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 day 3 after hip surgery, a patient suddenly becomes short of breath with sharp chest pain and an SpO₂ of 88%. What should the nurse do first?

  1. AMassage the patient’s calves to ease any muscle cramp
  2. BEncourage the patient to walk to improve the circulation
  3. CGive the next dose of oral analgesia and reassess the patient in an hour
  4. DRaise the head of the bed, give oxygen and call for urgent help
2.Prioritization & delegationHard

Which nursing assistant report should the nurse act on first?

  1. AA patient with pneumonia has coughed up yellow sputum
  2. BA patient with diabetes says their feet often feel tingly, as they usually do
  3. CA patient on bed rest is asking for a bedpan
  4. DAfter lumbar spinal fusion this morning, cannot feel or move the legs
3.Infection control & patient safetyMedium

A patient with a severe latex allergy is booked for surgery. Which measure is commonly used?

  1. AWrap latex items in plastic before use
  2. BGive the patient antihistamines before surgery and then use the normal supplies
  3. CUse latex gloves only for short procedures
  4. DUse latex-free supplies and schedule the patient as the first case of the day
4.Infection control & patient safetyHard

During a urinary catheter insertion with sterile technique, the catheter tip touches the patient’s thigh. What should the nurse do?

  1. AContinue, because the thigh was cleaned
  2. BWipe the tip with an antiseptic and continue
  3. CRinse the tip with sterile water and then continue
  4. DDiscard the catheter and use a new sterile one
5.Lab values & electrolytesMedium

A patient scheduled for surgery this morning has a potassium of 3.0 mEq/L on pre-operative tests. What should the nurse do?

  1. AGive an oral potassium dose without a prescription
  2. BRepeat the test after the surgery is finished
  3. CReport it to the surgical team before surgery
  4. DSend the patient to surgery without comment
6.Lab values & electrolytesHard

A patient on digoxin has a level of 1.2 ng/mL, a potassium of 2.8 mEq/L and new frequent ventricular ectopic beats. What is the best interpretation?

  1. ADigoxin cannot be the cause, because the level is within the usual range
  2. BPotassium has no effect on the heart rhythm
  3. CThe patient needs a higher digoxin dose to control the rhythm
  4. DToxicity is possible, because low potassium increases digoxin’s effect
7.Clinical nursingMedium

What happens in third-degree (complete) heart block?

  1. AThe ventricles beat very fast and regularly
  2. BNo impulses from the atria reach the ventricles, so they beat independently
  3. CEvery impulse reaches the ventricles, but each one is slightly delayed
  4. DThe atria beat chaotically with no P waves, and the ventricular rate is irregular
8.Clinical nursingHard

A patient who has had a kidney stone is taught about prevention. Which statement shows a need for further teaching?

  1. A"I will try to pass pale urine."
  2. B"I will drink less water so I don't need to pass urine as often."
  3. C"I will aim to drink plenty of fluids spread through every day."
  4. D"I will follow the diet advice for my stone type."
9.Med-surg: cardiovascular & respiratoryMedium

A patient has chest pain at rest in the early morning with brief ST elevation that resolves. Coronary arteries are later found to be clear. Which condition is most likely?

  1. AAcute pericarditis
  2. BVasospastic (Prinzmetal) angina
  3. CStable exertional angina from a fixed plaque
  4. DAortic stenosis
10.Med-surg: cardiovascular & respiratoryHard

Shortly after a thoracentesis, a patient becomes breathless with sharp chest pain and reduced breath sounds on the same side. What complication is most likely?

  1. APneumothorax
  2. BInfection at the puncture site
  3. CPulmonary embolism from the leg
  4. DRe-accumulation of the effusion
11.Med-surg: neuro, endocrine & renalMedium

Which side effects are common with oxybutynin for an overactive bladder?

  1. ADry mouth and constipation
  2. BA cough and a raised potassium
  3. CWeight loss and a fast tremor
  4. DDiarrhoea and heavy sweating
12.Med-surg: neuro, endocrine & renalHard

A patient with stable epilepsy on phenytoin started a new medicine last week. They now have nystagmus, an unsteady gait and slurred speech. What should the nurse do?

  1. AEncourage the patient to walk more to improve their balance
  2. BSuspect phenytoin toxicity, hold the next dose and ask for a drug level
  3. CSuspect a new stroke and give aspirin straight away before any scan
  4. DGive the next phenytoin dose early to prevent a seizure
13.Med-surg: GI, perioperative & oncologyMedium

Which lifestyle change most improves the course of Crohn's disease?

  1. AStopping smoking
  2. BEating more red meat
  3. CAvoiding all exercise
  4. DDrinking more coffee
14.Med-surg: GI, perioperative & oncologyHard

A patient on chemotherapy has white plaques on the tongue and cheeks that wipe off to leave red areas. What is most likely?

  1. ALeukoplakia from smoking
  2. BOral candidiasis
  3. CFood residue only
  4. DNormal mucositis healing

3Solutions

1.Prioritization & delegation

Answer: D · Raise the head of the bed, give oxygen and call for urgent help

Why this is the answer

Sudden breathlessness and chest pain after surgery suggest a pulmonary embolism. The nurse supports breathing with positioning and oxygen and escalates at once; walking or leg massage could make things worse.

