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

Before accessing a central venous catheter, what should the nurse do to prevent infection?

  1. ATouch the hub to check it is clean
  2. BRinse the hub with tap water and dry it
  3. CBlow on the hub to remove any dust before connecting the syringe or line
  4. DScrub the hub with an antiseptic such as chlorhexidine and let it dry
2.Prioritization & delegationHard

Which assignment to an LPN/LVN is most appropriate?

  1. AA patient with new atrial fibrillation who has just started an IV diltiazem infusion
  2. BA patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications
  3. CA patient who needs discharge teaching for newly started warfarin
  4. DA patient transferred from intensive care one hour ago
3.Infection control & patient safetyMedium

A patient is admitted to an inpatient mental health unit. Why are personal belongings checked?

  1. ATo make a list of valuable items for insurance
  2. BTo find out what the patient likes to wear during the hospital stay
  3. CTo remove items that could be used to harm self or others
  4. DTo decide which family members may visit
4.Infection control & patient safetyHard

Which patient with a suspected infection meets at least two SIRS criteria?

  1. ATemperature 38.6 °C and heart rate 112/min
  2. BRespiratory rate 16/min and WBC 8,000/mm3
  3. CTemperature 36.8 °C and respiratory rate 18/min
  4. DTemperature 37.2 °C and heart rate 80/min
5.Lab values & electrolytesMedium

A patient without symptoms has a fasting plasma glucose of 132 mg/dL (7.3 mmol/L) on Monday and 138 mg/dL (7.7 mmol/L) on Thursday. What does this show?

  1. AThe results are within the normal fasting range
  2. BThe results show reactive hypoglycemia
  3. CThe results meet the criteria for diabetes
  4. DThe results show prediabetes only
6.Lab values & electrolytesHard

Weeks after neck surgery, a patient has muscle cramps and tingling. Calcium is low, phosphate is high and parathyroid hormone (PTH) is low. Which condition fits best?

  1. AChronic kidney disease
  2. BHypoparathyroidism
  3. CPrimary hyperparathyroidism
  4. DVitamin D toxicity
7.Clinical nursingMedium

Why should a urinary catheter drainage bag be kept below the level of the bladder?

  1. ATo stop the catheter from falling out
  2. BTo keep the urine warm
  3. CTo make the bag easier for the nurse to empty
  4. DTo prevent urine flowing back into the bladder
8.Clinical nursingHard

A patient with a head injury has a GCS that falls from 14 to 10 and one pupil becomes larger and slow to react. What should the nurse do?

  1. AEscalate immediately as a neurological emergency
  2. BEncourage the patient to sleep
  3. CRecheck the GCS at the next routine observation round
  4. DGive a sedative to calm the patient
9.Med-surg: cardiovascular & respiratoryMedium

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

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

A patient with end-stage COPD has severe breathlessness at rest despite optimal treatment and wants comfort-focused care. Which measure is recognised to help?

  1. AHigh-flow oxygen at 15 L/min whatever the oxygen saturation is
  2. BEncouraging long walks to build fitness
  3. CStopping all medicines, including inhalers
  4. DA low-dose opioid with a hand-held fan and calm positioning
11.Med-surg: neuro, endocrine & renalMedium

A patient who has had type 1 diabetes for 30 years says they no longer feel the warning signs of a hypo. What is this called?

  1. AThe dawn phenomenon
  2. BHypoglycaemia unawareness
  3. CInsulin resistance
  4. DDiabetic ketoacidosis
12.Med-surg: neuro, endocrine & renalHard

A patient with myasthenia gravis took extra pyridostigmine doses. They now have more weakness, heavy salivation, sweating, diarrhoea, small pupils and a slow pulse. What is most likely?

  1. AA cholinergic crisis from too much medication
  2. BA normal response to a higher dose
  3. CA myasthenic crisis from too little medication
  4. DAn allergic reaction to the drug
13.Med-surg: GI, perioperative & oncologyMedium

Which burn should usually be discussed with a specialist burns service even if it is small?

  1. AA small superficial sunburn on the back
  2. BA partial-thickness burn on the hand
  3. CA tiny burn on the forearm with redness only
  4. DA healed burn scar from many years ago
14.Med-surg: GI, perioperative & oncologyHard

A patient's ileostomy output is 2.5 L a day. They feel tired and dizzy and are drinking large amounts of water. Which advice is usually appropriate?

  1. AStop all drinking for 24 hours
  2. BDrink even more plain water and tea to replace the losses
  3. CLimit plain drinks and use an oral rehydration solution
  4. DEat only fruit and fruit juice

3Solutions

1.Prioritization & delegation

Answer: D · Scrub the hub with an antiseptic such as chlorhexidine and let it dry

Why this is the answer

Scrubbing the needleless connector with an antiseptic, such as chlorhexidine or alcohol, and letting it dry reduces central line infections. Aseptic technique is used for every access.

