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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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

During START triage, a non-walking adult is breathing 36 times a minute. Which category is the victim given?

  1. ARed (immediate)
  2. BYellow (delayed)
  3. CBlack (expectant)
  4. DGreen (minor)
2.Prioritization & delegationHard

Two hours after a femoral cardiac catheterization, the nurse sees blood spreading from the puncture site. What is the first action?

  1. ARaise the head of the bed so the patient can sit up
  2. BApply firm, direct pressure just above the puncture site
  3. CRemove the dressing and leave the site open to the air
  4. DAsk the patient to bend the leg at the hip to stop the bleeding
3.Infection control & patient safetyMedium

A patient with suspected tuberculosis is in a negative-pressure room. Which practice is correct?

  1. ALet visitors enter without any protection
  2. BKeep the door closed except when entering or leaving
  3. CTurn off the room ventilation at night
  4. DKeep the door open so staff can see the patient at all times
4.Infection control & patient safetyHard

A patient with active pulmonary tuberculosis asks visitors to come in. What is the best response?

  1. AExplain the risk, limit visits and teach visitors to use the protection provided
  2. BBan all contact permanently, including phone calls
  3. CAsk visitors to stand in the open doorway instead of entering the room
  4. DAllow any visitor in without any precautions, to support the patient
5.Lab values & electrolytesMedium

When several samples are drawn at the same venipuncture, which tubes or bottles are filled first?

  1. AFluoride (glucose) tubes
  2. BEDTA (complete blood count) tubes
  3. CCoagulation (citrate) tubes
  4. DBlood culture bottles
6.Lab values & electrolytesHard

A patient with no kidney problems and a normal ECG has a potassium of 6.2 mEq/L. The laboratory comments that the sample was hemolyzed. What is the best interpretation?

  1. AThe patient has kidney failure
  2. BThe potassium is certainly normal and needs no follow-up
  3. CTreat immediately with insulin and glucose without further checks
  4. DThe result may be falsely high; assess the patient and arrange a repeat sample
7.Clinical nursingMedium

A patient with heart failure gains 2 kg in two days. What does this most likely indicate?

  1. ASuccessful treatment
  2. BFluid retention
  3. CDehydration
  4. DIncreased muscle mass
8.Clinical nursingHard

After a head injury, a patient has clear fluid leaking from the nose. What does this most likely suggest?

  1. AAllergic rhinitis triggered by the hospital environment
  2. BAcute sinusitis
  3. CA base-of-skull fracture with a cerebrospinal fluid leak
  4. DA normal and harmless response to head trauma
9.Med-surg: cardiovascular & respiratoryMedium

A 70 kg patient has passed 20 mL of urine per hour for the last three hours. How should this be interpreted?

  1. ANormal, because any measurable urine output is reassuring
  2. BNormal, because the target is 0.1 mL/kg/h
  3. CHigh, suggesting fluid overload that needs a diuretic
  4. DBelow 0.5 mL/kg/h, suggesting poor kidney perfusion
10.Med-surg: cardiovascular & respiratoryHard

Four hours after cardiac surgery, the mediastinal drain, which had been draining steadily, suddenly stops. BP falls to 84/60 mmHg, the heart rate rises and the CVP climbs. What should the nurse suspect?

  1. ACardiac tamponade from a clotted drain
  2. BNormal recovery, as the bleeding has stopped
  3. CA tension pneumothorax on the left side
  4. DFluid overload from intravenous fluids
11.Med-surg: neuro, endocrine & renalMedium

A patient with migraine takes painkillers or triptans on most days and now has a headache almost every day. What is the likely problem?

  1. AA brain tumour, which is almost certain
  2. BAn allergy to the painkillers
  3. CNormal progress of migraine
  4. DMedication overuse headache
12.Med-surg: neuro, endocrine & renalHard

Two days after a spinal cord injury, a patient has a swollen abdomen, no bowel sounds and is vomiting. What is most likely, and what is the nursing action?

  1. ANormal constipation, so give a large meal to stimulate the bowel
  2. BA full bladder, so encourage oral fluids
  3. CAn allergic reaction to food, so give an antihistamine
  4. DParalytic ileus, so keep nil by mouth and prepare for an NG tube
13.Med-surg: GI, perioperative & oncologyMedium

What is anticipatory nausea in chemotherapy?

  1. ANausea triggered by reminders of treatment before it is given
  2. BNausea caused only by the smell of food
  3. CNausea caused by low blood glucose
  4. DNausea that starts about a week after each cycle and lasts for days
14.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient to self-inject low molecular weight heparin at home. Which statement shows a need for further teaching?

  1. A"I'll rub the area afterwards to spread the medicine."
  2. B"I'll report any unusual bruising or bleeding."
  3. C"I'll put the used syringe in the sharps bin."
  4. D"I'll change the injection site each day."

3Solutions

1.Prioritization & delegation

Answer: A · Red (immediate)

Why this is the answer

In START, a respiratory rate over 30/min means the victim is tagged immediate (red). Rates of 30 or less move on to the perfusion and mental status checks.

