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
Using the Emergency Severity Index, which level fits a 70-year-old with chest pressure that suggests a heart attack, but normal vital signs?
- ALevel 5
- BLevel 4
- CLevel 1
- DLevel 2
2.Prioritization & delegationHard
A nurse has a needlestick injury from a used needle. What should the nurse do first?
- ASqueeze the wound hard and suck it
- BFinish the shift and report it tomorrow
- CScrub the area with bleach
- DWash the area with soap and water
3.Infection control & patient safetyMedium
A confused patient keeps pulling at an IV line. Which is a less restrictive option to consider before wrist restraints?
- ATying both arms to the bed frame
- BUsing a vest restraint in the chair so that the patient’s hands stay down
- CCovering the site with a sleeve or using hand mitts with supervision
- DGiving a sedative every few hours
4.Infection control & patient safetyHard
A nurse teaches an older adult about preventing falls at home. Which statement shows a need for further teaching?
- A“I wear shoes with non-slip soles around the house.”
- B“I keep small rugs in the hall so my feet stay warm.”
- C“I had grab bars put in next to the toilet.”
- D“I use night lights between my bedroom and the bathroom.”
5.Lab values & electrolytesMedium
A patient without symptoms has a fasting plasma glucose of 132 mg/dL (7.3 mmol/L) on Monday and 138 mg/dL (7.7 mmol/L) on Thursday. What does this show?
- AThe results show prediabetes only
- BThe results show reactive hypoglycemia
- CThe results meet the criteria for diabetes
- DThe results are within the normal fasting range
6.Lab values & electrolytesHard
A patient with a long-standing lung condition has a serum bicarbonate of 32 mEq/L, an arterial PaCO₂ that is always high and a pH of 7.36. Which condition fits best?
- AAcute diabetic ketoacidosis with severe dehydration and vomiting
- BAcute aspirin overdose with rapid breathing
- CAcute severe diarrhea with large bicarbonate losses
- DCOPD with chronic CO₂ retention and metabolic compensation
7.Clinical nursingMedium
Long-term amiodarone treatment can affect which of the following?
- AHair colour and nail growth only, with no effect on organs
- BThyroid function, the lungs and the skin's sensitivity to sunlight
- CThe sense of smell and taste only, with no other effects
- DBlood glucose and cholesterol only
8.Clinical nursingHard
A patient is recognised by the team as being in the last days of life. Which approach is correct?
- AReview and stop treatments that no longer help, and focus on comfort
- BContinue all routine blood tests and observations four-hourly
- CStop all medicines, including pain relief and anti-sickness drugs
- DAvoid talking with the family about what is happening
9.Med-surg: cardiovascular & respiratoryMedium
A patient with angle-closure glaucoma needs nebulised ipratropium. What precaution is sensible?
- ARun it at the highest possible gas flow
- BUse a mouthpiece or protect the eyes from the mist
- CGive it only with the patient lying completely flat
- DMix it with an eye drop before putting it in the nebuliser
10.Med-surg: cardiovascular & respiratoryHard
A patient on spironolactone and an ACE inhibitor has a potassium of 6.8 mmol/L (6.8 mEq/L) with peaked T waves. What is usually given first to protect the heart?
- AAn IV furosemide bolus as the only treatment
- BOral potassium supplements
- CA dose of digoxin
- DIntravenous calcium gluconate or chloride
11.Med-surg: neuro, endocrine & renalMedium
Why is intermittent self-catheterisation often taught after a spinal cord injury?
- AIt is mainly used to measure the urine output accurately
- BIt trains the bladder to grow gradually larger over time
- CIt removes all risk of a urinary tract infection completely
- DThe bladder may not empty, and regular emptying protects the kidneys
12.Med-surg: neuro, endocrine & renalHard
A patient on continuous overnight enteral feeding receives insulin timed to the feed. At 02:00 the tube blocks and the feed stops. What is the main risk, and what should the nurse do?
- ANo risk; the insulin will simply be stored until feeding restarts
- BHyperglycaemia; give an extra dose of insulin straight away
- CKetoacidosis; stop all insulin until the morning
- DHypoglycaemia; check glucose often and follow the plan for glucose cover
13.Med-surg: GI, perioperative & oncologyMedium
What is achalasia?
- AWeakness of the lower oesophageal sphincter that allows reflux
- BInflammation of the oesophagus caused by a fungal infection
- CFailure of the lower oesophageal sphincter to relax on swallowing
- DA tear at the junction of the oesophagus and the stomach
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
- BFeeling sick after eating shellfish once
- CHay fever every spring since childhood
- DItching with bananas, avocado and kiwi, and many operations
3Solutions
1.Prioritization & delegation
Answer: D · 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.
