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

A patient has a serum potassium of 6.8 mEq/L. Which action comes first?

  1. AGive the patient’s scheduled potassium supplement
  2. BPlace the patient on a cardiac monitor
  3. CRecheck the level next week
  4. DEncourage foods high in potassium
2.Prioritization & delegationHard

Two hours after a femoral cardiac catheterization, the nurse sees blood spreading from the puncture site. What is the first action?

  1. AApply firm, direct pressure just above the puncture site
  2. BRemove the dressing and leave the site open to the air
  3. CAsk the patient to bend the leg at the hip to stop the bleeding
  4. DRaise the head of the bed so the patient can sit up
3.Infection control & patient safetyMedium

A nurse finds a used needle in a patient’s bed linen. What should the nurse do?

  1. AFold it into the linen and send it to the laundry
  2. BPick it up by the hub or with forceps, put it in a sharps container and report it
  3. CLeave it where it is for the housekeeping staff to remove later in the day
  4. DRecap it with two hands before throwing it away
4.Infection control & patient safetyHard

A patient dies after a wrong-drug error, and the hospital carries out a root cause analysis. What is its main focus?

  1. AEstimating the legal costs for the hospital
  2. BIdentifying which staff member made the error and should be disciplined
  3. CDeciding whether to tell the family about the error
  4. DFinding the system and process weaknesses that allowed the error
5.Lab values & electrolytesMedium

A patient has IV fluids running into the left forearm. Where should the nurse take a blood sample?

  1. AFrom any vein, since the fluid does not affect results
  2. BFrom just above the IV site in the same arm
  3. CFrom the IV cannula while the fluid is running
  4. DFrom the opposite arm
6.Lab values & electrolytesHard

A patient with metastatic breast cancer has a calcium of 13.2 mg/dL (3.3 mmol/L), is confused and constipated. Which prescribed treatment would the nurse expect to start first?

  1. AOral calcium supplements
  2. BA thiazide diuretic
  3. CStrict bed rest
  4. DIV 0.9% sodium chloride
7.Clinical nursingMedium

Which blood results are typical of Addison's disease (primary adrenal insufficiency)?

  1. AHigh sodium and low potassium
  2. BHigh glucose and high calcium
  3. CLow haemoglobin and high platelets
  4. DLow sodium and high potassium
8.Clinical nursingHard

Why can pulse oximetry be misleading in carbon monoxide poisoning?

  1. AThe oximeter overheats in smoke-exposed patients
  2. BCarbon monoxide only affects the heart rate reading
  3. CCarbon monoxide makes the oximeter read zero even in a well patient
  4. DStandard oximeters cannot tell carboxyhaemoglobin from oxyhaemoglobin
9.Med-surg: cardiovascular & respiratoryMedium

A 34-year-old has hypertension that is hard to control and a low serum potassium without taking diuretics. Which cause should be considered?

  1. AEssential hypertension of ageing
  2. BHypothyroidism
  3. CPrimary hyperaldosteronism
  4. DIron-deficiency anaemia
10.Med-surg: cardiovascular & respiratoryHard

A patient with a mechanical mitral valve replacement on warfarin has an INR of 2.2. What should the nurse consider?

  1. AThe INR may be below this patient's higher target, so check it and report
  2. BThe INR is dangerously high and the dose must be withheld
  3. CThe INR should be about 1.0 for mechanical valves
  4. DThe INR is in range for every warfarin indication, so no action is needed
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. AHypoglycaemia unawareness
  2. BInsulin resistance
  3. CThe dawn phenomenon
  4. DDiabetic ketoacidosis
12.Med-surg: neuro, endocrine & renalHard

A seizure has lasted 12 minutes. Two doses of benzodiazepine have been given, and the seizure continues. Airway and oxygen are managed. What is the next step in common protocols?

  1. AA second-line IV drug such as levetiracetam or phenytoin
  2. BWaiting another 30 minutes to see whether the seizure stops
  3. CGiving oral antiseizure tablets once the patient can swallow
  4. DA third and fourth dose of benzodiazepine every two minutes
13.Med-surg: GI, perioperative & oncologyMedium

Which bedside assessments are used to follow ascites?

  1. ACapillary glucose before each meal
  2. BDaily weight and abdominal girth
  3. CPupil size and reaction twice daily
  4. DPeak flow and oxygen saturation
14.Med-surg: GI, perioperative & oncologyHard

Ten days after chemotherapy, a patient has a temperature of 37.6 °C but feels shivery and unwell, with a pulse of 112/min and BP 95/60 mmHg. What is the correct action?

  1. AReassure the patient, because the temperature is still below 38 °C
  2. BWait for the neutrophil count before deciding on any treatment
  3. CGive paracetamol and recheck the temperature again in four hours
  4. DTreat as possible neutropenic sepsis: IV antibiotics within an hour

3Solutions

1.Prioritization & delegation

Answer: B · Place the patient on a cardiac monitor

Why this is the answer

Severe hyperkalemia can cause dangerous arrhythmias, so continuous cardiac monitoring comes first while the provider is informed and treatment is prepared.

