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 drowsy patient who has just returned from surgery starts to vomit. What should the nurse do first?

  1. AGive an oral anti-sickness tablet
  2. BGive a drink of water
  3. CRaise the legs above the heart
  4. DTurn the patient onto their side
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 most severely injured person first
  2. BTreating the youngest victims first
  3. CTreating victims in the order in which they arrive
  4. DDoing the greatest good for the greatest number
3.Infection control & patient safetyMedium

A woman who is pregnant asks for the MMR vaccine because she is not immune to rubella. What is correct?

  1. AMMR is only given to pregnant women who work in hospitals
  2. BMMR should be given as soon as possible in the first trimester to protect the baby
  3. CMMR is a live vaccine and is not given during pregnancy, but can be given after delivery
  4. DMMR is safe at any stage of pregnancy
4.Infection control & patient safetyHard

A nurse has given a medication to the wrong patient. The patient seems well. What is the first priority?

  1. AWait until the end of the shift to tell anyone
  2. BSay nothing to the patient, in order to avoid worrying them
  3. CAssess the patient and monitor for effects of the drug
  4. DComplete the incident report before anything else
5.Lab values & electrolytesMedium

A patient with recurrent gout starts allopurinol. Which laboratory result shows that the treatment is achieving its goal?

  1. AA rising white cell count
  2. BA falling serum uric acid
  3. CA rising serum calcium
  4. DA falling serum potassium
6.Lab values & electrolytesHard

A patient has a positive hepatitis C antibody (anti-HCV) test. What is the most appropriate next step?

  1. ATell the patient they definitely have chronic hepatitis C
  2. BRepeat the antibody test, as a positive test is always false
  3. CGive hepatitis C vaccine to prevent further infection
  4. DTest for HCV RNA to find out whether infection is current
7.Clinical nursingMedium

Which electrolyte disturbance is most dangerous for the heart rhythm?

  1. ALow sodium
  2. BHigh chloride
  3. CHigh or low potassium
  4. DLow phosphate
8.Clinical nursingHard

A patient with a central venous catheter suddenly becomes breathless and hypotensive while the line is being disconnected with the patient sitting up. What complication is most likely?

  1. AAir embolism
  2. BHypoglycaemia
  3. CPneumonia
  4. DPhlebitis
9.Med-surg: cardiovascular & respiratoryMedium

According to current guidance, when should oxygen be given to a patient with an acute coronary syndrome?

  1. AOnly once the troponin result is available
  2. BOnly when SpO₂ is below the target range
  3. CAlways at 15 L/min, whatever the saturation
  4. DNever, because oxygen harms heart muscle
10.Med-surg: cardiovascular & respiratoryHard

After six weeks of treatment for tuberculosis, a patient has nausea, dark urine and yellow eyes. What should the nurse do?

  1. AReassure the patient that the urine colour is due to rifampicin
  2. BWithhold the next doses and report urgently for liver tests
  3. CAdvise taking the tablets with an alcoholic drink to settle the stomach
  4. DDouble the isoniazid dose to clear the infection faster
11.Med-surg: neuro, endocrine & renalMedium

How is cerebral perfusion pressure (CPP) calculated?

  1. ADiastolic pressure minus central venous pressure
  2. BMean arterial pressure divided by heart rate
  3. CMean arterial pressure minus intracranial pressure
  4. DSystolic arterial pressure plus intracranial pressure
12.Med-surg: neuro, endocrine & renalHard

During a TURP, a patient becomes confused and nauseated, with a slow pulse and a raised BP. The sodium is 121 mmol/L. What is most likely?

  1. AHypoglycaemia from fasting for many hours before surgery
  2. BA normal reaction to the spinal anaesthetic
  3. CTURP syndrome from absorbed irrigation fluid
  4. DAn allergic reaction to the catheter
13.Med-surg: GI, perioperative & oncologyMedium

Why are laxatives and enemas avoided when appendicitis is suspected?

  1. AThey stop antibiotics from being absorbed
  2. BThey make the blood tests impossible to read
  3. CThey always cause the appendix to bleed heavily
  4. DThey may increase the risk of perforation
14.Med-surg: GI, perioperative & oncologyHard

A patient has had a large terminal ileum resection for Crohn's disease. Which long-term problems should the nurse anticipate?

  1. AExcess vitamin D and calcium kidney stones in the first year
  2. BIron overload and constipation
  3. CVitamin B12 deficiency and bile-acid diarrhoea
  4. DInsulin deficiency and high blood glucose from loss of the islets

3Solutions

1.Prioritization & delegation

Answer: D · Turn the patient onto their side

Why this is the answer

A drowsy patient who vomits can aspirate. Turning them to the side lets vomit drain from the mouth; suction and a prescribed antiemetic follow.

