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 heart failure gained 2 kg (about 4 lb) since yesterday and is more breathless when lying down. What should the nurse do first?

  1. ARecord the weight on the chart and recheck it at the next weekly weigh-in
  2. BAssess the lungs, oxygen saturation and swelling, then inform the provider
  3. CEncourage extra fluids to correct the weight change
  4. DLay the patient flat to help them breathe more easily
2.Prioritization & delegationHard

During surgery under general anesthesia, a patient develops rising end-tidal carbon dioxide, muscle rigidity and a rapidly increasing temperature. Which drug should the nurse anticipate?

  1. AFlumazenil
  2. BAtropine
  3. CNaloxone
  4. DDantrolene
3.Infection control & patient safetyMedium

Why must an insulin pen never be used for more than one patient, even with a new needle?

  1. ABlood can flow back into the cartridge and spread infection
  2. BEach pen holds only one dose of insulin
  3. CThe insulin in the pen would expire faster once it is shared
  4. DSharing a pen changes the dose that is delivered
4.Infection control & patient safetyHard

A nurse caring for a patient with influenza on droplet precautions will assist with an aerosol-generating procedure, such as bronchoscopy. What change in PPE is needed?

  1. AWear gloves only, because the procedure is short
  2. BNo change, because influenza only needs droplet precautions
  3. CWear two surgical masks, one on top of the other, for the length of the procedure
  4. DWear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
5.Lab values & electrolytesMedium

A patient has macrocytic anemia with numbness and tingling of the feet and poor balance. Which deficiency is most likely?

  1. AFolate (folic acid)
  2. BIron (low ferritin)
  3. CVitamin C (ascorbic acid)
  4. DVitamin B12
6.Lab values & electrolytesHard

Which set of results most strongly suggests hemolytic anemia?

  1. ALow hemoglobin, low reticulocytes, low MCV, low ferritin
  2. BLow hemoglobin, low platelets, low white cells, low reticulocytes
  3. CLow hemoglobin, high MCV, low vitamin B12, normal bilirubin
  4. DLow hemoglobin, high reticulocytes, high unconjugated bilirubin, high LDH
7.Clinical nursingMedium

A patient with heart failure has pink, frothy sputum and crackles throughout both lungs. What is happening?

  1. APneumothorax
  2. BUpper gastrointestinal bleeding
  3. CAcute pulmonary oedema
  4. DAsthma attack
8.Clinical nursingHard

A patient on enteral tube feeding after a long period of starvation develops low phosphate, low potassium and arrhythmias. What is most likely?

  1. ADumping syndrome
  2. BRefeeding syndrome
  3. CHyperthyroidism
  4. DDiabetic ketoacidosis
9.Med-surg: cardiovascular & respiratoryMedium

Why are beta-blockers often started after a myocardial infarction?

  1. AThey raise the heart rate to improve blood flow to the muscle
  2. BThey reduce cholesterol in the blood
  3. CThey lower the heart's oxygen demand and reduce arrhythmias
  4. DThey dissolve the clot that is blocking the coronary artery
10.Med-surg: cardiovascular & respiratoryHard

A patient regains a pulse after a ventricular fibrillation arrest that was probably caused by a heart attack. Which investigation is most urgent?

  1. AA lumbar puncture
  2. BA 12-lead ECG
  3. CSpirometry
  4. DAn abdominal ultrasound
11.Med-surg: neuro, endocrine & renalMedium

When a patient sticks out their tongue, it points to the right. Which nerve is affected?

  1. AThe right hypoglossal nerve (XII)
  2. BThe left hypoglossal nerve (XII)
  3. CThe left trigeminal nerve (V)
  4. DThe right facial nerve (VII)
12.Med-surg: neuro, endocrine & renalHard

A haemodialysis patient with a tunnelled central venous catheter develops fever and rigors soon after dialysis starts. What should the nurse suspect and do?

  1. ACatheter-related bloodstream infection; stop, take cultures and escalate
  2. BAir embolism; tilt the patient head-up and continue
  3. CNormal reaction to dialysis; continue and give paracetamol only
  4. DDialysis disequilibrium; speed up dialysis to finish sooner
13.Med-surg: GI, perioperative & oncologyMedium

Which dressing is generally suitable for a dry, sloughy wound that needs moisture?

  1. AAn alginate
  2. BA foam
  3. CA hydrogel
  4. DDry gauze
14.Med-surg: GI, perioperative & oncologyHard

A patient finds daily wound dressing changes very painful. What is the most effective nursing approach?

  1. AAvoid analgesia so the patient can report any problems during the change
  2. BDo the dressing quickly and give analgesia afterwards
  3. CChange the dressing less often than the plan says
  4. DGive analgesia timed so it works during the dressing change

3Solutions

1.Prioritization & delegation

Answer: B · Assess the lungs, oxygen saturation and swelling, then inform the provider

Why this is the answer

A rapid weight gain with orthopnea suggests fluid overload and worsening heart failure. The nurse assesses breathing and fluid status and informs the provider, who may adjust the diuretic.

