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

Using the Emergency Severity Index, which patient receives the highest acuity level?

  1. AA patient with chest pain and normal vital signs
  2. BA patient with a possible ankle fracture
  3. CA patient with a sore throat for three days and normal vital signs
  4. DAn unresponsive patient with gasping, irregular breaths
2.Prioritization & delegationHard

A nurse teaches a patient to inject enoxaparin at home. Which statement shows a need for further teaching?

  1. A“I will rub the area after the injection to help it absorb.”
  2. B“I will inject into the fat of my abdomen, away from the navel.”
  3. C“I will tell my doctor if I notice unusual bruising or bleeding.”
  4. D“I will change the injection site each time.”
3.Infection control & patient safetyMedium

Before giving a tablet, the patient says, “This pill looks different from my usual one.” What should the nurse do?

  1. AStop and recheck the order and the drug before giving it
  2. BGive half the pill and watch for any unusual effects
  3. CReassure the patient and give the pill
  4. DTell the patient that all pills look different in hospital
4.Infection control & patient safetyHard

A handwritten order reads “10U regular insulin subcut now”. What is the nurse’s best action?

  1. AGive 100 units, as the order seems to say
  2. BAsk a nursing assistant to interpret the handwriting
  3. CGive 10 units without question, as written
  4. DClarify the order, because “U” can be misread
5.Lab values & electrolytesMedium

A patient with pneumonia had a CRP of 180 mg/L on admission and 40 mg/L after 4 days of antibiotics. What does this most likely show?

  1. AThe infection has spread to another organ
  2. BThe antibiotic is causing liver damage
  3. CThe patient has developed a new infection
  4. DThe inflammation is settling with treatment
6.Lab values & electrolytesHard

In the first 24 hours after a major burn, which laboratory pattern is most expected?

  1. ALow potassium and low hematocrit
  2. BHigh calcium and high albumin
  3. CLow sodium and low hematocrit
  4. DHigh potassium and high hematocrit
7.Clinical nursingMedium

A patient with DKA has an arterial blood gas showing a low pH and a low bicarbonate. Which disturbance is this?

  1. ARespiratory alkalosis
  2. BRespiratory acidosis
  3. CMetabolic alkalosis
  4. DMetabolic acidosis
8.Clinical nursingHard

A patient after a total hip replacement suddenly has severe hip pain, a shortened leg and the leg is rotated. What is the most likely complication?

  1. AWound infection
  2. BDeep vein thrombosis in the calf
  3. CUrinary retention
  4. DDislocation of the prosthesis
9.Med-surg: cardiovascular & respiratoryMedium

A patient with a long QT interval develops a polymorphic ventricular tachycardia that twists around the baseline but still has a pulse. Which drug is used first?

  1. AIntravenous adenosine
  2. BIntravenous magnesium sulfate
  3. COral digoxin
  4. DIntravenous potassium chloride as a bolus
10.Med-surg: cardiovascular & respiratoryHard

After four days of antibiotics for pneumonia, a patient still has fever and pleuritic pain. There is dullness and reduced breath sounds at the right base. What complication should be suspected?

  1. ANormal recovery from pneumonia
  2. BAsthma triggered by the infection
  3. CAn allergic reaction to the antibiotic
  4. DA parapneumonic effusion or empyema
11.Med-surg: neuro, endocrine & renalMedium

Why should long-term steroid treatment not be stopped suddenly?

  1. AThe suppressed adrenal glands cannot make enough cortisol at once
  2. BStopping suddenly makes the bones grow too quickly and then fracture
  3. CStopping causes the blood glucose to fall sharply
  4. DThe steroids build up and become toxic after they are stopped
12.Med-surg: neuro, endocrine & renalHard

Why might a frail 88-year-old with type 2 diabetes have a less strict HbA1c target?

  1. ATo save money on blood tests and drugs
  2. BTo reduce the risk of hypos, falls and confusion
  3. CBecause older people cannot use any glucose medicines
  4. DBecause diabetes cannot damage older people
13.Med-surg: GI, perioperative & oncologyMedium

Which electrolyte problem can occur in severe acute pancreatitis?

  1. AHypocalcaemia
  2. BHypernatraemia
  3. CHypercalcaemia
  4. DHyperkalaemia
14.Med-surg: GI, perioperative & oncologyHard

During radiotherapy to the chest, a patient develops pain on swallowing and is eating less. What is the most likely cause and nursing focus?

  1. ARadiation oesophagitis; analgesia, soft food and nutrition support
  2. BA heart attack; give aspirin and arrange an ECG
  3. CNormal ageing; no action needed
  4. DA stomach ulcer; give an antacid after meals only

3Solutions

1.Prioritization & delegation

Answer: D · An unresponsive patient with gasping, irregular breaths

Why this is the answer

An unresponsive patient with agonal breathing needs immediate airway and breathing support, which is ESI level 1. Chest pain with normal vital signs is high risk (level 2), and the others are lower levels.

