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 nurse asks a nursing assistant to “assess the patient’s pain and decide if the patient needs more medication”. Which right of delegation is violated?
- ARight supervision and evaluation
- BRight circumstance
- CRight task
- DRight person
2.Prioritization & delegationHard
Which patient on a renal unit should the nurse see first?
- AA patient on hemodialysis who missed yesterday’s session and now has muscle weakness and an irregular pulse
- BA patient asking for advice about a low-phosphate diet
- CA patient whose arteriovenous fistula has a strong thrill and bruit
- DA patient on peritoneal dialysis whose drained fluid is clear
3.Infection control & patient safetyMedium
What should a nurse do after an accidental splash of a patient’s blood into the eyes?
- ARinse the eyes at once with plenty of water or saline, then report
- BApply antibiotic eye drops and tell no one
- CFinish the procedure, then report it the next day
- DRub the eyes gently with a clean, dry tissue to remove the blood first
4.Infection control & patient safetyHard
A newly hired nurse has these hepatitis B results: HBsAg negative, anti-HBs positive, anti-HBc negative. What do they show?
- AImmunity from hepatitis B vaccination
- BA current hepatitis B infection
- CNo immunity, so the vaccine is needed
- DPast infection that has now cleared
5.Lab values & electrolytesMedium
When should the nurse check the glucose before giving a mealtime dose of rapid-acting insulin (such as lispro)?
- AJust before the meal, giving insulin when the food is ready
- BOnly once a day, then giving the same dose before every meal
- CAt bedtime only, then giving the mealtime insulin overnight
- DTwo hours after the meal, then giving the insulin dose
6.Lab values & electrolytesHard
The nurse teaches a patient who is starting warfarin. Which statement shows a need for further teaching?
- A"I will tell my dentist and pharmacist that I take warfarin"
- B"I will keep my intake of green leafy vegetables about the same"
- C"If I miss a dose, I will take two tablets the next day"
- D"I will have my INR checked as often as I am told to"
7.Clinical nursingMedium
Why are older adults at higher risk of dehydration?
- ATheir kidneys hold on to too much water
- BTheir body water content increases with age
- CThey always drink large amounts of tea
- DTheir sense of thirst is often reduced
8.Clinical nursingHard
A patient with a central venous catheter develops fever and rigors shortly after the line is flushed, with no other obvious source. What should be suspected?
- AA catheter-related bloodstream infection
- BNormal response to line use
- CA pulmonary embolism
- DAn allergic reaction to the saline flush
9.Med-surg: cardiovascular & respiratoryMedium
A patient with asthma uses their reliever inhaler more than three times a week. What does this suggest?
- AAsthma is well controlled with the current plan
- BAsthma control is poor and treatment needs review
- CThe reliever no longer works and should be stopped
- DThe preventer inhaler is no longer needed
10.Med-surg: cardiovascular & respiratoryHard
A 74-year-old man with a known abdominal aortic aneurysm suddenly has severe back and abdominal pain. His heart rate is 128/min and BP 82/50 mmHg. What is the priority?
- AArrange a routine outpatient ultrasound scan of the aneurysm
- BGive oral analgesia and reassess the pain in an hour
- CEncourage him to walk to ease the back pain
- DCall for emergency help and prepare for urgent vascular surgery
11.Med-surg: neuro, endocrine & renalMedium
Why might a patient bleed more from the needle sites straight after haemodialysis?
- AHeparin is often used to stop the circuit from clotting
- BDialysis removes all the platelets from the blood
- CThe fistula has been damaged and must be tied off
- DDialysis raises the blood pressure sharply for several hours
12.Med-surg: neuro, endocrine & renalHard
A drowsy patient's glucose meter shows "HI". What should the nurse do?
- AAssume the meter is broken and recheck tomorrow
- BGive glucose gel in case the reading is wrong
- CTreat it as very high, check ketones and escalate
- DRecord "normal" in the notes because no number appears
13.Med-surg: GI, perioperative & oncologyMedium
How does sucralfate help a peptic ulcer heal?
- AIt blocks histamine receptors on parietal cells
- BIt kills H. pylori in the stomach lining
- CIt speeds up emptying of the stomach
- DIt forms a protective coating over the ulcer base
14.Med-surg: GI, perioperative & oncologyHard
A patient with long-standing chronic pancreatitis now has weight loss, thirst and passing large volumes of urine. What should the nurse check first?
- ASerum amylase level
- BPeak expiratory flow
- CAbdominal girth
- DCapillary blood glucose
3Solutions
1.Prioritization & delegation
Answer: C · Right task
Why this is the answer
Assessing a patient and deciding on treatment need nursing judgement, so the task itself cannot be delegated to assistive personnel. An assistant can report what the patient says, but the RN assesses and decides.
