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 parent calls to say their toddler has just swallowed drain cleaner. What should the nurse advise?

  1. AMake the child vomit straight away to bring up the chemical
  2. BDo not make the child vomit; call poison control or emergency services now
  3. CWait to see whether the child develops any symptoms first
  4. DGive a large glass of fizzy drink or milk to dilute the cleaner before calling anyone
2.Prioritization & delegationHard

During START triage, a non-walking adult breathes 24 times a minute, has a radial pulse, but cannot follow simple commands. Which category is the victim given?

  1. ABlack (expectant)
  2. BYellow (delayed)
  3. CGreen (minor)
  4. DRed (immediate)
3.Infection control & patient safetyMedium

In a hospital fire, which means of moving patients is usually avoided?

  1. AMoving horizontally to another area on the same floor behind fire doors
  2. BWheeling beds through fire doors
  3. CElevators (lifts)
  4. DStairs
4.Infection control & patient safetyHard

A patient given naloxone for an opioid overdose wakes up. An hour later, the patient is drowsy again with slow breathing. What is the likely reason?

  1. AThe patient is now allergic to naloxone
  2. BThe patient is simply tired after the event
  3. CNaloxone itself causes slow breathing and drowsiness once it has been given
  4. DNaloxone wears off sooner than many opioids, so the opioid effect returns
5.Lab values & electrolytesMedium

A urine culture report states "mixed growth of three organisms, likely contamination." What is the nurse's best response?

  1. AStart treatment for all three organisms with three antibiotics
  2. BDiscard the report, because a mixed growth is always normal
  3. CInform the provider and arrange a new, correctly collected sample
  4. DRecord the result as a confirmed urinary tract infection
6.Lab values & electrolytesHard

A patient has a positive hepatitis C antibody (anti-HCV) test. What is the most appropriate next step?

  1. AGive hepatitis C vaccine to prevent further infection
  2. BTest for HCV RNA to find out whether infection is current
  3. CTell the patient they definitely have chronic hepatitis C
  4. DRepeat the antibody test, as a positive test is always false
7.Clinical nursingMedium

A patient without diabetes is started on high-dose prednisolone. Why might capillary blood glucose be monitored?

  1. ASteroids always cause hypoglycaemia
  2. BSteroids make glucose meters inaccurate
  3. CSteroids destroy the pancreas
  4. DSteroids can raise the blood glucose
8.Clinical nursingHard

A patient has sudden, severe "tearing" chest pain going through to the back and a large difference in blood pressure between the arms. What should be suspected?

  1. AStable angina
  2. BAortic dissection
  3. CPericarditis
  4. DGastro-oesophageal reflux
9.Med-surg: cardiovascular & respiratoryMedium

Which history is a contraindication to thrombolysis for a STEMI?

  1. AA previous haemorrhagic stroke
  2. BA previous appendicectomy many years ago
  3. CTreated high blood pressure
  4. DMild asthma controlled with inhalers
10.Med-surg: cardiovascular & respiratoryHard

Which task for a stable patient with heart failure can the registered nurse most appropriately delegate to a healthcare assistant (unlicensed assistive personnel)?

  1. ATeaching the patient about a low-salt diet
  2. BAssessing lung sounds for new crackles
  3. CMeasuring and recording the morning weight
  4. DDeciding whether to give the furosemide dose
11.Med-surg: neuro, endocrine & renalMedium

Why might a patient bleed more from the needle sites straight after haemodialysis?

  1. AThe fistula has been damaged and must be tied off
  2. BDialysis removes all the platelets from the blood
  3. CDialysis raises the blood pressure sharply for several hours
  4. DHeparin is often used to stop the circuit from clotting
12.Med-surg: neuro, endocrine & renalHard

A patient with type 1 diabetes is vomiting at home. Their glucose is 12 mmol/L (216 mg/dL), and blood ketones are 3.5 mmol/L. What advice is correct?

  1. AWait until the glucose is above 20 mmol/L (360 mg/dL)
  2. BStop insulin until the vomiting has settled
  3. CDrink less fluid to stop the vomiting
  4. DSeek urgent hospital assessment for possible DKA
13.Med-surg: GI, perioperative & oncologyMedium

Which statement correctly describes physical dependence on opioids?

  1. AWithdrawal occurs if the drug is stopped suddenly
  2. BThe patient is allergic to opioids
  3. CThe patient always craves the drug and misuses it despite harm
  4. DThe drug no longer has any side effects
14.Med-surg: GI, perioperative & oncologyHard

A patient's long-standing groin hernia has become tender, red and irreducible, and they are vomiting. What should the nurse do?