Answer

B · Assess the lungs, oxygen saturation and swelling, then inform the provider
2.Prioritization & delegation

Answer: D · Dantrolene

Why this is the answer

Malignant hyperthermia is a reaction to some anesthetic agents that causes hypermetabolism. The triggering drug is stopped and dantrolene is given, with active cooling and support.

Answer

D · Dantrolene
3.Infection control & patient safety

Answer: A · Blood can flow back into the cartridge and spread infection

Why this is the answer

Blood and skin cells can be drawn back into the cartridge, so sharing a pen can transmit bloodborne infections. Each pen is labeled for a single patient.

Answer

A · Blood can flow back into the cartridge and spread infection
4.Infection control & patient safety

Answer: D · Wear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask

Why this is the answer

Aerosol-generating procedures can spread influenza in small particles that a surgical mask does not filter well. Staff wear a fit-tested respirator (N95 in the US, FFP3 in the UK), eye protection, gown and gloves, and the number of people in the room is kept low.

Answer

D · Wear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
5.Lab values & electrolytes

Answer: D · Vitamin B12

Why this is the answer

B12 and folate deficiencies both cause macrocytic anemia, but B12 deficiency also damages the spinal cord and peripheral nerves, causing numbness, tingling and poor balance. Neurological damage can become permanent if treatment is delayed.Checked against: Vitamin B12 deficiency anemia - Medical Encyclopedia · MedlinePlus (NIH) (2026); Vitamin B12 level - Medical Encyclopedia · MedlinePlus (NIH) (2026)

Answer

D · Vitamin B12
6.Lab values & electrolytes

Answer: D · Low hemoglobin, high reticulocytes, high unconjugated bilirubin, high LDH

Why this is the answer

When red cells break down early, hemoglobin is turned into unconjugated bilirubin and LDH is released, while the marrow increases reticulocytes. Option B fits iron deficiency, C fits B12 deficiency and D fits marrow failure.Checked against: Hemolytic anemia · MedlinePlus (NIH) (2026); Reticulocyte Count · MedlinePlus (NIH) (2024); Bilirubin Blood Test · MedlinePlus (NIH) (2024)

Answer

D · Low hemoglobin, high reticulocytes, high unconjugated bilirubin, high LDH
7.Clinical nursing

Answer: C · Acute pulmonary oedema

Why this is the answer

Acute pulmonary oedema causes severe breathlessness, crackles and frothy sputum. Sit the patient up, give oxygen and call urgently for medical help; diuretics are commonly given.

Answer

C · Acute pulmonary oedema
8.Clinical nursing

Answer: B · Refeeding syndrome

Why this is the answer

Refeeding syndrome results from rapid shifts of phosphate, potassium and magnesium into cells when feeding resumes. High-risk patients start slowly with electrolyte monitoring and thiamine.

Answer

B · Refeeding syndrome
9.Med-surg: cardiovascular & respiratory

Answer: C · They lower the heart's oxygen demand and reduce arrhythmias

Why this is the answer

Beta-blockers slow the heart and reduce contractility, lowering myocardial oxygen demand, and protect against arrhythmias. They are particularly beneficial when the ejection fraction is reduced. They are used cautiously in heart block, severe bradycardia, acute heart failure and asthma.

Answer

C · They lower the heart's oxygen demand and reduce arrhythmias
10.Med-surg: cardiovascular & respiratory

Answer: B · A 12-lead ECG

Why this is the answer

After return of spontaneous circulation, a 12-lead ECG looks for STEMI, which needs urgent coronary angiography and PCI. Post-resuscitation care also aims for normal oxygen and CO₂ levels, blood pressure support, glucose control and avoiding fever.

Answer

B · A 12-lead ECG
11.Med-surg: neuro, endocrine & renal

Answer: A · The right hypoglossal nerve (XII)

Why this is the answer

With a lower motor neuron lesion of the hypoglossal nerve, the tongue deviates towards the side of the lesion, because the healthy muscles push it across. Wasting and fasciculation of that side may also be seen.

Answer

A · The right hypoglossal nerve (XII)
12.Med-surg: neuro, endocrine & renal

Answer: A · Catheter-related bloodstream infection; stop, take cultures and escalate

Why this is the answer

Fever and rigors when dialysis starts through a central catheter strongly suggest a catheter-related bloodstream infection. Dialysis is stopped or adjusted per protocol, blood cultures are taken (from the catheter and peripherally), the team is informed and IV antibiotics are started as prescribed. The exit site is inspected.

Answer

A · Catheter-related bloodstream infection; stop, take cultures and escalate
13.Med-surg: GI, perioperative & oncology

Answer: C · A hydrogel

Why this is the answer

Hydrogels donate moisture and promote autolytic debridement of dry slough or necrotic tissue. Alginates and foams absorb exudate and suit wet wounds; dry gauze sticks to the wound bed and damages new tissue when removed.

Answer

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

Answer: D · Give analgesia timed so it works during the dressing change

Why this is the answer

Procedural pain is best managed by giving analgesia so its peak effect matches the procedure. Non-adherent dressings, soaking adherent dressings and allowing the patient to call pauses also help.

Answer

D · Give analgesia timed so it works during the dressing change

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