Answer

D · Scrub the hub with an antiseptic such as chlorhexidine and let it dry
2.Prioritization & delegation

Answer: B · A patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications

Why this is the answer

A stable COPD patient with routine treatments has predictable care. A recent ICU transfer and a newly started IV rate-control infusion need RN assessment, and initial teaching about a new high-alert drug belongs to the RN.

Answer

B · A patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications
3.Infection control & patient safety

Answer: C · To remove items that could be used to harm self or others

Why this is the answer

Belongings are searched with the patient, according to policy, for items such as sharp objects, cords, drugs and lighters. These are stored safely to reduce the risk of self-harm or violence.

Answer

C · To remove items that could be used to harm self or others
4.Infection control & patient safety

Answer: A · Temperature 38.6 °C and heart rate 112/min

Why this is the answer

SIRS criteria include a temperature above 38 °C or below 36 °C, heart rate above 90/min, respiratory rate above 20/min and a WBC above 12,000 or below 4,000/mm3. Only the first patient meets two.

Answer

A · Temperature 38.6 °C and heart rate 112/min
5.Lab values & electrolytes

Answer: C · The results meet the criteria for diabetes

Why this is the answer

Two fasting results of 126 mg/dL (7.0 mmol/L) or more confirm diabetes in a person without symptoms. Prediabetes is 100–125 mg/dL. The nurse helps the patient understand the next steps, including education and follow-up.Checked against: Diabetes · MedlinePlus (NIH) (2025)

Answer

C · The results meet the criteria for diabetes
6.Lab values & electrolytes

Answer: B · Hypoparathyroidism

Why this is the answer

Without enough PTH, calcium is not released from bone or kept by the kidney, and phosphate is not excreted, so calcium falls and phosphate rises. It can follow injury or removal of the parathyroid glands during thyroid or neck surgery.Checked against: Hypoparathyroidism · MedlinePlus (NIH) (2026); Hypocalcemia · StatPearls (NCBI Bookshelf) (2026)

Answer

B · Hypoparathyroidism
7.Clinical nursing

Answer: D · To prevent urine flowing back into the bladder

Why this is the answer

Keeping the bag below the bladder allows drainage and prevents backflow, which reduces infection risk. The bag should also not touch the floor.

Answer

D · To prevent urine flowing back into the bladder
8.Clinical nursing

Answer: A · Escalate immediately as a neurological emergency

Why this is the answer

A falling GCS with a unilateral dilated pupil suggests rising intracranial pressure and possible brain herniation. Urgent medical review and imaging are needed.

Answer

A · Escalate immediately as a neurological emergency
9.Med-surg: cardiovascular & respiratory

Answer: C · 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

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

Answer: D · A low-dose opioid with a hand-held fan and calm positioning

Why this is the answer

Low-dose oral opioids can ease refractory breathlessness in advanced disease. A fan blowing air across the face, upright positioning, breathing techniques and anxiety management also help. Oxygen is used only if it relieves symptoms or corrects hypoxaemia.

Answer

D · A low-dose opioid with a hand-held fan and calm positioning
11.Med-surg: neuro, endocrine & renal

Answer: B · Hypoglycaemia unawareness

Why this is the answer

Long duration of diabetes and frequent hypos reduce the adrenaline response, so warning symptoms are lost. This greatly increases the risk of severe hypos. Strict avoidance of hypos for some weeks can partly restore awareness, and glucose sensors with alarms help.

Answer

B · Hypoglycaemia unawareness
12.Med-surg: neuro, endocrine & renal

Answer: A · A cholinergic crisis from too much medication

Why this is the answer

Too much cholinesterase inhibitor causes a cholinergic crisis: weakness plus muscarinic effects such as salivation, sweating, diarrhoea, miosis and bradycardia. A myasthenic crisis is weakness from under-treatment or triggers. Both can cause respiratory failure, so the airway is the priority.

Answer

A · A cholinergic crisis from too much medication
13.Med-surg: GI, perioperative & oncology

Answer: B · A partial-thickness burn on the hand

Why this is the answer

Burns of the face, hands, feet, genitalia, perineum and major joints, as well as circumferential, chemical, electrical and inhalation injuries, usually need specialist advice because of their risks and functional impact.

Answer

B · A partial-thickness burn on the hand
14.Med-surg: GI, perioperative & oncology

Answer: C · Limit plain drinks and use an oral rehydration solution

Why this is the answer

In high-output stomas, hypotonic drinks increase sodium loss through the stoma. Restricting them and using a glucose–salt oral rehydration solution, with antimotility drugs as prescribed and medical review, helps correct dehydration.

Answer

C · Limit plain drinks and use an oral rehydration solution

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