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

Using the Emergency Severity Index, which level fits a 70-year-old with chest pressure that suggests a heart attack, but normal vital signs?

  1. ALevel 2
  2. BLevel 1
  3. CLevel 5
  4. DLevel 4
2.Prioritization & delegationHard

A nursing assistant has twice not reported abnormal vital signs to the RN. What is the RN’s best action?

  1. ATalk to the assistant privately, restate what must be reported and follow up closely
  2. BSay nothing to the assistant and quietly recheck all of the assistant’s vital signs in secret
  3. CComplain about the assistant to the patients during care
  4. DStop delegating any tasks to the assistant for the rest of the year
3.Infection control & patient safetyMedium

A patient cannot bear weight and cannot help with transfers. Which method is safest to move the patient from bed to chair?

  1. AAsking the patient to stand and try their best
  2. BTwo nurses lifting the patient under the arms
  3. CA mechanical lift used by enough trained staff
  4. DOne nurse doing a standing pivot transfer
4.Infection control & patient safetyHard

A patient with a common cold asks for antibiotics “to be on the safe side”. Which response is best?

  1. ATell the patient that antibiotics will shorten the cold by several days
  2. BExplain that antibiotics do not work on viruses and overuse breeds resistant bacteria
  3. CAsk the provider to prescribe antibiotics anyway so that the patient is reassured
  4. DSuggest using leftover antibiotics from a previous illness
5.Lab values & electrolytesMedium

A patient on phenytoin has a level of 28 mcg/mL (usual range about 10–20 mcg/mL). Which findings would the nurse expect?

  1. ANystagmus, unsteady gait and slurred speech
  2. BTall, peaked T waves
  3. CHyperactive behavior and insomnia only
  4. DHunger and weight gain
6.Lab values & electrolytesHard

A patient with a new deep vein thrombosis is on a heparin infusion, and warfarin has just been started. Why is the heparin continued for several days?

  1. AWarfarin only works when heparin is given at the same time
  2. BHeparin prevents the side effects of warfarin
  3. CWarfarin takes several days to reach its full anticoagulant effect
  4. DHeparin increases the absorption of warfarin from the gut
7.Clinical nursingMedium

Why are patients encouraged to use an incentive spirometer after abdominal surgery?

  1. ATo strengthen the abdominal muscles around the wound
  2. BTo encourage deep breaths that prevent atelectasis and chest infection
  3. CTo measure their lung function so the result can go in the discharge letter
  4. DTo lower their heart rate before mobilising
8.Clinical nursingHard

An older patient with a hip fracture becomes breathless and confused, with a petechial rash on the chest two days after injury. Which complication should be suspected?

  1. AUrinary tract infection
  2. BPressure ulcer
  3. CCompartment syndrome
  4. DFat embolism syndrome
9.Med-surg: cardiovascular & respiratoryMedium

What does a raised D-dimer result mean?

  1. AThe anticoagulant dose is too low and must rise
  2. BA pulmonary embolism or DVT has been confirmed
  3. CFibrin breakdown is present, but it does not prove a clot
  4. DA deep vein thrombosis has been safely excluded
10.Med-surg: cardiovascular & respiratoryHard

A conscious adult in the dining room is suddenly unable to speak, cough or breathe after a mouthful of food. What should the nurse do first?

  1. ALie them down on the floor and start chest compressions immediately
  2. BEncourage them to drink a glass of water to wash the food down
  3. CUp to five back blows, then up to five abdominal thrusts if needed
  4. DSweep blindly in the mouth with a finger
11.Med-surg: neuro, endocrine & renalMedium

Why is once-daily prednisolone usually taken in the morning with food?

  1. ABecause it causes drowsiness and is safer to take during the day
  2. BTo match the natural cortisol rhythm and protect the stomach
  3. CBecause it cannot be absorbed at night
  4. DBecause food doubles the strength of the dose
12.Med-surg: neuro, endocrine & renalHard

A nurse teaches a patient with CKD and a high potassium about diet. Which statement shows a need for further teaching?

  1. A"I will keep bananas and dried fruit to a minimum."
  2. B"I will check food labels for added salt when I go shopping."
  3. C"I will use a salt substitute instead of ordinary salt."
  4. D"I will boil my potatoes and throw away the water."
13.Med-surg: GI, perioperative & oncologyMedium

Which statement about corticosteroids in inflammatory bowel disease is correct?

  1. AThey cure the disease after one course
  2. BThey are used to induce remission, not for maintenance
  3. CThey are given only as a one-off injection
  4. DThey are the best long-term maintenance treatment
14.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient going home between chemotherapy cycles. Which statement shows a need for further teaching?

  1. A"If I get a fever, I'll take paracetamol and see if it settles."
  2. B"I'll keep the emergency number and call if I feel shivery."
  3. C"I'll check my temperature whenever I feel hot, shivery or unwell."
  4. D"I'll wash my hands often and avoid people with infections."

3Solutions

1.Prioritization & delegation

Answer: A · Level 2

Why this is the answer

Possible acute coronary syndrome is a high-risk situation, so the patient is ESI level 2 and should be seen very soon. Level 1 is kept for patients who need an immediate life-saving intervention.