  1. APush the hernia firmly back in, then discharge home
  2. BAdvise the patient to wear a tight truss and rest
  3. CKeep them nil by mouth and arrange urgent surgical review
  4. DApply a hot water bottle and give a laxative

3Solutions

1.Prioritization & delegation

Answer: B · Do not make the child vomit; call poison control or emergency services now

Why this is the answer

Inducing vomiting after a corrosive is swallowed causes more burns to the throat and risks aspiration. The parent should get expert advice and emergency help at once.

Answer

B · Do not make the child vomit; call poison control or emergency services now
2.Prioritization & delegation

Answer: D · Red (immediate)

Why this is the answer

A victim who fails the mental status check (cannot follow simple commands) is immediate, even when breathing and perfusion are acceptable. This may signal a head injury or shock.

Answer

D · Red (immediate)
3.Infection control & patient safety

Answer: C · Elevators (lifts)

Why this is the answer

Elevators are not used during a fire unless the fire service directs it, because they can stop or fill with smoke. Patients are usually moved horizontally behind fire doors first, then downstairs if needed.

Answer

C · Elevators (lifts)
4.Infection control & patient safety

Answer: D · Naloxone wears off sooner than many opioids, so the opioid effect returns

Why this is the answer

Naloxone acts for a shorter time than many opioids, so sedation and respiratory depression can return. Patients are monitored closely, and repeat doses or an infusion may be needed.

Answer

D · Naloxone wears off sooner than many opioids, so the opioid effect returns
5.Lab values & electrolytes

Answer: C · Inform the provider and arrange a new, correctly collected sample

Why this is the answer

Several organisms in one urine sample usually mean contamination from the skin or perineum during collection. The provider is informed, and a new clean-catch or catheter-port sample is usually needed before an infection can be confirmed.

Answer

C · Inform the provider and arrange a new, correctly collected sample
6.Lab values & electrolytes

Answer: B · Test for HCV RNA to find out whether infection is current

Why this is the answer

Anti-HCV shows exposure, but some people clear the virus and keep antibodies. An HCV RNA test shows whether the infection is current. There is no vaccine for hepatitis C, but antiviral treatment can cure most infections.Checked against: Hepatitis C · MedlinePlus (NIH) (2025)

Answer

B · Test for HCV RNA to find out whether infection is current
7.Clinical nursing

Answer: D · Steroids can raise the blood glucose

Why this is the answer

Glucocorticoids increase glucose production and insulin resistance, causing steroid-induced hyperglycaemia. Glucose monitoring identifies patients who need treatment.

Answer

D · Steroids can raise the blood glucose
8.Clinical nursing

Answer: B · Aortic dissection

Why this is the answer

Aortic dissection classically causes abrupt, tearing pain radiating to the back, with unequal arm pulses or pressures. It is a surgical emergency, and thrombolysis must not be given.

Answer

B · Aortic dissection
9.Med-surg: cardiovascular & respiratory

Answer: A · A previous haemorrhagic stroke

Why this is the answer

Absolute contraindications include any previous intracranial haemorrhage, recent ischaemic stroke, active internal bleeding, suspected aortic dissection and recent major trauma or surgery. Thrombolysis is used when primary PCI cannot be delivered in time.

Answer

A · A previous haemorrhagic stroke
10.Med-surg: cardiovascular & respiratory

Answer: C · Measuring and recording the morning weight

Why this is the answer

Weighing a stable patient is a routine, measurable task that can be delegated, with the result reported to the nurse. Assessment, patient teaching and clinical decisions about medicines require the registered nurse's judgement and cannot be delegated.

Answer

C · Measuring and recording the morning weight
11.Med-surg: neuro, endocrine & renal

Answer: D · 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.

Answer

D · Heparin is often used to stop the circuit from clotting
12.Med-surg: neuro, endocrine & renal

Answer: D · Seek urgent hospital assessment for possible DKA

Why this is the answer

Blood ketones above 3 mmol/L, especially with vomiting, mean a high risk of DKA, even if the glucose is only moderately raised. The patient needs urgent assessment. Insulin should not be stopped.

Answer

D · Seek urgent hospital assessment for possible DKA
13.Med-surg: GI, perioperative & oncology

Answer: A · Withdrawal occurs if the drug is stopped suddenly

Why this is the answer

Physical dependence is a predictable adaptation to regular opioids, causing withdrawal if they stop suddenly, so doses are tapered. Addiction is a behavioural condition with craving, loss of control and continued use despite harm.

Answer

A · Withdrawal occurs if the drug is stopped suddenly
14.Med-surg: GI, perioperative & oncology

Answer: C · Keep them nil by mouth and arrange urgent surgical review

Why this is the answer

A tender, red, irreducible hernia with vomiting suggests strangulation and bowel obstruction. It needs emergency surgery; the nurse keeps the patient nil by mouth, gives analgesia, and starts IV access and fluids as prescribed.

Answer

C · Keep them nil by mouth and arrange urgent surgical review

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