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
Which nursing assistant task is appropriate for a patient two days after hip replacement?
- ATeaching the patient the hip precautions before discharge
- BHelping the patient into a chair, following the hip precautions
- CChecking the incision for redness, warmth and drainage
- DEvaluating whether the last dose of pain medication controlled the pain
2.Prioritization & delegationHard
A patient has peripheral arterial disease with a non-healing ulcer on the toe. Which advice about leg position is correct?
- AWrap the legs tightly with compression bandages
- BKeep the legs raised above the heart as much as possible
- CSit with the legs crossed to improve blood flow
- DKeep the legs level or slightly lowered, not raised
3.Infection control & patient safetyMedium
The laboratory calls with a critical lab result by phone. What should the nurse do?
- ARemember the value and enter it in the chart at the end of the shift
- BWait for the printed report to arrive before telling the provider about it
- CTell the patient the result first and then call the provider
- DWrite it down, read it back to confirm and report it to the provider promptly
4.Infection control & patient safetyHard
A nurse is unsure whether a sterile glove touched the edge of the sterile field. What is the correct action?
- AWipe the glove with alcohol
- BAsk the patient whether they saw it
- CContinue, because the nurse is not sure
- DTreat the glove as contaminated and change it
5.Lab values & electrolytesMedium
A patient is scheduled for a liver biopsy. Which laboratory results should the nurse check before the procedure?
- ATSH and free T4
- BPlatelet count and PT/INR
- CSerum sodium and chloride
- DHbA1c and lipid panel
6.Lab values & electrolytesHard
A patient with a round face, central weight gain and purple stretch marks has a glucose of 210 mg/dL (11.7 mmol/L) and a potassium of 3.1 mEq/L. Which condition fits best?
- ACushing syndrome
- BAdrenal insufficiency
- CDiabetes insipidus
- DHypothyroidism
7.Clinical nursingMedium
A patient with dysphagia after a stroke has been cleared for a modified diet. How should they be positioned for meals?
- ALying on their side with the knees bent
- BSemi-reclined at about 20 degrees, with the head supported on pillows
- CSitting fully upright, and staying upright for a time after eating
- DLying flat on their back with the head turned to one side
8.Clinical nursingHard
A patient's hypoglycaemia was caused by a sulfonylurea such as gliclazide or glipizide. Why might they need monitoring for longer than usual?
- ASulfonylureas act for a long time, so hypoglycaemia can recur
- BSulfonylureas only work at night
- CThe drug makes glucose tablets and drinks ineffective
- DThe drug causes rebound hyperglycaemia later the same day
9.Med-surg: cardiovascular & respiratoryMedium
Which vaccinations are usually recommended for people with COPD?
- AA yearly tetanus booster only
- BAnnual influenza and pneumococcal vaccination
- CA BCG vaccine every five years
- DNo vaccines at all, as they are known to trigger exacerbations
10.Med-surg: cardiovascular & respiratoryHard
A nurse teaches a patient who is starting warfarin. Which statement shows a need for further teaching?
- A"I will have regular INR blood tests."
- B"If I miss a dose, I will take two the next day."
- C"I will check before taking any new medicines or herbal remedies."
- D"I will tell my dentist that I take warfarin."
11.Med-surg: neuro, endocrine & renalMedium
A patient with a suspected basal skull fracture needs a gastric tube. Which route is preferred?
- AThrough the mouth (orogastric)
- BThrough the nose (nasogastric)
- CThrough a fine-bore nasal tube
- DThrough the nose with a guidewire
12.Med-surg: neuro, endocrine & renalHard
The nurse has four endocrine patients. Which one needs to be seen first?
- AA patient with Graves' disease asking about radioactive iodine
- BA patient with hypothyroidism who has been constipated for three days
- CA patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)
- DA patient after thyroidectomy with mild pain on swallowing
13.Med-surg: GI, perioperative & oncologyMedium
Which electrolyte pattern is typical of tumour lysis syndrome?
- AHigh potassium, phosphate and uric acid; low calcium
- BLow potassium and phosphate with high calcium
- CLow potassium, low phosphate and low uric acid
- DHigh sodium and high calcium with a low uric acid level
14.Med-surg: GI, perioperative & oncologyHard
An adult weighing 70 kg has 40% total body surface area burns. Using the Parkland formula, how is the first 24 hours' crystalloid usually divided?
- AAll of it in the first hour, then oral fluids only for the rest of the day
- BHalf in the first 8 hours from the time of the burn, half over the next 16 hours
- COne quarter in the first 8 hours from arrival, the rest over 16 hours
- DEqual hourly amounts over 24 hours, counted from arrival at hospital
3Solutions
1.Prioritization & delegation
Answer: B · Helping the patient into a chair, following the hip precautions
Why this is the answer
Helping a stable patient move, using precautions already set in the care plan, is a routine task. Inspecting the wound, teaching and evaluating pain relief need nursing assessment.
