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

A nursing assistant refuses a delegated task, saying they have not been trained to do it. What is the best response from the nurse?

  1. ALeave the task for the next shift, when someone trained is on
  2. BThank the assistant, make sure the task is done safely and arrange training
  3. CReport the assistant to the manager for refusing a task
  4. DTell the assistant it is in the job description and must be done
2.Prioritization & delegationHard

A patient with a severe asthma attack had a PaCO₂ of 32 mmHg (4.3 kPa) on arrival. An hour later it is 46 mmHg (6.1 kPa), and the patient seems tired. What does this suggest?

  1. AThe asthma is improving, because the PaCO₂ is now near normal
  2. BThe patient is hyperventilating even more than before and needs calming
  3. CRespiratory muscle fatigue with possible impending respiratory failure
  4. DA laboratory error that should be ignored
3.Infection control & patient safetyMedium

A patient has leftover opioid tablets after surgery. Which advice about disposal is best?

  1. AKeep them in an unlocked drawer at home in case of future pain
  2. BGive them to a friend or relative who has back pain
  3. CReturn them to a pharmacy or an approved take-back site
  4. DLeave them in the bathroom cabinet indefinitely
4.Infection control & patient safetyHard

A patient who speaks little English is being discharged with new medications. The patient’s 12-year-old child offers to interpret. What should the nurse do?

  1. ALet the child interpret, because the family prefers it
  2. BUse a professional medical interpreter
  3. CUse simple English and many hand gestures
  4. DGive written instructions in English only
5.Lab values & electrolytesMedium

A patient’s white cell count is 16 × 10³/µL with a high proportion of immature neutrophils (bands). What does this most likely indicate?

  1. AA normal result
  2. BIron-deficiency anemia
  3. CAn acute bacterial infection
  4. DA chronic viral illness only
6.Lab values & electrolytesHard

A patient with a stable INR on warfarin starts rifampin (rifampicin) for tuberculosis. Two weeks later the INR is 1.3. What is the most likely explanation?

  1. ARifampin speeds up warfarin metabolism
  2. BTuberculosis causes the INR to fall
  3. CRifampin raises the INR, so it is wrong
  4. DRifampin contains a lot of vitamin K
7.Clinical nursingMedium

An older adult has left lower abdominal pain, fever and a raised CRP. Which condition is most likely?

  1. AAppendicitis
  2. BGastric ulcer
  3. CBiliary colic
  4. DDiverticulitis
8.Clinical nursingHard

After a high spinal cord injury, a patient has low blood pressure with a slow heart rate and warm, dry skin. What is most likely?

  1. ANeurogenic shock
  2. BHypovolaemic shock
  3. CCardiac tamponade
  4. DSeptic shock
9.Med-surg: cardiovascular & respiratoryMedium

The monitor shows ventricular fibrillation. The patient is unresponsive and not breathing normally. What is the key treatment?

  1. ACPR and defibrillation as soon as possible
  2. BSynchronised cardioversion under deep sedation
  3. CIV atropine and external pacing
  4. DRapid IV adenosine followed by a flush
10.Med-surg: cardiovascular & respiratoryHard

Thirty minutes after extubation, a patient develops a high-pitched noise on breathing in and is anxious. SpO₂ is falling. What should the nurse do?

  1. AGive a large drink of cold water to soothe the throat and settle it
  2. BLay the patient flat and reassure them
  3. CSit the patient up, give oxygen and call for urgent airway help
  4. DEncourage the patient to sleep it off and recheck them in an hour
11.Med-surg: neuro, endocrine & renalMedium

A man starts finasteride for an enlarged prostate. Which statement is correct?

  1. AIt takes months to work; pregnant women must not handle broken tablets
  2. BIt works within hours by relaxing the bladder muscle
  3. CIt lowers the blood pressure, so dizziness is very common
  4. DIt is used only for a few days at a time
12.Med-surg: neuro, endocrine & renalHard

Which task for a stroke patient can a registered nurse safely delegate to a healthcare assistant (nursing assistant)?

  1. ARepositioning the patient every two hours as set out in the care plan
  2. BTeaching the patient how to take a new anticoagulant
  3. CAssessing a new weakness the patient reports in the leg
  4. DCarrying out the first bedside water swallow screen after admission
13.Med-surg: GI, perioperative & oncologyMedium

Dysphagia that started with solids and now includes liquids, with weight loss, most suggests which cause?

  1. ANormal ageing of the swallowing muscles
  2. BA narrowing such as an oesophageal tumour
  3. CSimple anxiety about swallowing tablets
  4. DA dry mouth from drinking too little water
14.Med-surg: GI, perioperative & oncologyHard

In week 5 of radiotherapy, the skin in the treatment field is broken, moist and painful. What should the nurse do?

  1. AUse a heat pad to speed healing
  2. BApply adhesive tape directly over the area to protect it from clothing
  3. CScrub the area with soap to prevent infection
  4. DReport it, keep it clean and use a non-adherent dressing

3Solutions

1.Prioritization & delegation

Answer: B · Thank the assistant, make sure the task is done safely and arrange training

Why this is the answer

A delegate should refuse a task they are not competent to do. The nurse makes sure the task is done safely now and arranges training for the future. Forcing the task or leaving it undone puts the patient at risk.

