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
A patient has a tonic-clonic seizure in bed. What should the nurse do first?
- AGive a drink of water to help the patient wake
- BProtect the head and turn the patient on their side when possible
- CHold the arms and legs down firmly to stop the jerking movements quickly
- DPlace a tongue depressor between the teeth
2.Prioritization & delegationHard
A team has an RN, an LPN/LVN and a nursing assistant. Which task is the best one to assign to the LPN/LVN?
- AAssessing a patient who returned from surgery 30 minutes ago
- BMeasuring the vital signs and weights of every patient on the unit before breakfast
- CGiving a scheduled subcutaneous anticoagulant injection to a stable patient
- DWriting the discharge teaching plan for a patient with new diabetes
3.Infection control & patient safetyMedium
How should a nurse handle soiled bed linen?
- ACarry it bundled against the body to the soiled utility room down the hall
- BShake it out first to check for lost items
- CPut it on the floor until the bed is made
- DHold it away from the uniform and place it straight into a linen bag
4.Infection control & patient safetyHard
A visitor is receiving an electric shock from a faulty lamp and is still touching it. What should the nurse do first?
- ASwitch off the power or unplug the lamp without touching the person
- BStart chest compressions straight away
- CThrow water over the lamp to stop the current
- DPull the visitor away from the lamp by the arm as quickly as possible
5.Lab values & electrolytesMedium
A patient with sickle cell disease takes hydroxyurea. Which laboratory test is monitored regularly for an adverse effect?
- AUrine ketone level
- BSerum lithium level
- CComplete blood count
- DSerum amylase level
6.Lab values & electrolytesHard
A patient with chronic kidney disease has a phosphate of 7.2 mg/dL (2.3 mmol/L). Which dietary teaching is most appropriate?
- ADrink more cola-type soft drinks to stay hydrated
- BTake calcium supplements on an empty stomach instead of the binder
- CLimit phosphate-rich foods, such as processed foods and colas
- DIncrease milk and cheese to protect the bones from calcium loss
7.Clinical nursingMedium
Which lifestyle advice helps a patient with gastro-oesophageal reflux disease?
- AAvoid large meals late in the evening and raise the head of the bed
- BLie down straight after each meal to let the food settle
- CEat one very large meal a day rather than several small ones
- DWear tight belts to support the stomach
8.Clinical nursingHard
A patient has new facial weakness. Which feature suggests a stroke rather than Bell's palsy?
- AThe whole of one side of the face, including the forehead, is weak
- BThe patient has had a recent cold
- CThe patient has pain behind the ear
- DThe forehead can still be wrinkled on the affected side
9.Med-surg: cardiovascular & respiratoryMedium
Before the first treatment dose of a low-molecular-weight heparin for a PE, what does the nurse need to make sure of?
- AA chest drain is in place
- BThe patient's blood glucose is above 10 mmol/L (180 mg/dL)
- CThe patient has fasted for 12 hours
- DAn accurate, recent body weight is recorded
10.Med-surg: cardiovascular & respiratoryHard
A nurse has four cardiac patients. Which one should be seen first?
- AA patient with heart failure whose weight is 0.3 kg up on yesterday's morning weight
- BA patient after a radial angiogram asking when they can eat
- CA patient with AF and a heart rate of 86/min who is due an apixaban dose this morning
- DA patient with angina whose chest pain has not eased with rest and who is sweating
11.Med-surg: neuro, endocrine & renalMedium
During DKA treatment, glucose falls below about 14 mmol/L (around 250 mg/dL) but ketones are still raised. What usually happens?
- AGlucose is added to the fluids; insulin continues
- BThe insulin infusion is stopped straight away
- CAll IV fluids are stopped to avoid fluid overload
- DThe patient eats a meal and IV treatment stops
12.Med-surg: neuro, endocrine & renalHard
A patient recovering from acute tubular necrosis enters the polyuric phase, passing over 4 L of urine a day. What is the main nursing concern?
- AHypoglycaemia caused by excess insulin
- BRetention of urine in a distended bladder
- CDehydration with low potassium and sodium
- DFluid overload with high potassium levels
13.Med-surg: GI, perioperative & oncologyMedium
Which score is used to assess risk in an upper GI bleed before endoscopy?
- AGlasgow Coma Scale
- BWells score for DVT
- CGlasgow-Blatchford score
- DWaterlow pressure ulcer risk score
14.Med-surg: GI, perioperative & oncologyHard
Which preoperative task can a registered nurse usually delegate to a healthcare assistant (nursing assistant)?
- AAssessing the patient's understanding of the surgery
- BRecording baseline vital signs
- CDeciding whether abnormal results need reporting
- DTeaching the patient how to use a PCA pump
3Solutions
1.Prioritization & delegation
Answer: B · Protect the head and turn the patient on their side when possible
Why this is the answer
During a seizure the nurse protects the patient from injury and turns them to the side to keep the airway clear. Nothing is put in the mouth, movements are not restrained and nothing is given by mouth.