Answer

A · Level 2
2.Prioritization & delegation

Answer: A · Talk to the assistant privately, restate what must be reported and follow up closely

Why this is the answer

The RN gives direct, private feedback, restates the reporting limits and increases supervision. If the problem continues, it is escalated to the manager according to policy.

Answer

A · Talk to the assistant privately, restate what must be reported and follow up closely
3.Infection control & patient safety

Answer: C · A mechanical lift used by enough trained staff

Why this is the answer

For a patient who cannot bear weight or help, a mechanical lift prevents injury to both patient and staff. Lifting under the arms can injure the shoulders, and pivot transfers need weight bearing.

Answer

C · A mechanical lift used by enough trained staff
4.Infection control & patient safety

Answer: B · Explain that antibiotics do not work on viruses and overuse breeds resistant bacteria

Why this is the answer

Colds are caused by viruses, which antibiotics do not kill. Unneeded antibiotics cause side effects and drive resistance, so the nurse explains this and offers advice on managing symptoms.

Answer

B · Explain that antibiotics do not work on viruses and overuse breeds resistant bacteria
5.Lab values & electrolytes

Answer: A · Nystagmus, unsteady gait and slurred speech

Why this is the answer

Phenytoin toxicity causes nystagmus, ataxia, slurred speech and drowsiness. The nurse holds the dose and informs the prescriber. Low albumin increases the free (active) drug, so toxicity can occur even with a normal total level.

Answer

A · Nystagmus, unsteady gait and slurred speech
6.Lab values & electrolytes

Answer: C · Warfarin takes several days to reach its full anticoagulant effect

Why this is the answer

Warfarin blocks the making of new vitamin K–dependent clotting factors, but existing factors last for days. Heparin is therefore overlapped until the INR has been in the target range, typically for at least 24 hours and after a minimum of about 5 days.

Answer

C · Warfarin takes several days to reach its full anticoagulant effect
7.Clinical nursing

Answer: B · To encourage deep breaths that prevent atelectasis and chest infection

Why this is the answer

Shallow breathing after surgery lets alveoli collapse, causing atelectasis and pneumonia. Deep-breathing exercises with an incentive spirometer help keep the lungs expanded.

Answer

B · To encourage deep breaths that prevent atelectasis and chest infection
8.Clinical nursing

Answer: D · Fat embolism syndrome

Why this is the answer

Fat embolism typically appears 24–72 hours after a long-bone or pelvic fracture, with the triad of respiratory distress, neurological changes and a petechial rash.

Answer

D · Fat embolism syndrome
9.Med-surg: cardiovascular & respiratory

Answer: C · Fibrin breakdown is present, but it does not prove a clot

Why this is the answer

D-dimer is a breakdown product of fibrin. A normal result in a patient with a low clinical probability (for example a low Wells score) helps exclude DVT or PE. A raised result is common in many conditions, so imaging (duplex ultrasound or CT pulmonary angiography) is needed to confirm a clot.

Answer

C · Fibrin breakdown is present, but it does not prove a clot
10.Med-surg: cardiovascular & respiratory

Answer: C · Up to five back blows, then up to five abdominal thrusts if needed

Why this is the answer

For a conscious adult with severe choking, current UK, European and AHA (2025) guidance teach up to five back blows, then up to five abdominal thrusts, repeated until the obstruction clears; some older courses used abdominal thrusts alone. If the person becomes unconscious, CPR is started. Blind finger sweeps can push the object further in.

Answer

C · Up to five back blows, then up to five abdominal thrusts if needed
11.Med-surg: neuro, endocrine & renal

Answer: B · To match the natural cortisol rhythm and protect the stomach

Why this is the answer

Morning dosing mimics the normal early-morning cortisol peak, causes less adrenal suppression and less sleep disturbance. Taking it with food reduces gastric irritation.

Answer

B · To match the natural cortisol rhythm and protect the stomach
12.Med-surg: neuro, endocrine & renal

Answer: C · "I will use a salt substitute instead of ordinary salt."

Why this is the answer

Salt substitutes often contain potassium chloride, which can cause dangerous hyperkalaemia in CKD. Patients should reduce salt without using these products. Boiling vegetables and limiting high-potassium foods are correct.

Answer

C · "I will use a salt substitute instead of ordinary salt."
13.Med-surg: GI, perioperative & oncology

Answer: B · They are used to induce remission, not for maintenance

Why this is the answer

Steroids settle flares but are not effective or safe for maintenance because of side effects such as osteoporosis, diabetes and infection. Drugs such as aminosalicylates, immunomodulators or biologics maintain remission.

Answer

B · They are used to induce remission, not for maintenance
14.Med-surg: GI, perioperative & oncology

Answer: A · "If I get a fever, I'll take paracetamol and see if it settles."

Why this is the answer

Fever or feeling unwell during the nadir may mean neutropenic sepsis, which needs urgent assessment and antibiotics within an hour. Patients must call the emergency line straight away, not wait at home.

Answer

A · "If I get a fever, I'll take paracetamol and see if it settles."

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