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 with asthma uses a peak flow meter. A reading below 50% of personal best is in the red zone. Which statement shows correct understanding?

  1. A“I will stop all my inhalers until the reading is back up.”
  2. B“I will use my reliever inhaler and get emergency help straight away.”
  3. C“I will go for a short run to open up my lungs.”
  4. D“I will wait until tomorrow morning to see if the reading gets better on its own.”
2.Prioritization & delegationHard

Weeks after a kidney transplant, a patient has a fever, less urine and tenderness over the new kidney. What should the nurse suspect?

  1. AA side effect of eating salty food
  2. BRejection of the transplant
  3. CNormal healing of the transplant
  4. DDehydration from drinking too much
3.Infection control & patient safetyMedium

Which glove-removal technique is correct?

  1. APeel the first off by its outside, then slide a bare finger under the second cuff
  2. BPull both gloves off at the same time by the fingertips
  3. CWash the gloved hands and reuse the gloves for the next task
  4. DRemove the second glove by pinching its outside with the bare hand, then wash
4.Infection control & patient safetyHard

A patient was harmed by a medication error and asks the nurse what happened. Which approach is best?

  1. ATell the patient nothing happened to avoid worry
  2. BBlame the pharmacy for the error so that the nurse and the ward are not at fault
  3. CTell the patient to make a formal complaint to find out
  4. DBe honest that an error occurred and involve the provider and team in disclosure per policy
5.Lab values & electrolytesMedium

Why can a patient with liver failure have a raised INR without taking warfarin?

  1. AThe kidneys stop clearing the clotting factors from the blood
  2. BAlbumin is a clotting factor, and its level falls
  3. CThe liver makes most clotting factors, so production falls
  4. DBilirubin directly destroys the clotting factors
6.Lab values & electrolytesHard

A patient with long-standing rheumatoid arthritis has a hemoglobin of 10.5 g/dL (105 g/L), a low serum iron, a low total iron-binding capacity (TIBC) and a high-normal ferritin. Which condition fits best?

  1. AAnemia of chronic disease (inflammation)
  2. BAcute blood loss anemia
  3. CVitamin B12 deficiency anemia
  4. DIron-deficiency anemia
7.Clinical nursingMedium

Why are alternate sutures sometimes removed first when taking out stitches?

  1. ATo check the wound stays closed before removing the rest
  2. BBecause the remaining sutures dissolve on their own within a day
  3. CTo reduce the cost of dressings
  4. DTo make the procedure faster
8.Clinical nursingHard

After a high spinal cord injury, a patient has low blood pressure with a slow heart rate and warm, dry skin. What is most likely?

  1. AHypovolaemic shock
  2. BCardiac tamponade
  3. CSeptic shock
  4. DNeurogenic shock
9.Med-surg: cardiovascular & respiratoryMedium

A patient with angle-closure glaucoma needs nebulised ipratropium. What precaution is sensible?

  1. AUse a mouthpiece or protect the eyes from the mist
  2. BGive it only with the patient lying completely flat
  3. CMix it with an eye drop before putting it in the nebuliser
  4. DRun it at the highest possible gas flow
10.Med-surg: cardiovascular & respiratoryHard

An adult inhales a peanut while laughing and now has a persistent cough and wheeze on one side. Where is the peanut most likely to have lodged?

  1. AThe right main bronchus
  2. BThe nasal cavity
  3. CThe left main bronchus
  4. DThe oesophagus
11.Med-surg: neuro, endocrine & renalMedium

A conscious patient with a glucose of 3.1 mmol/L (56 mg/dL) can swallow safely. Which is the best first treatment?

  1. AA chocolate bar and a cup of tea with milk
  2. BA dose of rapid-acting insulin with a sandwich
  3. CGlucose tablets or a small glass of fruit juice
  4. DA glass of milk and two plain biscuits
12.Med-surg: neuro, endocrine & renalHard

A patient with SIADH needs IV fluid. Which fluid is most likely to worsen the hyponatraemia?

  1. A8.4% sodium bicarbonate
  2. B20% human albumin
  3. C3% saline
  4. D5% glucose (dextrose, D5W)
13.Med-surg: GI, perioperative & oncologyMedium

After laparoscopic cholecystectomy, a patient has pain in the right shoulder. What is the most likely cause?

  1. AAn allergy to the dressing on the wound
  2. BA heart attack during the operation
  3. CGas used during surgery irritating the diaphragm
  4. DA dislocated shoulder from patient positioning
14.Med-surg: GI, perioperative & oncologyHard

Which preoperative blood result should the nurse report to the team before elective surgery?

  1. APotassium 2.9 mmol/L
  2. BSodium 139 mmol/L
  3. CHaemoglobin 138 g/L (13.8 g/dL) in a man
  4. DFasting glucose 5.4 mmol/L (97 mg/dL)

3Solutions

1.Prioritization & delegation

Answer: B · “I will use my reliever inhaler and get emergency help straight away.”