Answer

D · Raise the head of the bed, give oxygen and call for urgent help
2.Prioritization & delegation

Answer: D · After lumbar spinal fusion this morning, cannot feel or move the legs

Why this is the answer

New inability to feel or move the legs after spinal surgery can mean a hematoma pressing on the spinal cord or nerves, which needs immediate assessment and escalation. Yellow sputum in pneumonia and long-standing neuropathy are expected.

Answer

D · After lumbar spinal fusion this morning, cannot feel or move the legs
3.Infection control & patient safety

Answer: D · Use latex-free supplies and schedule the patient as the first case of the day

Why this is the answer

Latex proteins can become airborne on glove powder and settle in the room. Using a latex-safe room and supplies and scheduling the patient first, when airborne latex is lowest, reduce the risk.

Answer

D · Use latex-free supplies and schedule the patient as the first case of the day
4.Infection control & patient safety

Answer: D · Discard the catheter and use a new sterile one

Why this is the answer

Once a sterile item touches a non-sterile surface, it is contaminated and is replaced. Inserting a contaminated catheter brings bacteria into the bladder and increases the risk of urinary tract infection.

Answer

D · Discard the catheter and use a new sterile one
5.Lab values & electrolytes

Answer: C · Report it to the surgical team before surgery

Why this is the answer

Hypokalemia increases the risk of arrhythmias during anesthesia and can prolong muscle weakness. Abnormal pre-operative results are reported to the surgeon and anesthetist, who decide whether to correct it or delay surgery.Checked against: Hypokalemia · StatPearls (NCBI Bookshelf) (2025)

Answer

C · Report it to the surgical team before surgery
6.Lab values & electrolytes

Answer: D · Toxicity is possible, because low potassium increases digoxin’s effect

Why this is the answer

Hypokalemia increases digoxin binding to heart cells, so toxicity can occur at a normal level. The nurse holds the dose, reports the result and expects potassium replacement.Checked against: Low blood potassium · MedlinePlus (NIH) (2025)

Answer

D · Toxicity is possible, because low potassium increases digoxin’s effect
7.Clinical nursing

Answer: B · No impulses from the atria reach the ventricles, so they beat independently

Why this is the answer

In complete heart block the atria and ventricles are dissociated, and a slow escape rhythm drives the ventricles. Patients may be dizzy or collapse and often need pacing.

Answer

B · No impulses from the atria reach the ventricles, so they beat independently
8.Clinical nursing

Answer: B · "I will drink less water so I don't need to pass urine as often."

Why this is the answer

A high fluid intake dilutes urine and is the most important general measure to prevent stones. Dietary advice depends on the stone's composition.

Answer

B · "I will drink less water so I don't need to pass urine as often."
9.Med-surg: cardiovascular & respiratory

Answer: B · Vasospastic (Prinzmetal) angina

Why this is the answer

Vasospastic angina is caused by temporary coronary artery spasm, often at rest or at night, with transient ST elevation. It responds to calcium channel blockers and nitrates. Triggers include smoking, cold and cocaine.

Answer

B · Vasospastic (Prinzmetal) angina
10.Med-surg: cardiovascular & respiratory

Answer: A · Pneumothorax

Why this is the answer

Pneumothorax is a common complication of thoracentesis, caused by the needle puncturing the lung or air entering the chest. The nurse assesses the patient, gives oxygen and informs the team, who will arrange a chest X-ray. An effusion re-accumulates over days, and infection appears later.

Answer

A · Pneumothorax
11.Med-surg: neuro, endocrine & renal

Answer: A · Dry mouth and constipation

Why this is the answer

Oxybutynin blocks muscarinic receptors, causing dry mouth, constipation, blurred vision, urinary retention and, especially in older adults, confusion. Newer agents may have fewer effects on the brain.

Answer

A · Dry mouth and constipation
12.Med-surg: neuro, endocrine & renal

Answer: B · Suspect phenytoin toxicity, hold the next dose and ask for a drug level

Why this is the answer

Nystagmus, ataxia and slurred speech are classic signs of phenytoin toxicity. Interacting drugs can raise its level. The nurse holds the dose, ensures safety and escalates for a level and a review. A new neurological deficit still needs medical assessment.

Answer

B · Suspect phenytoin toxicity, hold the next dose and ask for a drug level
13.Med-surg: GI, perioperative & oncology

Answer: A · Stopping smoking

Why this is the answer

Smoking worsens Crohn's disease, increasing flares, complications and the need for surgery. Stopping smoking is one of the most effective changes a patient can make.

Answer

A · Stopping smoking
14.Med-surg: GI, perioperative & oncology

Answer: B · Oral candidiasis

Why this is the answer

Oral thrush is common during chemotherapy, especially with steroids or antibiotics. It is reported so that antifungal treatment can be prescribed, and good oral care continues.

Answer

B · Oral candidiasis

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