B · Helping the patient into a chair, following the hip precautions
2.Prioritization & delegation
Answer: D · Keep the legs level or slightly lowered, not raised
Why this is the answer
In arterial disease, gravity helps blood reach the feet, so legs are not elevated. Elevation and compression suit venous disease, and crossing the legs reduces flow further.
D · Keep the legs level or slightly lowered, not raised
3.Infection control & patient safety
Answer: D · Write it down, read it back to confirm and report it to the provider promptly
Why this is the answer
Writing down and reading back critical results confirms they were heard correctly. The nurse then reports them promptly to the responsible provider and documents who was told and when.
D · Write it down, read it back to confirm and report it to the provider promptly
4.Infection control & patient safety
Answer: D · Treat the glove as contaminated and change it
Why this is the answer
The principle is “if in doubt, it is not sterile”. The edge of the field is non-sterile, so the glove is changed. Continuing on an uncertain basis puts the patient at risk of infection.
D · Treat the glove as contaminated and change it
5.Lab values & electrolytes
Answer: B · Platelet count and PT/INR
Why this is the answer
Liver biopsy carries a risk of bleeding, and liver disease often lowers platelets and clotting factors. Platelets and PT/INR are checked beforehand, and abnormal results are reported so they can be corrected or the procedure postponed.Checked against: Liver biopsy · MedlinePlus (NIH) (2025)
B · Platelet count and PT/INR
6.Lab values & electrolytes
Answer: A · Cushing syndrome
Why this is the answer
Excess cortisol raises glucose, causes central obesity, a round face and purple striae, and has some mineralocorticoid effect that lowers potassium. Adrenal insufficiency causes low glucose and high potassium.Checked against: Hypercortisolism (Cushing Syndrome) · StatPearls (NCBI Bookshelf) (2025); Hypokalemia · StatPearls (NCBI Bookshelf) (2025)
7.Clinical nursing
Answer: C · Sitting fully upright, and staying upright for a time after eating
Why this is the answer
Sitting upright during and after meals reduces the risk of aspiration. The patient should also be supervised and given the consistency recommended by the speech and language therapist.
C · Sitting fully upright, and staying upright for a time after eating
8.Clinical nursing
Answer: A · Sulfonylureas act for a long time, so hypoglycaemia can recur
Why this is the answer
Sulfonylureas stimulate insulin release and have a long duration of action. Hypoglycaemia can be prolonged or recur, so glucose is monitored closely after treatment.
A · Sulfonylureas act for a long time, so hypoglycaemia can recur
9.Med-surg: cardiovascular & respiratory
Answer: B · Annual influenza and pneumococcal vaccination
Why this is the answer
Vaccination against influenza, pneumococcus and other respiratory infections recommended in national schedules (such as COVID-19 and, for older adults, RSV) reduces infections and exacerbations in COPD.
B · Annual influenza and pneumococcal vaccination
10.Med-surg: cardiovascular & respiratory
Answer: B · "If I miss a dose, I will take two the next day."
Why this is the answer
Doubling up after a missed dose can cause over-anticoagulation and bleeding. Patients are usually told to take a missed dose the same day if they remember, or skip it and record it, then seek advice. Regular INR checks, telling other clinicians and checking interactions are correct.
B · "If I miss a dose, I will take two the next day."
11.Med-surg: neuro, endocrine & renal
Answer: A · Through the mouth (orogastric)
Why this is the answer
A tube passed through the nose could enter the cranial vault through the fractured skull base. An orogastric route avoids this. Nasal suction and nose blowing are also avoided.
A · Through the mouth (orogastric)
12.Med-surg: neuro, endocrine & renal
Answer: C · A patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)
Why this is the answer
Fever and confusion in a patient with hyperthyroidism suggest thyroid storm, which can be fatal without urgent treatment. The other problems are expected or non-urgent.
C · A patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)
13.Med-surg: GI, perioperative & oncology
Answer: A · High potassium, phosphate and uric acid; low calcium
Why this is the answer
Tumour lysis releases potassium, phosphate and nucleic acids (raising uric acid). Phosphate binds calcium, lowering it. Calcium phosphate and uric acid crystals can damage the kidneys.
A · High potassium, phosphate and uric acid; low calcium
14.Med-surg: GI, perioperative & oncology
Answer: B · Half in the first 8 hours from the time of the burn, half over the next 16 hours
Why this is the answer
Parkland gives 4 × 70 × 40 = 11 200 mL in 24 hours. Half (5600 mL) is given in the first 8 hours counted from the time of the burn, not from arrival, and the rest over 16 hours. The rate is then adjusted to urine output.
B · Half in the first 8 hours from the time of the burn, half over the next 16 hours
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