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
A malnourished patient admitted with alcohol use disorder needs IV glucose. Which vitamin is given before or with it?
- AThiamine (vitamin B1)
- BVitamin D (calciferol)
- CVitamin C (ascorbic acid)
- DVitamin K (phytonadione)
2.Prioritization & delegationHard
Which nursing assistant report should the nurse act on first?
- AA patient with diabetes says their feet often feel tingly, as they usually do
- BAfter lumbar spinal fusion this morning, cannot feel or move the legs
- CA patient with pneumonia has coughed up yellow sputum
- DA patient on bed rest is asking for a bedpan
3.Infection control & patient safetyMedium
Which type of white blood cell is most often raised in viral infections?
- ANeutrophils
- BLymphocytes
- CEosinophils
- DBasophils
4.Infection control & patient safetyHard
During a urinary catheter insertion with sterile technique, the catheter tip touches the patient’s thigh. What should the nurse do?
- AWipe the tip with an antiseptic and continue
- BRinse the tip with sterile water and then continue
- CDiscard the catheter and use a new sterile one
- DContinue, because the thigh was cleaned
5.Lab values & electrolytesMedium
After surgery for colon cancer, a patient's CEA had fallen to normal, but it has been rising over the last two checks. What does this most likely suggest?
- APossible recurrence that needs further assessment
- BA sign of iron deficiency from the earlier bleeding
- CA normal change after surgery that needs no follow-up
- DA sure sign that the cancer has been fully cured
6.Lab values & electrolytesHard
A patient on IV gentamicin has a trough level above the target, and the creatinine has risen since yesterday. The next dose is due. What is the best action?
- AGive the dose with extra oral fluids to protect the kidneys
- BHold the dose and report the results to the prescriber
- CGive the dose now and recheck the levels next week
- DGive half of the dose and document the reason for it
7.Clinical nursingMedium
Which advice is correct for a patient taking levothyroxine?
- ATake it with a large meal to avoid nausea and stomach upset
- BTake it only on days when feeling tired
- CStop taking it once the symptoms improve
- DTake it on an empty stomach, usually before breakfast
8.Clinical nursingHard
A patient on a heparin infusion develops a sudden fall in platelet count five days after starting it. What should you suspect?
- ANormal response to heparin
- BVitamin K deficiency from poor intake
- CIron deficiency anaemia
- DHeparin-induced thrombocytopenia
9.Med-surg: cardiovascular & respiratoryMedium
Rheumatic heart disease most often follows which infection?
- AA fungal infection of the lungs
- BA viral infection of the upper airway
- CStaphylococcal infection of the skin
- DA group A streptococcal throat infection
10.Med-surg: cardiovascular & respiratoryHard
A patient with a confirmed calf DVT has started therapeutic anticoagulation and asks whether they must stay in bed. What is the most accurate answer?
- AWalking as tolerated is usually encouraged once treated
- BWalking is not allowed until the clot has fully dissolved
- CStrict bed rest is needed for at least two weeks
- DThe leg should be massaged before each walk
11.Med-surg: neuro, endocrine & renalMedium
A patient with CKD is booked for a CT scan with iodinated contrast. Which measure helps protect the kidneys?
- ARestricting all fluids for 24 hours before the scan
- BGood hydration around the scan, often with IV fluids
- CDoubling the dose of contrast for a clearer image
- DGiving a dose of ibuprofen before the scan
12.Med-surg: neuro, endocrine & renalHard
An 84-year-old man became more confused a week after starting oxybutynin. Infection has been ruled out. What should the nurse suspect?
- AAnticholinergic side effects of the drug
- BNormal ageing that needs no review
- CA sign that the drug dose is too low
- DA symptom of a high potassium from the drug
13.Med-surg: GI, perioperative & oncologyMedium
Which complication is more typical of Crohn's disease than of ulcerative colitis?
- AInflammation limited to the rectal lining
- BDisease that is cured by removing the colon
- CBleeding only from the rectum
- DFistulas between the bowel and other organs
14.Med-surg: GI, perioperative & oncologyHard
A patient with a sacral pressure ulcer keeps sliding down the bed when the head is raised high. Which advice best reduces shear?
- AKeep the head of the bed at or below 30° if possible; use slide sheets
- BRaise the head of the bed to 90° and pull the patient up the bed by the arms
- CUse a dry sheet and drag the patient up the bed
- DSit the patient upright without any support for the feet
3Solutions
1.Prioritization & delegation
Answer: A · Thiamine (vitamin B1)
Why this is the answer
Thiamine deficiency is common in heavy alcohol use, and giving glucose without thiamine can trigger Wernicke encephalopathy. Thiamine is given before or with glucose.