2.Prioritization & delegation
Answer: A · A patient on hemodialysis who missed yesterday’s session and now has muscle weakness and an irregular pulse
Why this is the answer
A missed dialysis session lets potassium build up. Muscle weakness and an irregular pulse suggest hyperkalemia, which can cause fatal arrhythmias, so the nurse assesses at once, arranges cardiac monitoring and escalates. A thrill and bruit and clear effluent are expected findings, and diet advice can wait.
A · A patient on hemodialysis who missed yesterday’s session and now has muscle weakness and an irregular pulse
3.Infection control & patient safety
Answer: A · Rinse the eyes at once with plenty of water or saline, then report
Why this is the answer
Mucous membranes are rinsed straight away with plenty of water or saline, for example at an eyewash station. The exposure is reported immediately so the risk can be assessed and post-exposure treatment considered.
A · Rinse the eyes at once with plenty of water or saline, then report
4.Infection control & patient safety
Answer: A · Immunity from hepatitis B vaccination
Why this is the answer
The vaccine contains surface antigen, so it produces anti-HBs only. A negative anti-HBc shows there has been no natural infection, and a negative HBsAg rules out current infection.
A · Immunity from hepatitis B vaccination
5.Lab values & electrolytes
Answer: A · Just before the meal, giving insulin when the food is ready
Why this is the answer
Rapid-acting insulin starts working within about 15 minutes, so glucose is checked before the meal and the insulin is given when the meal is available, usually within 15 minutes of eating. Giving it without food can cause hypoglycemia.
A · Just before the meal, giving insulin when the food is ready
6.Lab values & electrolytes
Answer: C · "If I miss a dose, I will take two tablets the next day"
Why this is the answer
Doubling a missed warfarin dose can raise the INR and cause bleeding; the patient should follow the prescriber's instructions, usually taking the missed dose the same day or skipping it. A steady vitamin K intake, regular INR checks and telling other providers are correct.Checked against: Warfarin (drug information) · MedlinePlus (NIH) (2026)
C · "If I miss a dose, I will take two tablets the next day"
7.Clinical nursing
Answer: D · Their sense of thirst is often reduced
Why this is the answer
With age, thirst is blunted, kidney concentrating ability falls and total body water decreases. Cognitive or physical problems can also make it harder to drink.
D · Their sense of thirst is often reduced
8.Clinical nursing
Answer: A · A catheter-related bloodstream infection
Why this is the answer
Rigors after flushing suggest bacteria colonising the catheter. Blood cultures are taken (often from the line and a peripheral vein) and the team decides whether to remove the line.
A · A catheter-related bloodstream infection
9.Med-surg: cardiovascular & respiratory
Answer: B · Asthma control is poor and treatment needs review
Why this is the answer
Needing a reliever often, waking at night with symptoms or limiting activity indicates poorly controlled asthma. Inhaler technique, adherence and triggers should be checked and the regular preventer treatment stepped up.
B · Asthma control is poor and treatment needs review
10.Med-surg: cardiovascular & respiratory
Answer: D · Call for emergency help and prepare for urgent vascular surgery
Why this is the answer
Sudden abdominal or back pain with hypotension in a patient with an AAA suggests rupture, which is often fatal without urgent repair. The team is called at once, large-bore IV access and blood are arranged, and the patient goes to theatre. Fluid may be limited so the blood pressure is not pushed high (permissive hypotension), as directed by the team.
D · Call for emergency help and prepare for urgent vascular surgery
11.Med-surg: neuro, endocrine & renal
Answer: A · Heparin is often used to stop the circuit from clotting
Why this is the answer
Heparin is commonly used during haemodialysis to prevent clotting in the circuit. Its effect can cause prolonged bleeding from puncture sites, so procedures such as IM injections may be timed with care.
A · Heparin is often used to stop the circuit from clotting
12.Med-surg: neuro, endocrine & renal
Answer: C · Treat it as very high, check ketones and escalate
Why this is the answer
"HI" means the glucose is above the meter's upper range. In a drowsy patient this may be DKA or HHS. A laboratory glucose, ketones, observations and urgent medical review are needed.
C · Treat it as very high, check ketones and escalate
13.Med-surg: GI, perioperative & oncology
Answer: D · It forms a protective coating over the ulcer base
Why this is the answer
Sucralfate binds to the ulcer base and forms a barrier against acid and pepsin. It works best on an empty stomach and can reduce the absorption of other drugs, so doses are separated.
D · It forms a protective coating over the ulcer base
14.Med-surg: GI, perioperative & oncology
Answer: D · Capillary blood glucose
Why this is the answer
Destruction of islet cells in chronic pancreatitis can cause diabetes (type 3c). Thirst, polyuria and weight loss suggest hyperglycaemia, which is checked straight away.
D · Capillary blood glucose
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