B · Protect the head and turn the patient on their side when possible
2.Prioritization & delegation
Answer: C · Giving a scheduled subcutaneous anticoagulant injection to a stable patient
Why this is the answer
LPNs/LVNs usually give scheduled injections to stable patients. A fresh postoperative assessment and teaching plans need the RN, and routine vital signs are better given to the assistant so the LPN/LVN can use their skills.
C · Giving a scheduled subcutaneous anticoagulant injection to a stable patient
3.Infection control & patient safety
Answer: D · Hold it away from the uniform and place it straight into a linen bag
Why this is the answer
Soiled linen is rolled up, held away from the uniform and placed directly into a laundry bag at the bedside. Shaking linen spreads organisms into the air, and the floor is a contaminated surface.
D · Hold it away from the uniform and place it straight into a linen bag
4.Infection control & patient safety
Answer: A · Switch off the power or unplug the lamp without touching the person
Why this is the answer
The rescuer must not touch someone still in contact with live current. The power is switched off or the plug pulled first, then the person is assessed and resuscitation is started if needed.
A · Switch off the power or unplug the lamp without touching the person
5.Lab values & electrolytes
Answer: C · Complete blood count
Why this is the answer
Hydroxyurea increases fetal hemoglobin and reduces sickling crises, but it can suppress the bone marrow. The CBC, including neutrophils and platelets, is monitored regularly, and doses are adjusted if counts fall.Checked against: Sickle cell disease · MedlinePlus (NIH) (2026)
6.Lab values & electrolytes
Answer: C · Limit phosphate-rich foods, such as processed foods and colas
C · Limit phosphate-rich foods, such as processed foods and colas
7.Clinical nursing
Answer: A · Avoid large meals late in the evening and raise the head of the bed
Why this is the answer
Smaller meals, not eating close to bedtime, raising the head of the bed, weight loss and stopping smoking reduce reflux. Lying flat after eating makes it worse.
A · Avoid large meals late in the evening and raise the head of the bed
8.Clinical nursing
Answer: D · The forehead can still be wrinkled on the affected side
Why this is the answer
In a stroke (upper motor neurone lesion), the forehead is usually spared because it has bilateral cortical supply. Bell's palsy (lower motor neurone) weakens the whole side, including the forehead.
D · The forehead can still be wrinkled on the affected side
9.Med-surg: cardiovascular & respiratory
Answer: D · An accurate, recent body weight is recorded
Why this is the answer
Treatment doses of LMWH are based on body weight, so an accurate measured weight is essential. Renal function and platelet count are also checked before starting. Guessing the weight can lead to under- or overdosing.
D · An accurate, recent body weight is recorded
10.Med-surg: cardiovascular & respiratory
Answer: D · A patient with angina whose chest pain has not eased with rest and who is sweating
Why this is the answer
Chest pain that does not settle with rest, especially with sweating, suggests an acute coronary syndrome and needs immediate assessment and a 12-lead ECG. A controlled heart rate in AF, a very small weight change and a question about eating are not urgent.
D · A patient with angina whose chest pain has not eased with rest and who is sweating
11.Med-surg: neuro, endocrine & renal
Answer: A · Glucose is added to the fluids; insulin continues
Why this is the answer
Insulin is continued until ketoacidosis has resolved. To prevent hypoglycaemia as glucose falls, a glucose infusion (for example 10% glucose in UK protocols, 5% dextrose in others) is added alongside the saline. Stopping the insulin early would let ketones rise again.
A · Glucose is added to the fluids; insulin continues
12.Med-surg: neuro, endocrine & renal
Answer: C · Dehydration with low potassium and sodium
Why this is the answer
In the diuretic phase of ATN, filtration recovers before tubular reabsorption, so large volumes of dilute urine are passed. Patients risk hypovolaemia and losses of potassium and sodium. Fluid balance, daily weight and electrolytes are monitored and fluids replaced as prescribed.
C · Dehydration with low potassium and sodium
13.Med-surg: GI, perioperative & oncology
Answer: C · Glasgow-Blatchford score
Why this is the answer
The Glasgow-Blatchford score uses urea, haemoglobin, systolic blood pressure, pulse, melaena, syncope, liver disease and heart failure to identify patients who need intervention. The full Rockall score is used after endoscopy.
C · Glasgow-Blatchford score
14.Med-surg: GI, perioperative & oncology
Answer: B · Recording baseline vital signs
Why this is the answer
Trained assistants can record routine observations and report them. Assessment, teaching and interpreting results need registered nurse knowledge and judgement.
B · Recording baseline vital signs
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