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

On the first day after abdominal surgery, a patient has a temperature of 37.9 °C and reduced breath sounds at the lung bases. Which nursing action is most helpful?

  1. AKeep the patient lying flat in bed to rest the incision fully
  2. BGive a cough suppressant so that the incision is not strained
  3. CRestrict oral fluids so that the lungs do not fill up with extra fluid
  4. DEncourage deep breathing, coughing and use of the incentive spirometer
2.Prioritization & delegationHard

A patient had sudden difficulty speaking 45 minutes ago. Which action has the highest priority?

  1. AActivate the stroke team for urgent imaging, noting when last known well
  2. BGive aspirin by mouth straight away to limit the clot
  3. CGive water so the patient can take the usual morning medicines
  4. DWait until the neurologist can assess the patient on the morning ward round
3.Infection control & patient safetyMedium

Which statement about the use of physical restraints is correct?

  1. ARestraints are checked once at the end of each shift
  2. BAlternatives come first, and a time-limited order is needed
  3. CRestraints can be used whenever the unit is short of nursing staff
  4. DStanding as-needed restraint orders are good practice
4.Infection control & patient safetyHard

A patient with fever and a spreading rash is suspected of having smallpox. Which precautions are needed?

  1. ADroplet precautions with a surgical mask
  2. BContact precautions only
  3. CStandard precautions only
  4. DAirborne and contact precautions
5.Lab values & electrolytesMedium

A patient taking phenazopyridine for bladder pain has bright orange urine. What should the nurse know about urine tests?

  1. AThe color shows severe liver failure is present
  2. BThe dye can interfere with dipstick color readings
  3. CThe color proves blood is present in the urine
  4. DThe drug improves the accuracy of all dipsticks
6.Lab values & electrolytesHard

On the evening after surgery, a patient’s hemoglobin has fallen from 12.5 g/dL to 8.1 g/dL (125 to 81 g/L), and the heart rate is 118/min. What is the most likely problem?

  1. AAn improving condition
  2. BBleeding
  3. CNormal dilution after surgery that needs no action
  4. DDehydration
7.Clinical nursingMedium

Which is the correct technique for using a metered-dose inhaler without a spacer?

  1. ABreathe in quickly through the nose while pressing the canister
  2. BPress the canister twice quickly, then breathe in fast and breathe straight out again
  3. CBreathe out, then breathe in slowly and deeply while pressing the canister, then hold
  4. DPress the canister and wait one minute before breathing in
8.Clinical nursingHard

An arterial blood gas shows a low PaO2 with a low or normal PaCO2. How is this classified?

  1. AType 2 respiratory failure
  2. BType 1 respiratory failure
  3. CMetabolic acidosis
  4. DNormal blood gas
9.Med-surg: cardiovascular & respiratoryMedium

Virchow's triad describes three factors that promote venous thrombosis. Which patient factor represents venous stasis?

  1. AAn inherited clotting disorder
  2. BTaking an oestrogen-containing pill
  3. CDamage to a vein during hip surgery
  4. DImmobility after major surgery
10.Med-surg: cardiovascular & respiratoryHard

Thirty minutes after extubation, a patient develops a high-pitched noise on breathing in and is anxious. SpO₂ is falling. What should the nurse do?

  1. AGive a large drink of cold water to soothe the throat and settle it
  2. BLay the patient flat and reassure them
  3. CEncourage the patient to sleep it off and recheck them in an hour
  4. DSit the patient up, give oxygen and call for urgent airway help
11.Med-surg: neuro, endocrine & renalMedium

Why is pyridostigmine often taken about 30–60 minutes before meals by patients with myasthenia gravis?

  1. ATo improve the strength of chewing and swallowing at mealtimes
  2. BTo stop the drug from irritating an empty stomach later on
  3. CTo lower the blood glucose rise after eating a meal
  4. DTo reduce stomach acid so the food is digested better
12.Med-surg: neuro, endocrine & renalHard

A haemodialysis patient missed their last two sessions. They are breathless, with crackles, and the potassium is 6.9 mmol/L. What is the priority?

  1. AOral potassium supplements and rest
  2. BUrgent dialysis, with cardiac monitoring meanwhile
  3. CLarge IV fluid boluses to improve the circulation
  4. DA routine dialysis session at the next planned slot
13.Med-surg: GI, perioperative & oncologyMedium

Why are patients with diabetes often placed early on the operating list?

  1. ABecause their surgery always takes longer than others
  2. BBecause their wounds heal faster in the morning
  3. CTo shorten fasting and reduce swings in blood glucose
  4. DBecause they need to go home before midday
14.Med-surg: GI, perioperative & oncologyHard

On day 3 after a major burn, the patient starts passing large volumes of urine. Which electrolyte problem should the nurse anticipate?

  1. AHypercalcaemia, caused by bed rest and immobilisation
  2. BHyperkalaemia, as new tissue damage releases potassium
  3. CHypokalaemia, as fluid returns to the circulation
  4. DHypernatraemia, as the kidneys begin to retain sodium

3Solutions

1.Prioritization & delegation

Answer: D · Encourage deep breathing, coughing and use of the incentive spirometer

Why this is the answer

Reduced basal breath sounds and a mild temperature early after surgery often mean atelectasis. Deep breathing, coughing, incentive spirometry and early mobilization help re-expand the lungs.