Why this is the answer

A red-zone reading means a severe flare. The patient uses their quick-relief inhaler as in their action plan and seeks emergency care at once.

Answer

B · “I will use my reliever inhaler and get emergency help straight away.”
2.Prioritization & delegation

Answer: B · Rejection of the transplant

Why this is the answer

Fever, falling urine output and graft tenderness are signs of possible rejection. The nurse reports promptly, because early treatment can save the kidney.

Answer

B · Rejection of the transplant
3.Infection control & patient safety

Answer: A · Peel the first off by its outside, then slide a bare finger under the second cuff

Why this is the answer

The outside of the gloves is contaminated, so it only touches the other glove; the bare hand only touches the inside of the second glove. Hand hygiene follows. Gloves are never washed and reused.

Answer

A · Peel the first off by its outside, then slide a bare finger under the second cuff
4.Infection control & patient safety

Answer: D · Be honest that an error occurred and involve the provider and team in disclosure per policy

Why this is the answer

Open, honest disclosure of errors is an ethical duty and part of a safety culture. The nurse follows policy, which usually involves the provider and risk team, and does not hide or blame.

Answer

D · Be honest that an error occurred and involve the provider and team in disclosure per policy
5.Lab values & electrolytes

Answer: C · The liver makes most clotting factors, so production falls

Why this is the answer

The liver makes most clotting factors, including the vitamin K–dependent ones. In severe liver disease their production falls, so the INR rises. A raised INR is one of the markers of how severe liver failure is.Checked against: Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024)

Answer

C · The liver makes most clotting factors, so production falls
6.Lab values & electrolytes

Answer: A · Anemia of chronic disease (inflammation)

Why this is the answer

In chronic inflammation, iron is trapped in stores, so serum iron is low but ferritin is normal or high and TIBC is low. In iron deficiency, ferritin is low and TIBC is high. Iron supplements help iron deficiency much more than anemia of chronic disease.Checked against: Ferritin Blood Test · MedlinePlus (NIH) (2025); Serum iron test · MedlinePlus (NIH) (2026)

Answer

A · Anemia of chronic disease (inflammation)
7.Clinical nursing

Answer: A · To check the wound stays closed before removing the rest

Why this is the answer

Removing alternate sutures allows the nurse to see whether the wound edges stay together. If they begin to separate, the remaining sutures can be left and the team informed.

Answer

A · To check the wound stays closed before removing the rest
8.Clinical nursing

Answer: D · Neurogenic shock

Why this is the answer

Neurogenic shock from cervical or high thoracic injury causes vasodilation and bradycardia because sympathetic outflow is lost. Hypovolaemic shock usually causes tachycardia and cool, pale skin.

Answer

D · Neurogenic shock
9.Med-surg: cardiovascular & respiratory

Answer: A · 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.

Answer

A · Use a mouthpiece or protect the eyes from the mist
10.Med-surg: cardiovascular & respiratory

Answer: A · The right main bronchus

Why this is the answer

Inhaled foreign bodies most often enter the right main bronchus and right lower lobe, because the right bronchus is wider, shorter and more vertical. Signs include a unilateral wheeze, reduced breath sounds and recurrent infection. Bronchoscopy is used for removal.

Answer

A · The right main bronchus
11.Med-surg: neuro, endocrine & renal

Answer: C · Glucose tablets or a small glass of fruit juice

Why this is the answer

About 15–20 g of fast-acting carbohydrate, such as glucose tablets or juice, raises glucose quickly. Chocolate and milk contain fat, which slows absorption. Glucose is rechecked after about 15 minutes.

Answer

C · Glucose tablets or a small glass of fruit juice
12.Med-surg: neuro, endocrine & renal

Answer: D · 5% glucose (dextrose, D5W)

Why this is the answer

5% glucose (5% dextrose, D5W) provides free water once the glucose is metabolised. In SIADH, this water is kept, so sodium falls further. Hypotonic fluids are avoided. Hypertonic saline is used for severe symptomatic hyponatraemia.

Answer

D · 5% glucose (dextrose, D5W)
13.Med-surg: GI, perioperative & oncology

Answer: C · Gas used during surgery irritating the diaphragm

Why this is the answer

Carbon dioxide used to inflate the abdomen irritates the diaphragm, causing referred shoulder-tip pain. It usually settles within a few days; walking and simple analgesia help.

Answer

C · Gas used during surgery irritating the diaphragm
14.Med-surg: GI, perioperative & oncology

Answer: A · Potassium 2.9 mmol/L

Why this is the answer

Normal potassium is about 3.5–5.0 mmol/L. Hypokalaemia increases the risk of arrhythmias during anaesthesia and needs correction before elective surgery. The other results are within normal ranges.

Answer

A · Potassium 2.9 mmol/L

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