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

Which postoperative patient should the nurse see first?

  1. AAsking when the urinary catheter will be removed
  2. BDressing soaked with bright red blood and a heart rate rising to 118/min
  3. CPain of 4/10 one hour after an oral analgesic
  4. DWants help with washing her hair before her visitors arrive this afternoon
2.Prioritization & delegationHard

A dehydrated child is to receive IV fluids with added potassium. Which finding should the nurse confirm first?

  1. AThat the child is passing urine
  2. BThat the child can walk without help
  3. CThat the child’s temperature is normal
  4. DThat the child is hungry
3.Infection control & patient safetyMedium

A patient has botulism after eating contaminated food. Which precautions are needed?

  1. AContact precautions
  2. BDroplet precautions
  3. CAirborne precautions
  4. DStandard precautions
4.Infection control & patient safetyHard

A nurse finds an unknown liquid leaking from a container in the utility room, with a strong smell. What should the nurse do first?

  1. ALeave the area, keep others out and alert the trained response team
  2. BPour water over it to dilute it
  3. CMove closer and smell it carefully to identify what the substance is
  4. DMop it up with paper towels
5.Lab values & electrolytesMedium

An older adult with chronic kidney disease takes glyburide (glibenclamide, a sulfonylurea) and has repeated low glucose readings. Why is this a concern?

  1. AThe drug and its metabolites build up and cause long lows
  2. BThe drug stops working entirely when the kidneys fail
  3. CThe drug causes high potassium that lowers the glucose
  4. DThe drug makes the glucose meter read falsely low
6.Lab values & electrolytesHard

A patient on an IV insulin infusion has a blood glucose of 65 mg/dL (3.6 mmol/L). What is the best action?

  1. AContinue at the same rate and recheck in four hours
  2. BFollow the protocol for low glucose and inform the provider
  3. CStop the infusion and leave the glucose recheck until the morning
  4. DGive oral potassium to protect the heart
7.Clinical nursingMedium

Which group of features is typical of nephrotic syndrome?

  1. APolyuria, thirst and weight loss
  2. BHeavy proteinuria, low serum albumin and oedema
  3. CBlood in the urine, high blood pressure and reduced urine output only
  4. DSevere loin pain and fever
8.Clinical nursingHard

A patient has a swollen, warm, tender calf on one side. Which action should the nurse avoid?

  1. AChecking whether VTE prophylaxis was given
  2. BMassaging the calf
  3. CMeasuring and comparing calf circumference
  4. DReporting the findings to the doctor
9.Med-surg: cardiovascular & respiratoryMedium

Which finding shows that long-standing hypertension has caused target organ damage?

  1. AA heart rate of 72/min
  2. BLeft ventricular hypertrophy on the ECG
  3. CClear lung fields on the chest X-ray
  4. DA normal fasting glucose
10.Med-surg: cardiovascular & respiratoryHard

A nurse has four cardiac patients. Which one should be seen first?

  1. AA patient with AF and a heart rate of 86/min who is due an apixaban dose this morning
  2. BA patient with heart failure whose weight is 0.3 kg up on yesterday's morning weight
  3. CA patient with angina whose chest pain has not eased with rest and who is sweating
  4. DA patient after a radial angiogram asking when they can eat
11.Med-surg: neuro, endocrine & renalMedium

After a thyroidectomy, why are suture or clip removers often kept at the bedside?

  1. AThey are needed to take blood from the neck veins
  2. BThe sutures must be removed on the first evening after surgery
  3. CThey are used to adjust the drain when it stops working
  4. DA neck haematoma can compress the airway and may need release
12.Med-surg: neuro, endocrine & renalHard

A patient with a known ureteric stone develops a fever of 39 °C (102.2 °F) and rigors. Scanning shows a blocked, swollen kidney. What is needed?

  1. AOral antibiotics and waiting for the stone to pass
  2. BA fluid restriction to reduce the swelling
  3. CStrong pain relief alone, then discharge
  4. DUrgent drainage of the kidney plus IV antibiotics
13.Med-surg: GI, perioperative & oncologyMedium

A patient with cirrhosis takes lactulose for hepatic encephalopathy. What is the usual aim?

  1. ATwo to three soft stools a day
  2. BOne firm stool every week
  3. CNo bowel movement for several days
  4. DTen or more watery stools a day
14.Med-surg: GI, perioperative & oncologyHard

Two days after a PEG insertion, a patient reports pain on feeding, and feed is leaking around the site. What should the nurse do?

  1. AContinue feeding and apply a thicker dressing
  2. BIncrease the feed rate to improve nutrition
  3. CStop the feed at once and seek urgent medical advice
  4. DGive the next medicines through the tube as usual

3Solutions

1.Prioritization & delegation

Answer: B · Dressing soaked with bright red blood and a heart rate rising to 118/min

Why this is the answer

Heavy fresh bleeding with a rising heart rate suggests hemorrhage and early shock. The other patients have routine needs that can wait.