Answer

D · Encourage deep breathing, coughing and use of the incentive spirometer
2.Prioritization & delegation

Answer: A · Activate the stroke team for urgent imaging, noting when last known well

Why this is the answer

Thrombolysis is time-dependent and needs imaging first to rule out a bleed. The time last known well decides eligibility. Aspirin is not given before imaging, and nothing is given by mouth until swallowing has been screened.

Answer

A · Activate the stroke team for urgent imaging, noting when last known well
3.Infection control & patient safety

Answer: B · Alternatives come first, and a time-limited order is needed

Why this is the answer

Restraints are used only when other measures have failed and the patient or others are at risk. An order that is time-limited and regularly reviewed is needed, “as needed” orders are not allowed, and the patient is monitored often.

Answer

B · Alternatives come first, and a time-limited order is needed
4.Infection control & patient safety

Answer: D · Airborne and contact precautions

Why this is the answer

Smallpox spreads by respiratory particles and by contact with lesions or contaminated items, so airborne and contact precautions are used. Only immunized staff should provide care where possible.

Answer

D · Airborne and contact precautions
5.Lab values & electrolytes

Answer: B · The dye can interfere with dipstick color readings

Why this is the answer

Phenazopyridine is a urinary analgesic dye that turns urine orange-red. It can interfere with color-based dipstick tests, so the laboratory should be told. The color is harmless, but it can stain contact lenses and clothing.Checked against: Urine - abnormal color · MedlinePlus (NIH) (2025)

Answer

B · The dye can interfere with dipstick color readings
6.Lab values & electrolytes

Answer: B · Bleeding

Why this is the answer

A fall of more than 4 g/dL with a fast heart rate suggests ongoing blood loss. The nurse assesses the wound and drains, monitors the vital signs and escalates urgently. Some dilution from IV fluids is common, but not this much, and not with tachycardia.Checked against: Hemoglobin Test · MedlinePlus (NIH) (2024)

Answer

B · Bleeding
7.Clinical nursing

Answer: C · Breathe out, then breathe in slowly and deeply while pressing the canister, then hold

Why this is the answer

The patient breathes out, seals the lips around the mouthpiece, starts breathing in slowly, presses the canister and continues a deep breath, then holds it for about 10 seconds. Spacers make coordination easier.

Answer

C · Breathe out, then breathe in slowly and deeply while pressing the canister, then hold
8.Clinical nursing

Answer: B · Type 1 respiratory failure

Why this is the answer

Type 1 respiratory failure is hypoxaemia without hypercapnia, as in pneumonia or pulmonary embolism. Type 2 includes a raised PaCO2 from inadequate ventilation, as in COPD exacerbations.

Answer

B · Type 1 respiratory failure
9.Med-surg: cardiovascular & respiratory

Answer: D · Immobility after major surgery

Why this is the answer

Virchow's triad is stasis of blood, vessel wall injury and hypercoagulability. Immobility, long journeys and heart failure cause stasis. Surgery and trauma injure vessel walls. Oestrogen, cancer, pregnancy and inherited thrombophilias increase coagulability.

Answer

D · Immobility after major surgery
10.Med-surg: cardiovascular & respiratory

Answer: D · Sit the patient up, give oxygen and call for urgent airway help

Why this is the answer

Post-extubation stridor suggests laryngeal oedema and may progress to complete obstruction. The patient is sat up, given humidified oxygen and assessed by an airway expert urgently. Nebulised adrenaline and steroids may be used, and reintubation may be needed.

Answer

D · Sit the patient up, give oxygen and call for urgent airway help
11.Med-surg: neuro, endocrine & renal

Answer: A · To improve the strength of chewing and swallowing at mealtimes

Why this is the answer

Pyridostigmine inhibits acetylcholinesterase, so more acetylcholine is available at the neuromuscular junction. Timing it before meals gives the best muscle strength for chewing and swallowing, which lowers the risk of aspiration.

Answer

A · To improve the strength of chewing and swallowing at mealtimes
12.Med-surg: neuro, endocrine & renal

Answer: B · Urgent dialysis, with cardiac monitoring meanwhile

Why this is the answer

Missing dialysis causes fluid overload and hyperkalaemia, both of which can be fatal. The patient needs cardiac monitoring, emergency treatment of the potassium and urgent dialysis to remove fluid and potassium.

Answer

B · Urgent dialysis, with cardiac monitoring meanwhile
13.Med-surg: GI, perioperative & oncology

Answer: C · To shorten fasting and reduce swings in blood glucose

Why this is the answer

Shorter fasting reduces the risk of hypoglycaemia and makes it easier to restart normal eating and medicines. Glucose is monitored, and a variable-rate insulin infusion may be used for longer fasts.

Answer

C · To shorten fasting and reduce swings in blood glucose
14.Med-surg: GI, perioperative & oncology

Answer: C · Hypokalaemia, as fluid returns to the circulation

Why this is the answer

In the first hours, cell destruction and fluid shifts can raise potassium. After about 48–72 hours, capillary integrity improves, fluid returns to the circulation and diuresis begins, with potassium loss and hypokalaemia. Electrolytes are monitored throughout.

Answer

C · Hypokalaemia, as fluid returns to the circulation

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