A · Thiamine (vitamin B1)
2.Prioritization & delegation
Answer: B · After lumbar spinal fusion this morning, cannot feel or move the legs
Why this is the answer
New inability to feel or move the legs after spinal surgery can mean a hematoma pressing on the spinal cord or nerves, which needs immediate assessment and escalation. Yellow sputum in pneumonia and long-standing neuropathy are expected.
B · After lumbar spinal fusion this morning, cannot feel or move the legs
3.Infection control & patient safety
Answer: B · Lymphocytes
Why this is the answer
Lymphocytes increase in many viral infections. Neutrophils rise mainly with bacterial infections, and eosinophils with allergies and parasites.
4.Infection control & patient safety
Answer: C · Discard the catheter and use a new sterile one
Why this is the answer
Once a sterile item touches a non-sterile surface, it is contaminated and is replaced. Inserting a contaminated catheter brings bacteria into the bladder and increases the risk of urinary tract infection.
C · Discard the catheter and use a new sterile one
5.Lab values & electrolytes
Answer: A · Possible recurrence that needs further assessment
Why this is the answer
CEA is not specific enough for screening, but a rising level after successful treatment can signal recurrence, so imaging and further assessment are usually arranged. Smoking and some benign conditions can also raise CEA.Checked against: CEA Test · MedlinePlus (NIH) (2026)
A · Possible recurrence that needs further assessment
6.Lab values & electrolytes
Answer: B · Hold the dose and report the results to the prescriber
Why this is the answer
A high aminoglycoside trough with rising creatinine means the drug is accumulating, which increases the risk of kidney damage and hearing loss. The nurse holds the dose, reports to the prescriber and asks about hearing changes and tinnitus. Only the prescriber or pharmacist changes the regimen.Checked against: Gentamicin sulfate injection - Boxed Warning (US prescribing information) · Pfizer Medical Information (FDA label)
B · Hold the dose and report the results to the prescriber
7.Clinical nursing
Answer: D · Take it on an empty stomach, usually before breakfast
Why this is the answer
Levothyroxine is absorbed best on an empty stomach and is usually taken at the same time each morning. It is normally lifelong, with doses adjusted by thyroid blood tests.
D · Take it on an empty stomach, usually before breakfast
8.Clinical nursing
Answer: D · Heparin-induced thrombocytopenia
Why this is the answer
HIT typically appears 5–10 days after starting heparin, with a platelet drop of more than 50% and a risk of thrombosis. Heparin is stopped and a non-heparin anticoagulant used.
D · Heparin-induced thrombocytopenia
9.Med-surg: cardiovascular & respiratory
Answer: D · A group A streptococcal throat infection
Why this is the answer
Rheumatic fever is an autoimmune reaction weeks after group A streptococcal pharyngitis. It can permanently damage heart valves, most often the mitral valve. Prompt antibiotic treatment of strep throat prevents it.
D · A group A streptococcal throat infection
10.Med-surg: cardiovascular & respiratory
Answer: A · Walking as tolerated is usually encouraged once treated
Why this is the answer
Early mobilisation with effective anticoagulation does not increase the risk of pulmonary embolism and may reduce pain, swelling and post-thrombotic syndrome. Routine bed rest is no longer recommended. Massage of the affected leg should be avoided.
A · Walking as tolerated is usually encouraged once treated
11.Med-surg: neuro, endocrine & renal
Answer: B · Good hydration around the scan, often with IV fluids
Why this is the answer
Iodinated contrast can contribute to AKI in at-risk patients. Good hydration, using the lowest dose needed, avoiding nephrotoxic drugs and checking kidney function afterwards help reduce the risk.
B · Good hydration around the scan, often with IV fluids
12.Med-surg: neuro, endocrine & renal
Answer: A · Anticholinergic side effects of the drug
Why this is the answer
Anticholinergic drugs such as oxybutynin can cause confusion and worsen cognition in older people. The prescriber should review the medicine and the patient's overall anticholinergic burden.
A · Anticholinergic side effects of the drug
13.Med-surg: GI, perioperative & oncology
Answer: D · Fistulas between the bowel and other organs
Why this is the answer
Transmural inflammation in Crohn's disease can create fistulas, abscesses and strictures. Ulcerative colitis is mucosal, and removing the colon and rectum is curative.
D · Fistulas between the bowel and other organs
14.Med-surg: GI, perioperative & oncology
Answer: A · Keep the head of the bed at or below 30° if possible; use slide sheets
Why this is the answer
A high head position makes patients slide, causing shear on the sacrum. A lower head position when clinically possible, knee break or foot support, and slide sheets for moving reduce shear and friction.
A · Keep the head of the bed at or below 30° if possible; use slide sheets
This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.