Answer

D · Turn the patient onto their side
2.Prioritization & delegation

Answer: D · 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

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

Answer: C · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery

Why this is the answer

Live vaccines such as MMR and varicella are not given during pregnancy. A non-immune woman is vaccinated after delivery, and pregnancy is avoided for a period after vaccination.

Answer

C · MMR is a live vaccine and is not given during pregnancy, but can be given after delivery
4.Infection control & patient safety

Answer: C · Assess the patient and monitor for effects of the drug

Why this is the answer

The first priority is the patient’s safety: assess, monitor and inform the prescriber, who decides on any treatment. The error is then reported through the hospital’s system and the patient is told according to policy.

Answer

C · Assess the patient and monitor for effects of the drug
5.Lab values & electrolytes

Answer: B · A falling serum uric acid

Why this is the answer

Allopurinol reduces uric acid production by blocking xanthine oxidase. Over time, a lower serum uric acid reduces gout attacks and dissolves urate crystals. Kidney function is checked, and a rash must be reported because of rare severe skin reactions.Checked against: Gout · StatPearls (NCBI Bookshelf) (2026)

Answer

B · A falling serum uric acid
6.Lab values & electrolytes

Answer: D · Test for HCV RNA to find out whether infection is current

Why this is the answer

Anti-HCV shows exposure, but some people clear the virus and keep antibodies. An HCV RNA test shows whether the infection is current. There is no vaccine for hepatitis C, but antiviral treatment can cure most infections.Checked against: Hepatitis C · MedlinePlus (NIH) (2025)

Answer

D · Test for HCV RNA to find out whether infection is current
7.Clinical nursing

Answer: C · High or low potassium

Why this is the answer

Both hyperkalaemia and hypokalaemia can cause life-threatening arrhythmias. Potassium must never be given as an undiluted rapid IV bolus.

Answer

C · High or low potassium
8.Clinical nursing

Answer: A · Air embolism

Why this is the answer

Air embolism can occur when a central line is open to air. Clamp the line, lay the patient on the left side with head down if possible, give high-flow oxygen and call for help.

Answer

A · Air embolism
9.Med-surg: cardiovascular & respiratory

Answer: B · Only when SpO₂ is below the target range

Why this is the answer

Routine high-flow oxygen in patients who are not hypoxaemic offers no benefit and may increase infarct size. Oxygen is given when saturation falls below the target (for example below 90% in some guidelines, below 94% in others).

Answer

B · Only when SpO₂ is below the target range
10.Med-surg: cardiovascular & respiratory

Answer: B · Withhold the next doses and report urgently for liver tests

Why this is the answer

Isoniazid, rifampicin and pyrazinamide can all cause hepatotoxicity. Jaundice, dark urine and nausea suggest drug-induced hepatitis, so the drugs are stopped and liver function is checked urgently. Orange urine from rifampicin does not cause yellow eyes. Alcohol increases the risk.

Answer

B · Withhold the next doses and report urgently for liver tests
11.Med-surg: neuro, endocrine & renal

Answer: C · Mean arterial pressure minus intracranial pressure

Why this is the answer

CPP = MAP − ICP. A CPP of at least about 60 mmHg is usually targeted in adults with brain injury. If ICP rises or MAP falls, CPP falls and the brain becomes ischaemic.

Answer

C · Mean arterial pressure minus intracranial pressure
12.Med-surg: neuro, endocrine & renal

Answer: C · TURP syndrome from absorbed irrigation fluid

Why this is the answer

In TURP syndrome, irrigating fluid is absorbed into the blood, causing fluid overload and dilutional hyponatraemia. Signs include confusion, nausea, bradycardia, hypertension and, if severe, seizures. It needs urgent medical treatment.

Answer

C · TURP syndrome from absorbed irrigation fluid
13.Med-surg: GI, perioperative & oncology

Answer: D · They may increase the risk of perforation

Why this is the answer

Stimulating peristalsis can raise pressure on an inflamed appendix and may lead to rupture and peritonitis. The patient is kept nil by mouth while awaiting surgical assessment.

Answer

D · They may increase the risk of perforation
14.Med-surg: GI, perioperative & oncology

Answer: C · Vitamin B12 deficiency and bile-acid diarrhoea

Why this is the answer

The terminal ileum absorbs vitamin B12 and bile acids. After resection, B12 replacement may be needed, and unabsorbed bile acids reaching the colon cause diarrhoea.

Answer

C · Vitamin B12 deficiency and bile-acid diarrhoea

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