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

An Rh-negative mother has just given birth to an Rh-positive baby. What does the nurse expect to give the mother?

  1. ANo treatment is needed
  2. BVitamin K to the mother
  3. CRh immunoglobulin within 72 hours
  4. DA dose of the hepatitis B vaccine instead
2.Prioritization & delegationHard

Which assignment by the charge nurse should be changed?

  1. AAn RN is assigned to a patient receiving a blood transfusion
  2. BAn LPN/LVN is assigned to give oral medications to stable patients
  3. CAn LPN/LVN is assigned to admit a new patient from the emergency department
  4. DA nursing assistant is assigned to help several stable patients with their meals
3.Infection control & patient safetyMedium

When should a nurse call the rapid response team?

  1. AOnly when the provider has written an order for a rapid response call in the chart
  2. BOnly when the patient’s family makes a complaint
  3. CWhen a patient shows an acute decline, such as new confusion or a sharp change in vital signs
  4. DOnly after a patient has had a cardiac or respiratory arrest on the ward
4.Infection control & patient safetyHard

A patient receiving chemotherapy has an absolute neutrophil count of 400/mm3 (0.4 × 109/L) and a new temperature of 38.3 °C (100.9 °F). What should the nurse do?

  1. AGive an antipyretic and reassess at the next routine round
  2. BEncourage oral fluids and record the result in the chart
  3. CRecheck the temperature in four hours before calling anyone about it
  4. DReport it at once, because fever with severe neutropenia is an emergency
5.Lab values & electrolytesMedium

A patient who has been vomiting for two days has a BUN of 32 mg/dL (urea 11.4 mmol/L) and a normal creatinine. What is the most likely cause?

  1. ADehydration
  2. BLiver failure
  3. COverhydration
  4. DLow-protein diet
6.Lab values & electrolytesHard

A patient with sepsis has the following new results. Which set best shows organ dysfunction?

  1. APlatelets 70 × 10³/µL, creatinine doubled, bilirubin raised
  2. BCalcium 9.4 mg/dL, phosphate 3.5 mg/dL, magnesium 1.9 mEq/L
  3. CWBC 11.5 × 10³/µL, potassium 4.2 mEq/L, albumin 3.8 g/dL
  4. DHemoglobin 12.5 g/dL, sodium 138 mEq/L, glucose 105 mg/dL
7.Clinical nursingMedium

Why must a patient with a new coronary stent not stop their antiplatelet medicines without specialist advice?

  1. AStopping early greatly increases the risk of a clot forming in the stent
  2. BThe stent will dissolve if the drugs are stopped before the course ends
  3. CStopping causes immediate kidney failure
  4. DStopping causes severe low blood pressure
8.Clinical nursingHard

A patient with stress incontinence is taught self-care. Which statement shows a need for further teaching?

  1. A"I'll try to lose some weight if I can."
  2. B"I'll drink as little as possible so I don't leak."
  3. C"I'll cut down on caffeine."
  4. D"I'll do my pelvic floor exercises every day."
9.Med-surg: cardiovascular & respiratoryMedium

Before compression therapy is applied for a venous leg ulcer, which assessment is essential?

  1. AAn ankle–brachial pressure index (ABPI)
  2. BA full blood count and CRP
  3. CA chest X-ray and ECG
  4. DA wound swab for culture and sensitivity
10.Med-surg: cardiovascular & respiratoryHard

A patient on warfarin for atrial fibrillation has an INR of 8.5 but no bleeding. What is the most likely management?

  1. AGive prothrombin complex concentrate and a blood transfusion
  2. BWithhold warfarin, inform the prescriber and recheck the INR soon
  3. CContinue the usual dose and recheck the INR in a month
  4. DGive IV protamine sulfate immediately to reverse it
11.Med-surg: neuro, endocrine & renalMedium

A patient taking sodium valproate becomes tired and is vomiting, and the nurse notices yellowing of the eyes. What is the main concern?

  1. AA sign that the dose is too low
  2. BLiver toxicity from valproate
  3. CDehydration from drinking too little
  4. DA normal adjustment reaction to the drug
12.Med-surg: neuro, endocrine & renalHard

A patient with multiple sclerosis has had worse leg weakness for one day, together with a fever and burning on passing urine. What is the most likely explanation?

  1. AA side effect of physiotherapy
  2. BA change to progressive MS
  3. CA true relapse that needs high-dose steroids
  4. DA pseudo-relapse caused by infection
13.Med-surg: GI, perioperative & oncologyMedium

Which statement about feeding in mild acute pancreatitis fits current guidance?

  1. AFood is withheld until the amylase is back to normal
  2. BPatients must stay nil by mouth for at least three weeks to rest the pancreas
  3. CPatients should be fed only by parenteral nutrition
  4. DOral feeding can restart early, once pain and nausea allow
14.Med-surg: GI, perioperative & oncologyHard

On day 3 after laparoscopic cholecystectomy, a patient has abdominal pain, fever and mild jaundice, and green fluid is draining from the drain. What is most likely?

  1. ANormal post-operative drainage
  2. BA bile leak
  3. CA wound haematoma
  4. DUrinary retention

3Solutions

1.Prioritization & delegation

Answer: C · Rh immunoglobulin within 72 hours

Why this is the answer

Rh immunoglobulin given within 72 hours of birth prevents the mother from forming anti-D antibodies, which could harm a future Rh-positive baby.