Answer

B · Thank the assistant, make sure the task is done safely and arrange training
2.Prioritization & delegation

Answer: C · Respiratory muscle fatigue with possible impending respiratory failure

Why this is the answer

Early in an asthma attack, fast breathing lowers the PaCO₂. A rising, “normal” value in a tiring patient means they can no longer move enough air, which is a warning sign of respiratory failure.

Answer

C · Respiratory muscle fatigue with possible impending respiratory failure
3.Infection control & patient safety

Answer: C · Return them to a pharmacy or an approved take-back site

Why this is the answer

Returning unused opioids to a pharmacy or an approved take-back site is the preferred way to dispose of them. Leftover opioids at home can be misused or taken by children or pets.

Answer

C · Return them to a pharmacy or an approved take-back site
4.Infection control & patient safety

Answer: B · Use a professional medical interpreter

Why this is the answer

Professional medical interpreters reduce errors and protect privacy. Children and other family members may translate wrongly, leave things out or be placed in a difficult position.

Answer

B · Use a professional medical interpreter
5.Lab values & electrolytes

Answer: C · An acute bacterial infection

Why this is the answer

A raised white count with more bands (a “left shift”) suggests that the marrow is responding to an acute bacterial infection or severe inflammation. The result is read together with the patient’s signs, such as fever.Checked against: Blood Differential · MedlinePlus (NIH) (2024)

Answer

C · An acute bacterial infection
6.Lab values & electrolytes

Answer: A · Rifampin speeds up warfarin metabolism

Why this is the answer

Rifampin induces liver enzymes that break down warfarin, so warfarin's effect falls and the INR drops, increasing clot risk. The INR is monitored closely and the dose adjusted; the reverse happens when rifampin is stopped.

Answer

A · Rifampin speeds up warfarin metabolism
7.Clinical nursing

Answer: D · Diverticulitis

Why this is the answer

Diverticulitis is inflammation of diverticula, usually in the sigmoid colon, so pain is typically in the left iliac fossa. It is common in older adults.

Answer

D · Diverticulitis
8.Clinical nursing

Answer: A · Neurogenic shock

Why this is the answer

Neurogenic shock from cervical or high thoracic injury causes vasodilation and bradycardia because sympathetic outflow is lost. Hypovolaemic shock usually causes tachycardia and cool, pale skin.

Answer

A · Neurogenic shock
9.Med-surg: cardiovascular & respiratory

Answer: A · CPR and defibrillation as soon as possible

Why this is the answer

Ventricular fibrillation is a cardiac arrest rhythm. High-quality CPR and early unsynchronised defibrillation are the interventions that improve survival. Synchronised cardioversion is for tachyarrhythmias with a pulse; atropine and pacing are for bradycardia.

Answer

A · CPR and defibrillation as soon as possible
10.Med-surg: cardiovascular & respiratory

Answer: C · Sit the patient up, give oxygen and call for urgent airway help

Why this is the answer

Post-extubation stridor suggests laryngeal oedema and may progress to complete obstruction. The patient is sat up, given humidified oxygen and assessed by an airway expert urgently. Nebulised adrenaline and steroids may be used, and reintubation may be needed.

Answer

C · Sit the patient up, give oxygen and call for urgent airway help
11.Med-surg: neuro, endocrine & renal

Answer: A · It takes months to work; pregnant women must not handle broken tablets

Why this is the answer

Finasteride, a 5-alpha reductase inhibitor, reduces the conversion of testosterone to dihydrotestosterone and shrinks the prostate over several months. It can harm a male fetus, so pregnant women should avoid handling crushed or broken tablets.

Answer

A · It takes months to work; pregnant women must not handle broken tablets
12.Med-surg: neuro, endocrine & renal

Answer: A · Repositioning the patient every two hours as set out in the care plan

Why this is the answer

Repositioning to a set plan is a routine task that trained assistants can carry out. Swallow screening, assessing new symptoms and medication teaching need the nurse's clinical judgement and stay with the registered nurse.

Answer

A · Repositioning the patient every two hours as set out in the care plan
13.Med-surg: GI, perioperative & oncology

Answer: B · A narrowing such as an oesophageal tumour

Why this is the answer

Progressive dysphagia, solids first then liquids, with weight loss, is typical of a mechanical obstruction such as oesophageal cancer or a stricture. It needs an urgent referral for endoscopy.

Answer

B · A narrowing such as an oesophageal tumour
14.Med-surg: GI, perioperative & oncology

Answer: D · Report it, keep it clean and use a non-adherent dressing

Why this is the answer

Moist desquamation is a more severe radiation skin reaction. The radiotherapy team is informed; the area is kept clean and covered with non-adherent dressings, avoiding adhesive on the skin, and analgesia is given. Infection is watched for.

Answer

D · Report it, keep it clean and use a non-adherent dressing

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