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 stable adult has abdominal pain and normal vital signs. They will need blood tests and a CT scan. Which ESI level fits?
- ALevel 4
- BLevel 1
- CLevel 3
- DLevel 5
2.Prioritization & delegationHard
A patient with a new tracheostomy is coughing, has noisy breathing and an SpO₂ that has fallen to 86%. What is the first action?
- AGive a nebulized bronchodilator
- BSuction the tracheostomy
- CDocument the SpO₂ and recheck in 30 minutes
- DChange the tracheostomy ties
3.Infection control & patient safetyMedium
A parent says, “I tell my son his medicine is candy so he takes it.” What should the nurse teach?
- AIt only matters for medicines that taste bitter or are hard to swallow
- BThis is a good idea and makes giving medicine easier
- CDo not call medicine candy, because the child may take it when no one is watching
- DIt is fine as long as the medicine is kept in the fridge
4.Infection control & patient safetyHard
A patient refuses to wear an identification wristband. What should the nurse do?
- AStop giving the patient any care until they agree to wear the band
- BForce the band onto the patient’s wrist
- CAccept the refusal and identify the patient by room number and bed space instead
- DExplain why it is needed, use other ID methods per policy and document
5.Lab values & electrolytesMedium
A blood sample drawn just after a patient ate a fatty meal is reported as "lipemic." What does this mean for the results?
- AThe sample was contaminated by an IV fluid with dextrose
- BThe sample shows the patient has diabetic ketoacidosis
- CThe results are more accurate than in a fasting sample
- DHigh fat in the sample may interfere with some test results
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?
- AHypoparathyroidism
- BVitamin D toxicity
- CPrimary hyperparathyroidism
- DChronic kidney disease
7.Clinical nursingMedium
A patient on the ward has shingles with open blisters. Which people are most at risk from contact?
- APregnant women and immunocompromised people who have not had chickenpox
- BNo one, because shingles cannot spread
- CPeople who have already had chickenpox in childhood and are now healthy
- DOnly people over 80 who have already had shingles themselves
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?
- AThe drug makes glucose tablets and drinks ineffective
- BThe drug causes rebound hyperglycaemia later the same day
- CSulfonylureas only work at night
- DSulfonylureas act for a long time, so hypoglycaemia can recur
9.Med-surg: cardiovascular & respiratoryMedium
Which patient is most typical of a primary spontaneous pneumothorax?
- AA tall, thin young man who smokes
- BAn older woman with long-standing heart failure
- CA child with a viral sore throat
- DA middle-aged woman with high blood pressure
10.Med-surg: cardiovascular & respiratoryHard
A patient who has had a total laryngectomy becomes breathless and needs oxygen. How should it be given?
- AVia a non-rebreather mask over the mouth only
- BVia nasal cannula at 2 L/min
- CVia a standard face mask over the nose and mouth
- DVia a mask or humidified device over the neck stoma
11.Med-surg: neuro, endocrine & renalMedium
How does bladder training help urge incontinence?
- AThe patient goes to the toilet every 15 minutes
- BThe patient drinks as little as possible
- CA catheter is used every night
- DThe time between voids is slowly increased
12.Med-surg: neuro, endocrine & renalHard
Which statement correctly distinguishes spinal shock from neurogenic shock?
- AThey are two names for exactly the same condition
- BSpinal shock is lost reflexes; neurogenic shock is low BP and slow pulse
- CSpinal shock is low blood pressure; neurogenic shock is the loss of reflexes
- DNeurogenic shock is caused by blood loss; spinal shock is caused by infection
13.Med-surg: GI, perioperative & oncologyMedium
A patient received IV morphine 20 minutes ago and the surgical consent form has not been signed. What should the nurse do?
- ASign the form on the patient's behalf as a witness
- BAsk a relative to sign instead of the patient
- CTell the surgeon, as the patient may not be able to consent now
- DAsk the patient to sign quickly before they get sleepier
14.Med-surg: GI, perioperative & oncologyHard
Which history should most alert the nurse to a possible latex allergy before surgery?
- AA rash after taking amoxicillin as a child, with a family history of asthma
- BHay fever every spring since childhood
- CFeeling sick after eating shellfish once
- DItching with bananas, avocado and kiwi, and many operations
3Solutions
1.Prioritization & delegation
Answer: C · Level 3
Why this is the answer
Blood tests (one resource) plus a CT scan (a second resource) make two resources, which is ESI level 3 when the vital signs are acceptable.