Answer

B · Place the patient on a cardiac monitor
2.Prioritization & delegation

Answer: A · Apply firm, direct pressure just above the puncture site

Why this is the answer

Direct manual pressure just above the puncture site compresses the femoral artery and stops bleeding. The patient keeps the leg straight, and the nurse checks vital signs and distal pulses and informs the provider.

Answer

A · Apply firm, direct pressure just above the puncture site
3.Infection control & patient safety

Answer: B · Pick it up by the hub or with forceps, put it in a sharps container and report it

Why this is the answer

A loose needle is a hazard to everyone who handles the linen. The nurse disposes of it safely without recapping, using an instrument if needed, and reports the incident so the cause can be addressed.

Answer

B · Pick it up by the hub or with forceps, put it in a sharps container and report it
4.Infection control & patient safety

Answer: D · Finding the system and process weaknesses that allowed the error

Why this is the answer

A root cause analysis looks beyond the individual to the system factors, such as storage, labeling, staffing or workflow, that allowed the error. The aim is to change the system so the error cannot happen again.

Answer

D · Finding the system and process weaknesses that allowed the error
5.Lab values & electrolytes

Answer: D · From the opposite arm

Why this is the answer

Blood taken near a running infusion is mixed with the IV fluid, causing false results, such as a high glucose or a low hemoglobin. The sample is taken from the other arm, or according to policy if that is not possible.

Answer

D · From the opposite arm
6.Lab values & electrolytes

Answer: D · IV 0.9% sodium chloride

Why this is the answer

Hypercalcemia causes large urine volumes and dehydration. IV saline restores volume and helps the kidneys excrete calcium; bisphosphonates usually follow. Thiazides reduce calcium excretion, and immobility releases calcium from bone.Checked against: Hypercalcemia · MedlinePlus (NIH) (2026)

Answer

D · IV 0.9% sodium chloride
7.Clinical nursing

Answer: D · Low sodium and high potassium

Why this is the answer

Without aldosterone, the kidneys lose sodium and retain potassium. Patients may also have low blood pressure, low glucose and increased skin pigmentation.

Answer

D · Low sodium and high potassium
8.Clinical nursing

Answer: D · Standard oximeters cannot tell carboxyhaemoglobin from oxyhaemoglobin

Why this is the answer

Standard SpO2 can appear normal despite severe tissue hypoxia. Carboxyhaemoglobin is measured on a blood gas, and high-concentration oxygen is given.

Answer

D · Standard oximeters cannot tell carboxyhaemoglobin from oxyhaemoglobin
9.Med-surg: cardiovascular & respiratory

Answer: C · Primary hyperaldosteronism

Why this is the answer

Excess aldosterone (for example from an adrenal adenoma, Conn's syndrome) causes sodium retention, hypertension and potassium loss. Young age, resistant hypertension and unexplained hypokalaemia suggest a secondary cause and need investigation.

Answer

C · Primary hyperaldosteronism
10.Med-surg: cardiovascular & respiratory

Answer: A · The INR may be below this patient's higher target, so check it and report

Why this is the answer

Mechanical heart valves, especially in the mitral position, often need a higher INR target (for example 2.5–3.5, depending on valve type and risk factors). An INR of 2.2 may be subtherapeutic, increasing the risk of valve thrombosis and stroke. The nurse checks the documented target and informs the prescriber. DOACs are not used for mechanical valves.

Answer

A · The INR may be below this patient's higher target, so check it and report
11.Med-surg: neuro, endocrine & renal

Answer: A · 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

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

Answer: A · A second-line IV drug such as levetiracetam or phenytoin

Why this is the answer

Status epilepticus that continues after two doses of benzodiazepine (established status) is treated with a second-line IV drug. If it still continues (refractory status), anaesthesia and intubation in critical care are needed. Glucose, airway and monitoring continue throughout. Repeated benzodiazepines increase respiratory depression without much extra benefit.

Answer

A · A second-line IV drug such as levetiracetam or phenytoin
13.Med-surg: GI, perioperative & oncology

Answer: B · Daily weight and abdominal girth

Why this is the answer

Daily weights and abdominal girth measured at the same marked level show whether ascites is increasing or decreasing. Fluid balance, renal function and electrolytes are also monitored, especially on diuretics.

Answer

B · Daily weight and abdominal girth
14.Med-surg: GI, perioperative & oncology

Answer: D · Treat as possible neutropenic sepsis: IV antibiotics within an hour

Why this is the answer

A patient who is unwell during the expected nadir is treated as having neutropenic sepsis even without a high fever; rigors, tachycardia and hypotension are warning signs. Blood cultures are taken and empirical IV antibiotics started within 1 hour, without waiting for the blood count. Antipyretics can mask fever and should not delay assessment.

Answer

D · Treat as possible neutropenic sepsis: IV antibiotics within an hour

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