2.Prioritization & delegation
Answer: D · Wash the area with soap and water
Why this is the answer
The wound is washed with soap and water at once. The nurse then reports the injury immediately so the source patient can be tested and post-exposure treatment considered.
D · Wash the area with soap and water
3.Infection control & patient safety
Answer: C · Covering the site with a sleeve or using hand mitts with supervision
Why this is the answer
Covering the line, keeping it out of view and using mitts while observing the patient can stop pulling without fully restricting movement. Restraints and sedation are used only if these fail.
C · Covering the site with a sleeve or using hand mitts with supervision
4.Infection control & patient safety
Answer: B · “I keep small rugs in the hall so my feet stay warm.”
Why this is the answer
Loose rugs are a common cause of trips and falls and should be removed or secured. Night lights, grab bars and non-slip footwear all reduce fall risk.
B · “I keep small rugs in the hall so my feet stay warm.”
5.Lab values & electrolytes
Answer: C · The results meet the criteria for diabetes
Why this is the answer
Two fasting results of 126 mg/dL (7.0 mmol/L) or more confirm diabetes in a person without symptoms. Prediabetes is 100–125 mg/dL. The nurse helps the patient understand the next steps, including education and follow-up.Checked against: Diabetes · MedlinePlus (NIH) (2025)
C · The results meet the criteria for diabetes
6.Lab values & electrolytes
Answer: D · COPD with chronic CO₂ retention and metabolic compensation
Why this is the answer
In chronic CO₂ retention, as in severe COPD, the kidneys retain bicarbonate over days and bring the pH back towards normal, often to the low end of the range. DKA and diarrhea lower bicarbonate, and aspirin overdose causes rapid breathing that lowers the PaCO₂.Checked against: Respiratory Acidosis · StatPearls (NCBI Bookshelf)
D · COPD with chronic CO₂ retention and metabolic compensation
7.Clinical nursing
Answer: B · Thyroid function, the lungs and the skin's sensitivity to sunlight
Why this is the answer
Amiodarone can cause hypo- or hyperthyroidism, pulmonary fibrosis, liver problems and photosensitivity. Regular monitoring of thyroid and liver function is needed.
B · Thyroid function, the lungs and the skin's sensitivity to sunlight
8.Clinical nursing
Answer: A · Review and stop treatments that no longer help, and focus on comfort
Why this is the answer
When dying is recognised, non-beneficial interventions are stopped and anticipatory medicines for symptoms such as pain, agitation and secretions are prescribed. Clear communication with the patient and family is essential.
A · Review and stop treatments that no longer help, and focus on comfort
9.Med-surg: cardiovascular & respiratory
Answer: B · Use a mouthpiece or protect the eyes from the mist
Why this is the answer
Ipratropium is an antimuscarinic bronchodilator. Mist escaping from a face mask can reach the eyes, dilate the pupil and trigger acute angle-closure glaucoma in susceptible patients. A mouthpiece or eye protection reduces the risk.
B · Use a mouthpiece or protect the eyes from the mist
10.Med-surg: cardiovascular & respiratory
Answer: D · Intravenous calcium gluconate or chloride
Why this is the answer
Severe hyperkalaemia with ECG changes is an emergency. IV calcium stabilises the myocardium within minutes. Insulin with glucose and nebulised salbutamol shift potassium into cells, and the cause (here spironolactone and the ACE inhibitor) is stopped. Cardiac monitoring is essential.
D · Intravenous calcium gluconate or chloride
11.Med-surg: neuro, endocrine & renal
Answer: D · The bladder may not empty, and regular emptying protects the kidneys
Why this is the answer
Spinal cord injury often causes neurogenic bladder. Clean intermittent catheterisation at regular intervals empties the bladder, prevents high pressures, reduces infection and kidney damage and avoids triggering autonomic dysreflexia.
D · The bladder may not empty, and regular emptying protects the kidneys
12.Med-surg: neuro, endocrine & renal
Answer: D · Hypoglycaemia; check glucose often and follow the plan for glucose cover
Why this is the answer
If a feed stops while insulin given to cover it is still acting, the patient can become hypoglycaemic. The nurse checks glucose frequently, informs the team, restores feeding if possible and follows the prescribed plan (for example IV glucose) until feeding restarts. Basal insulin is not simply stopped in type 1 diabetes.
D · Hypoglycaemia; check glucose often and follow the plan for glucose cover
13.Med-surg: GI, perioperative & oncology
Answer: C · Failure of the lower oesophageal sphincter to relax on swallowing
Why this is the answer
In achalasia, peristalsis is lost and the lower oesophageal sphincter does not relax, causing dysphagia to both solids and liquids, regurgitation and weight loss. Treatments include dilatation and surgical myotomy.
C · Failure of the lower oesophageal sphincter to relax on swallowing
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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