhenever the ankles look swollen, on those days only
  3. CJust before the evening meal, with a large drink
  4. DIn the morning, to avoid needing the toilet at night
10.Med-surg: cardiovascular & respiratoryHard

Four hours after PCI via the femoral artery, the groin dressing is soaked with blood and a firm swelling is growing. What is the immediate action?

  1. AHelp the patient sit up and walk to the toilet to void
  2. BIncrease the heparin infusion rate so that no clot forms at the site
  3. CApply firm pressure just above the puncture site and call for help
  4. DRemove the dressing and leave the site open to the air
11.Med-surg: neuro, endocrine & renalMedium

Why is intermittent self-catheterisation often taught after a spinal cord injury?

  1. AIt is mainly used to measure the urine output accurately
  2. BThe bladder may not empty, and regular emptying protects the kidneys
  3. CIt trains the bladder to grow gradually larger over time
  4. DIt removes all risk of a urinary tract infection completely
12.Med-surg: neuro, endocrine & renalHard

A patient on peritoneal dialysis notices that less fluid drains out than was put in. They have not opened their bowels for four days, and the effluent is clear. What is the most likely cause?

  1. AConstipation obstructing outflow
  2. BBacterial peritonitis
  3. CDialysate given too cold
  4. DNormal absorption with no action needed
13.Med-surg: GI, perioperative & oncologyMedium

Which treatment often relieves pain from a bone metastasis?

  1. AIron supplements by mouth for several months
  2. BA diet low in calcium and vitamin D
  3. CComplete bed rest for a month
  4. DPalliative radiotherapy to the area
14.Med-surg: GI, perioperative & oncologyHard

An 80 kg adult has 30% TBSA partial- and full-thickness burns. Using the Parkland formula, how much crystalloid is planned for the first 8 hours from the time of the burn?

  1. A9600 mL
  2. B2400 mL
  3. C3200 mL
  4. D4800 mL

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: A · A patient five days after a stroke who needs help with bathing and has stable vital signs

Why this is the answer

A stable patient who needs help with activities of daily living is suitable for routine care by an assistant. A new chest tube, symptomatic hypoglycemia and the first postoperative assessment need a licensed nurse.

Answer

A · A patient five days after a stroke who needs help with bathing and has stable vital signs
3.Infection control & patient safety

Answer: A · Wash hands often and do not share towels, pillows or eye drops

Why this is the answer

Viral conjunctivitis spreads easily by contact with eye secretions. Hand hygiene, not touching the eyes and not sharing towels, pillows or eye products reduce spread.

Answer

A · Wash hands often and do not share towels, pillows or eye drops
4.Infection control & patient safety

Answer: B · Removing the patient’s clothing

Why this is the answer

Removing clothing, then gently washing the skin, gets rid of most external radioactive contamination. Hard scrubbing damages the skin, and potassium iodide only protects the thyroid from radioactive iodine.

Answer

B · Removing the patient’s clothing
5.Lab values & electrolytes

Answer: B · Magnesium sulfate

Why this is the answer

IV magnesium sulfate is the standard drug treatment for torsades de pointes, even when serum magnesium is normal. Low magnesium and low potassium both prolong the QT interval and raise the risk.

Answer

B · Magnesium sulfate
6.Lab values & electrolytes

Answer: A · Alcohol-related liver disease

Why this is the answer

An AST:ALT ratio of about 2:1 or more with a high GGT is typical of alcohol-related liver disease. In acute viral hepatitis ALT is usually higher than AST and often very high; bile-duct obstruction mainly raises ALP.

Answer

A · Alcohol-related liver disease
7.Clinical nursing

Answer: A · Confusion, headache and seizures

Why this is the answer

Low sodium causes water to move into brain cells, leading to nausea, headache, confusion and in severe cases seizures. It must be corrected slowly to avoid osmotic demyelination.

Answer

A · Confusion, headache and seizures
8.Clinical nursing

Answer: D · Disseminated intravascular coagulation

Why this is the answer

In DIC, widespread activation of clotting consumes platelets and clotting factors, causing both small clots and bleeding. Treating the underlying cause and replacing blood products as needed are key.

Answer

D · Disseminated intravascular coagulation
9.Med-surg: cardiovascular & respiratory

Answer: D · In the morning, to avoid needing the toilet at night

Why this is the answer

Loop diuretics produce a brisk diuresis that lasts several hours. Taking them in the morning (and a second dose by early afternoon if prescribed) avoids nocturia, broken sleep and night-time falls.

Answer

D · In the morning, to avoid needing the toilet at night
10.Med-surg: cardiovascular & respiratory

Answer: C · Apply firm pressure just above the puncture site and call for help

Why this is the answer

Bleeding or haematoma at the arterial access site is a common complication, made worse by antiplatelet and anticoagulant drugs. Firm manual pressure just above the skin puncture (over the arterial puncture), with the patient lying flat, is the first action, together with vital signs, distal pulses and escalation. Retroperitoneal bleeding can be hidden, so watch for back pain and hypotension.

Answer

C · Apply firm pressure just above the puncture site and call for help
11.Med-surg: neuro, endocrine & renal

Answer: B · The bladder may not empty, and regular emptying protects the kidneys

Why this is the answer

Spinal cord injury often causes neurogenic bladder. Clean intermittent catheterisation at regular intervals empties the bladder, prevents high pressures, reduces infection and kidney damage and avoids triggering autonomic dysreflexia.

Answer

B · The bladder may not empty, and regular emptying protects the kidneys
12.Med-surg: neuro, endocrine & renal

Answer: A · Constipation obstructing outflow

Why this is the answer

Poor outflow is often caused by constipation, catheter kinking or catheter displacement. Changing position, checking clamps and tubing and treating constipation often help; it should be reported. If it persists, imaging checks the catheter position. Clear effluent makes peritonitis less likely.

Answer

A · Constipation obstructing outflow
13.Med-surg: GI, perioperative & oncology

Answer: D · Palliative radiotherapy to the area

Why this is the answer

A single fraction or short course of radiotherapy relieves pain from bone metastases in many patients. Analgesia, including NSAIDs where suitable, and bone-targeted drugs are also used.

Answer

D · Palliative radiotherapy to the area
14.Med-surg: GI, perioperative & oncology

Answer: D · 4800 mL

Why this is the answer

Parkland gives 4 × 80 × 30 = 9600 mL in 24 hours, with half (4800 mL) in the first 8 hours from the time of injury. The rate is then adjusted to urine output and clinical response. Many burn centres now start lower, for example at 2 mL/kg/%TBSA in adults, and titrate to urine output.

Answer

D · 4800 mL

This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.

ExamProblems · examproblems.com/courses/nclex-style-prioritization-and-delegation