Answer

B · Dressing soaked with bright red blood and a heart rate rising to 118/min
2.Prioritization & delegation

Answer: A · That the child is passing urine

Why this is the answer

Potassium is not added to IV fluids until the child is passing urine, because poor kidney function can let potassium build up to dangerous levels.

Answer

A · That the child is passing urine
3.Infection control & patient safety

Answer: D · Standard precautions

Why this is the answer

Botulism is caused by a toxin and does not spread from person to person, so standard precautions are used. Suspected cases are reported to public health at once.

Answer

D · Standard precautions
4.Infection control & patient safety

Answer: A · Leave the area, keep others out and alert the trained response team

Why this is the answer

An unknown chemical spill may be toxic or flammable. The nurse moves people away, prevents entry and calls the designated hazardous materials team, who check the Safety Data Sheet and use the right equipment.

Answer

A · Leave the area, keep others out and alert the trained response team
5.Lab values & electrolytes

Answer: A · The drug and its metabolites build up and cause long lows

Why this is the answer

Glyburide and its active metabolites are cleared by the kidneys, so they accumulate in CKD and can cause severe, prolonged hypoglycemia. Older adults are at greater risk. The prescriber is informed, and a different drug is usually chosen.

Answer

A · The drug and its metabolites build up and cause long lows
6.Lab values & electrolytes

Answer: B · Follow the protocol for low glucose and inform the provider

Why this is the answer

A glucose below 70 mg/dL on an insulin infusion is hypoglycemia. The nurse follows the hospital’s protocol, which typically stops or reduces the insulin and gives glucose, rechecks often and informs the provider.Checked against: Low blood sugar · MedlinePlus (NIH) (2026)

Answer

B · Follow the protocol for low glucose and inform the provider
7.Clinical nursing

Answer: B · Heavy proteinuria, low serum albumin and oedema

Why this is the answer

In nephrotic syndrome, damaged glomeruli leak protein, so albumin falls and fluid moves into tissues, causing oedema. Cholesterol is often raised too.

Answer

B · Heavy proteinuria, low serum albumin and oedema
8.Clinical nursing

Answer: B · Massaging the calf

Why this is the answer

Unilateral calf swelling and tenderness suggests DVT. Massaging the leg is avoided in case it dislodges the clot; the patient needs medical review and investigation.

Answer

B · Massaging the calf
9.Med-surg: cardiovascular & respiratory

Answer: B · Left ventricular hypertrophy on the ECG

Why this is the answer

Target organ damage from hypertension includes left ventricular hypertrophy, retinopathy, chronic kidney disease with proteinuria, and stroke. Its presence changes treatment urgency and targets.

Answer

B · Left ventricular hypertrophy on the ECG
10.Med-surg: cardiovascular & respiratory

Answer: C · A patient with angina whose chest pain has not eased with rest and who is sweating

Why this is the answer

Chest pain that does not settle with rest, especially with sweating, suggests an acute coronary syndrome and needs immediate assessment and a 12-lead ECG. A controlled heart rate in AF, a very small weight change and a question about eating are not urgent.

Answer

C · A patient with angina whose chest pain has not eased with rest and who is sweating
11.Med-surg: neuro, endocrine & renal

Answer: D · A neck haematoma can compress the airway and may need release

Why this is the answer

A neck haematoma after thyroid surgery can quickly compress the airway. Many units keep clip or suture removers and airway equipment at the bedside so the wound can be opened in an emergency. The nurse watches for swelling, stridor and difficulty breathing.

Answer

D · A neck haematoma can compress the airway and may need release
12.Med-surg: neuro, endocrine & renal

Answer: D · Urgent drainage of the kidney plus IV antibiotics

Why this is the answer

Infection behind an obstruction can quickly cause sepsis and kidney damage. Antibiotics alone will not clear it. The kidney needs urgent decompression, usually with a nephrostomy or ureteric stent.

Answer

D · Urgent drainage of the kidney plus IV antibiotics
13.Med-surg: GI, perioperative & oncology

Answer: A · Two to three soft stools a day

Why this is the answer

Lactulose acidifies the colon and traps ammonia, and it speeds transit. The dose is titrated to 2–3 soft stools a day. Excessive diarrhoea can cause dehydration and electrolyte disturbance that worsen encephalopathy.

Answer

A · Two to three soft stools a day
14.Med-surg: GI, perioperative & oncology

Answer: C · Stop the feed at once and seek urgent medical advice

Why this is the answer

Pain on feeding, external leakage or new bleeding soon after PEG insertion may mean feed is leaking into the peritoneum. Feeding and medicines are stopped immediately and senior review is arranged to exclude peritonitis.

Answer

C · Stop the feed at once and seek urgent medical advice

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