Answer

A · Red (immediate)
2.Prioritization & delegation

Answer: B · Apply firm, direct pressure just above the puncture site

Why this is the answer

Direct manual pressure just above the puncture site compresses the femoral artery and stops bleeding. The patient keeps the leg straight, and the nurse checks vital signs and distal pulses and informs the provider.

Answer

B · Apply firm, direct pressure just above the puncture site
3.Infection control & patient safety

Answer: B · Keep the door closed except when entering or leaving

Why this is the answer

The door is kept closed so that the airflow into the room is maintained. Visitors are limited and instructed about respiratory protection according to policy.

Answer

B · Keep the door closed except when entering or leaving
4.Infection control & patient safety

Answer: A · Explain the risk, limit visits and teach visitors to use the protection provided

Why this is the answer

Visits are limited and supported with education and protection according to policy, while the patient remains in a closed negative-pressure room. Visiting at an open door defeats the negative pressure.

Answer

A · Explain the risk, limit visits and teach visitors to use the protection provided
5.Lab values & electrolytes

Answer: D · Blood culture bottles

Why this is the answer

Blood cultures are drawn first to reduce contamination. A standard order of draw then follows (citrate, serum, heparin, EDTA, fluoride), which prevents additives being carried from one tube into the next and distorting results.

Answer

D · Blood culture bottles
6.Lab values & electrolytes

Answer: D · The result may be falsely high; assess the patient and arrange a repeat sample

Why this is the answer

Red cells are rich in potassium. When they break in the tube (from a tight tourniquet, fist clenching or a small needle), potassium leaks out and the result is falsely high. The nurse still assesses the patient and repeats the test, because true hyperkalemia must not be missed.Checked against: Potassium Blood Test · MedlinePlus (NIH) (2024)

Answer

D · The result may be falsely high; assess the patient and arrange a repeat sample
7.Clinical nursing

Answer: B · Fluid retention

Why this is the answer

Sudden weight gain in heart failure usually means fluid overload. Daily weights are the simplest way to track fluid balance.

Answer

B · Fluid retention
8.Clinical nursing

Answer: C · A base-of-skull fracture with a cerebrospinal fluid leak

Why this is the answer

Clear fluid from the nose or ear after head injury suggests a CSF leak from a skull base fracture, with a risk of meningitis. Nasal tubes and nose-blowing should be avoided and the patient reviewed urgently.

Answer

C · A base-of-skull fracture with a cerebrospinal fluid leak
9.Med-surg: cardiovascular & respiratory

Answer: D · Below 0.5 mL/kg/h, suggesting poor kidney perfusion

Why this is the answer

A urine output below about 0.5 mL/kg/h (35 mL/h for 70 kg) for several hours is oliguria and may indicate hypovolaemia, shock or acute kidney injury. It should be reported along with the other observations, and the catheter checked for blockage.

Answer

D · Below 0.5 mL/kg/h, suggesting poor kidney perfusion
10.Med-surg: cardiovascular & respiratory

Answer: A · Cardiac tamponade from a clotted drain

Why this is the answer

A sudden stop in drainage with falling blood pressure, tachycardia and rising venous pressure suggests blood is collecting around the heart because the drain is blocked. Tamponade after cardiac surgery is an emergency: the surgeon is called at once and the chest may need to be reopened.

Answer

A · Cardiac tamponade from a clotted drain
11.Med-surg: neuro, endocrine & renal

Answer: D · Medication overuse headache

Why this is the answer

Frequent use of painkillers or triptans can cause medication overuse headache. Treatment involves withdrawing the overused drug under guidance and starting a preventive treatment if needed.

Answer

D · Medication overuse headache
12.Med-surg: neuro, endocrine & renal

Answer: D · Paralytic ileus, so keep nil by mouth and prepare for an NG tube

Why this is the answer

Paralytic ileus is common in the first days after a spinal cord injury. The patient is kept nil by mouth, and a nasogastric tube decompresses the stomach to prevent vomiting and aspiration until bowel sounds return.

Answer

D · Paralytic ileus, so keep nil by mouth and prepare for an NG tube
13.Med-surg: GI, perioperative & oncology

Answer: A · Nausea triggered by reminders of treatment before it is given

Why this is the answer

Anticipatory nausea is a conditioned response after previous poorly controlled nausea, triggered by sights or smells linked to treatment. Good antiemetic control from the first cycle helps prevent it; relaxation techniques and anxiolytics may help.

Answer

A · Nausea triggered by reminders of treatment before it is given
14.Med-surg: GI, perioperative & oncology

Answer: A · "I'll rub the area afterwards to spread the medicine."

Why this is the answer

Rubbing the site after LMWH increases bruising and is avoided. Rotating sites, reporting bleeding and safe sharps disposal are correct.

Answer

A · "I'll rub the area afterwards to spread the medicine."

This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.

ExamProblems · examproblems.com/courses/nclex-style-prioritization-and-delegation