Answer

D · An unresponsive patient with gasping, irregular breaths
2.Prioritization & delegation

Answer: A · “I will rub the area after the injection to help it absorb.”

Why this is the answer

Rubbing the site after a low-molecular-weight heparin injection increases bruising. The abdomen away from the navel, rotating sites and reporting bleeding are correct.

Answer

A · “I will rub the area after the injection to help it absorb.”
3.Infection control & patient safety

Answer: A · Stop and recheck the order and the drug before giving it

Why this is the answer

A patient’s concern is a safety check. The nurse stops and checks the order, the drug, the dose and the patient, and contacts the pharmacy if needed. Sometimes the reason is a different brand, but this must be confirmed first.

Answer

A · Stop and recheck the order and the drug before giving it
4.Infection control & patient safety

Answer: D · Clarify the order, because “U” can be misread

Why this is the answer

“10U” can be read as 100 or 104 units, a potentially fatal overdose. The nurse clarifies the order and asks for “units” to be written in full. Guessing is never acceptable for insulin.

Answer

D · Clarify the order, because “U” can be misread
5.Lab values & electrolytes

Answer: D · The inflammation is settling with treatment

Why this is the answer

CRP has a short half-life of about 19 hours, so it falls within days when inflammation is controlled. A falling CRP, together with clinical improvement, supports a response to treatment; a CRP that stays high or rises again needs review.Checked against: C-reactive protein · MedlinePlus (NIH) (2025)

Answer

D · The inflammation is settling with treatment
6.Lab values & electrolytes

Answer: D · High potassium and high hematocrit

Why this is the answer

Early after a burn, damaged cells release potassium, and plasma shifts into the tissues, which concentrates the blood and raises the hematocrit. Later, as fluid returns and the kidneys excrete potassium, hypokalemia can develop.Checked against: High potassium level · MedlinePlus (NIH) (2025)

Answer

D · High potassium and high hematocrit
7.Clinical nursing

Answer: D · Metabolic acidosis

Why this is the answer

In DKA, ketoacids consume bicarbonate, causing a metabolic acidosis. The patient breathes deeply and fast (Kussmaul breathing) to lower PaCO2 as compensation.

Answer

D · Metabolic acidosis
8.Clinical nursing

Answer: D · Dislocation of the prosthesis

Why this is the answer

Hip dislocation after arthroplasty causes sudden pain, shortening and rotation. It needs urgent review and reduction; patients are taught movement precautions.

Answer

D · Dislocation of the prosthesis
9.Med-surg: cardiovascular & respiratory

Answer: B · Intravenous magnesium sulfate

Why this is the answer

Torsades de pointes is treated with IV magnesium, plus correction of low potassium and stopping drugs that prolong the QT interval. If the patient loses their pulse, defibrillation is needed. Potassium must never be given as an IV bolus.

Answer

B · Intravenous magnesium sulfate
10.Med-surg: cardiovascular & respiratory

Answer: D · A parapneumonic effusion or empyema

Why this is the answer

Persistent fever and signs of pleural fluid suggest a parapneumonic effusion, which may become infected (empyema). Ultrasound and diagnostic pleural aspiration are needed, and an infected collection usually needs a chest drain in addition to antibiotics.

Answer

D · A parapneumonic effusion or empyema
11.Med-surg: neuro, endocrine & renal

Answer: A · The suppressed adrenal glands cannot make enough cortisol at once

Why this is the answer

Long-term glucocorticoids suppress ACTH, and the adrenal glands shrink. Stopping abruptly can cause adrenal insufficiency or crisis. Doses are reduced gradually so the glands can recover.

Answer

A · The suppressed adrenal glands cannot make enough cortisol at once
12.Med-surg: neuro, endocrine & renal

Answer: B · To reduce the risk of hypos, falls and confusion

Why this is the answer

In frail older adults, tight control brings little long-term benefit and a high risk of hypoglycaemia, which can cause falls, fractures and confusion. Targets are individualised to balance safety and quality of life.

Answer

B · To reduce the risk of hypos, falls and confusion
13.Med-surg: GI, perioperative & oncology

Answer: A · Hypocalcaemia

Why this is the answer

Fat necrosis releases fatty acids that bind calcium (saponification), lowering serum calcium. Hypocalcaemia is a marker of severity and can cause tetany and arrhythmias. Hypercalcaemia, on the other hand, can be a cause of pancreatitis.

Answer

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

Answer: A · Radiation oesophagitis; analgesia, soft food and nutrition support

Why this is the answer

Radiotherapy to the chest can inflame the oesophagus, causing painful swallowing. Analgesia (sometimes before meals), soft moist food, nutritional supplements, dietitian input and monitoring weight are important.

Answer

A · Radiation oesophagitis; analgesia, soft food and nutrition support

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