2.Prioritization & delegation
Answer: B · Suction the tracheostomy
Why this is the answer
Noisy breathing, coughing and a falling SpO₂ in a patient with a tracheostomy suggest secretions in the tube. Suctioning clears the airway. If the airway is still blocked, follow the emergency tracheostomy algorithm and call for help.
B · Suction the tracheostomy
3.Infection control & patient safety
Answer: C · Do not call medicine candy, because the child may take it when no one is watching
Why this is the answer
Calling medicine candy encourages children to look for it and swallow it, which can lead to poisoning. Parents are taught to call medicine medicine and keep it locked away.
C · Do not call medicine candy, because the child may take it when no one is watching
4.Infection control & patient safety
Answer: D · Explain why it is needed, use other ID methods per policy and document
Why this is the answer
The nurse explains how the band prevents errors. If the patient still refuses, the nurse follows policy for alternative identification using two identifiers, informs the team and documents it.
D · Explain why it is needed, use other ID methods per policy and document
5.Lab values & electrolytes
Answer: D · High fat in the sample may interfere with some test results
Why this is the answer
Lipemia makes serum cloudy and can interfere with several laboratory methods, giving inaccurate results. The test may need to be repeated, often after a fast, according to laboratory advice.
D · High fat in the sample may interfere with some test results
6.Lab values & electrolytes
Answer: A · 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)
7.Clinical nursing
Answer: A · Pregnant women and immunocompromised people who have not had chickenpox
Why this is the answer
Someone who has never had chickenpox can catch chickenpox from contact with shingles blisters. Non-immune pregnant and immunocompromised people are at particular risk, so lesions are covered and precautions followed.
A · Pregnant women and immunocompromised people who have not had chickenpox
8.Clinical nursing
Answer: D · 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.
D · Sulfonylureas act for a long time, so hypoglycaemia can recur
9.Med-surg: cardiovascular & respiratory
Answer: A · A tall, thin young man who smokes
Why this is the answer
Primary spontaneous pneumothorax usually occurs in tall, thin young men, often smokers, when small apical blebs rupture. Secondary pneumothorax occurs in people with lung disease such as COPD and tends to be more serious.
A · A tall, thin young man who smokes
10.Med-surg: cardiovascular & respiratory
Answer: D · Via a mask or humidified device over the neck stoma
Why this is the answer
A total laryngectomy separates the trachea from the upper airway, so the patient breathes only through the neck stoma. Oxygen and any rescue breaths must be given via the stoma. These patients are "neck breathers" and often carry an alert card.
D · Via a mask or humidified device over the neck stoma
11.Med-surg: neuro, endocrine & renal
Answer: D · The time between voids is slowly increased
Why this is the answer
In bladder training, the patient follows a schedule and gradually lengthens the time between voids while using urge-suppression techniques. Over weeks, bladder capacity and control improve. Very low fluid intake makes urine concentrated and irritating.
D · The time between voids is slowly increased
12.Med-surg: neuro, endocrine & renal
Answer: B · Spinal shock is lost reflexes; neurogenic shock is low BP and slow pulse
Why this is the answer
Spinal shock is the temporary loss of reflexes and tone below the injury. Neurogenic shock is hypotension and bradycardia caused by loss of sympathetic tone, usually with injuries at T6 or above. The two can occur together.
B · Spinal shock is lost reflexes; neurogenic shock is low BP and slow pulse
13.Med-surg: GI, perioperative & oncology
Answer: C · Tell the surgeon, as the patient may not be able to consent now
Why this is the answer
Opioids and sedatives can impair understanding, so consent may not be valid. The surgeon is informed; consent is obtained when the patient has capacity, or other legal processes are followed in an emergency.
C · Tell the surgeon, as the patient may not be able to consent now
14.Med-surg: GI, perioperative & oncology
Answer: D · Itching with bananas, avocado and kiwi, and many operations
Why this is the answer
Latex–fruit syndrome links latex allergy with foods such as banana, avocado, kiwi and chestnut. Repeated exposure, for example through many operations or catheters, also increases risk.
D · Itching with bananas, avocado and kiwi, and many operations
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