Answer

C · Rh immunoglobulin within 72 hours
2.Prioritization & delegation

Answer: C · An LPN/LVN is assigned to admit a new patient from the emergency department

Why this is the answer

Admitting a new patient includes the initial assessment and plan of care, which belong to the RN. The other assignments match each staff member’s role.

Answer

C · An LPN/LVN is assigned to admit a new patient from the emergency department
3.Infection control & patient safety

Answer: C · When a patient shows an acute decline, such as new confusion or a sharp change in vital signs

Why this is the answer

Rapid response teams bring critical care skills to a patient who is getting worse, with the aim of preventing cardiac arrest or ICU transfer. Any nurse who is worried about an acute change can call them.

Answer

C · When a patient shows an acute decline, such as new confusion or a sharp change in vital signs
4.Infection control & patient safety

Answer: D · Report it at once, because fever with severe neutropenia is an emergency

Why this is the answer

Febrile neutropenia can progress to sepsis quickly. The nurse reports it immediately so cultures can be taken and antibiotics started without delay.

Answer

D · Report it at once, because fever with severe neutropenia is an emergency
5.Lab values & electrolytes

Answer: A · Dehydration

Why this is the answer

When the body is short of fluid, the kidneys reabsorb more urea, so the BUN rises out of proportion to creatinine (a BUN-to-creatinine ratio above 20:1). Liver failure and a low-protein diet lower the BUN.Checked against: BUN (Blood Urea Nitrogen) · MedlinePlus (NIH) (2024)

Answer

A · Dehydration
6.Lab values & electrolytes

Answer: A · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised

Why this is the answer

In sepsis, falling platelets (coagulation), a rising creatinine (kidney) and a raised bilirubin (liver) show organ dysfunction, which indicates severe disease. The other sets are normal or near normal.Checked against: Bacterial Sepsis · StatPearls (NCBI Bookshelf) (2023); Laboratory Evaluation of Sepsis · StatPearls (NCBI Bookshelf) (2023)

Answer

A · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised
7.Clinical nursing

Answer: A · Stopping early greatly increases the risk of a clot forming in the stent

Why this is the answer

Dual antiplatelet therapy prevents stent thrombosis while the stent becomes covered by the artery lining. Stopping early can cause a sudden myocardial infarction.

Answer

A · Stopping early greatly increases the risk of a clot forming in the stent
8.Clinical nursing

Answer: B · "I'll drink as little as possible so I don't leak."

Why this is the answer

Restricting fluids concentrates urine, irritates the bladder and risks dehydration and infection. Pelvic floor exercises, weight loss and reducing caffeine are recommended measures.

Answer

B · "I'll drink as little as possible so I don't leak."
9.Med-surg: cardiovascular & respiratory

Answer: A · An ankle–brachial pressure index (ABPI)

Why this is the answer

Compression helps venous return but can cause tissue necrosis if the arterial supply is inadequate. The ABPI compares ankle and arm systolic pressures; a value below about 0.8 (or above about 1.3, suggesting calcified vessels) needs specialist review before compression.

Answer

A · An ankle–brachial pressure index (ABPI)
10.Med-surg: cardiovascular & respiratory

Answer: B · Withhold warfarin, inform the prescriber and recheck the INR soon

Why this is the answer

A very high INR without bleeding is usually managed by withholding warfarin, informing the prescriber and repeating the INR. Low-dose oral vitamin K may also be prescribed depending on the INR and local protocol (UK guidance gives it above an INR of 8; US guidance mainly above 10 or with high bleeding risk). Prothrombin complex concentrate and IV vitamin K are used for major bleeding. Protamine reverses heparin. The reason for the rise (new drugs, illness, diet) should be explored.

Answer

B · Withhold warfarin, inform the prescriber and recheck the INR soon
11.Med-surg: neuro, endocrine & renal

Answer: B · Liver toxicity from valproate

Why this is the answer

Valproate can cause serious liver injury, especially early in treatment. Jaundice, vomiting, lethargy or abdominal pain need urgent review and liver function tests. Pancreatitis is another rare but serious effect.

Answer

B · Liver toxicity from valproate
12.Med-surg: neuro, endocrine & renal

Answer: D · A pseudo-relapse caused by infection

Why this is the answer

Infection and fever can temporarily worsen existing MS symptoms without new damage (a pseudo-relapse). The infection, here probably a UTI, is treated first. Steroids for a true relapse are considered only if the infection is excluded.

Answer

D · A pseudo-relapse caused by infection
13.Med-surg: GI, perioperative & oncology

Answer: D · Oral feeding can restart early, once pain and nausea allow

Why this is the answer

Early oral or enteral feeding helps maintain the gut barrier and reduces infection compared with prolonged nil by mouth or parenteral nutrition. In mild pancreatitis, a low-fat diet is usually restarted as soon as tolerated; enzyme levels need not be normal first.

Answer

D · Oral feeding can restart early, once pain and nausea allow
14.Med-surg: GI, perioperative & oncology

Answer: B · A bile leak

Why this is the answer

Bile leakage from the cystic duct or a duct injury causes pain, fever and sometimes jaundice, with bile in the drain. It needs urgent surgical review and often ERCP and stenting.

Answer

B · A bile leak

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