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 cardiac monitor shows a flat line (asystole) for a patient, but the patient is sitting up and talking. What does the nurse do first?

  1. APrepare the defibrillator to deliver a shock
  2. BStart chest compressions at once
  3. CCheck the patient and the electrode leads
  4. DCall the cardiac arrest team
2.Prioritization & delegationHard

A toddler with tetralogy of Fallot becomes very blue and breathless while crying. What should the nurse do first?

  1. AEncourage the child to keep crying to open the lungs
  2. BLay the child flat on their back
  3. CPlace the child in a knee-to-chest position
  4. DGive a large drink of water to calm the child
3.Infection control & patient safetyMedium

Which household item is a strangulation risk for young children?

  1. ASoft cotton socks
  2. BA large wooden building block
  3. CLooped cords on window blinds
  4. DA plastic picture book
4.Infection control & patient safetyHard

A patient is receiving a high-alert drug by continuous infusion. At handover, which practice is safest?

  1. AThe incoming nurse checks it at the end of the shift
  2. BBoth nurses check the pump and bag against the prescription
  3. CThe outgoing nurse says that “the pump is fine” at the desk
  4. DOnly the rate is checked, not the drug or concentration
5.Lab values & electrolytesMedium

A patient on a heparin infusion has blood in the urine and an aPTT far above the target. The nurse stops the infusion and informs the provider. Which antidote should the nurse anticipate?

  1. AVitamin K (phytonadione)
  2. BProtamine sulfate
  3. CNaloxone
  4. DCalcium gluconate
6.Lab values & electrolytesHard

A patient's total calcium is 7.6 mg/dL and the albumin is 2.0 g/dL. Using the common correction (add 0.8 mg/dL for each 1 g/dL that albumin is below 4.0), what is the corrected calcium?

  1. A6.0 mg/dL, well below the normal range
  2. B7.6 mg/dL, below the normal range
  3. C11.6 mg/dL, above the normal range
  4. D9.2 mg/dL, within the normal range
7.Clinical nursingMedium

Why is continuous bladder irrigation used after a transurethral resection of the prostate (TURP)?

  1. ATo stop blood clots from blocking the catheter
  2. BTo stretch the bladder back to its normal size
  3. CTo measure the patient's kidney function
  4. DTo give antibiotics directly into the kidneys
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 normal and harmless response to head trauma
  4. DA base-of-skull fracture with a cerebrospinal fluid leak
9.Med-surg: cardiovascular & respiratoryMedium

Before compression therapy is applied for a venous leg ulcer, which assessment is essential?

  1. AAn ankle–brachial pressure index (ABPI)
  2. BA wound swab for culture and sensitivity
  3. CA full blood count and CRP
  4. DA chest X-ray and ECG
10.Med-surg: cardiovascular & respiratoryHard

A patient with a confirmed pulmonary embolism has BP 78/50 mmHg despite fluids, and the right ventricle is dilated on echocardiography. Which treatment is most likely?

  1. AAn inhaled bronchodilator
  2. BCompression stockings and bed rest
  3. COral apixaban only, started next week
  4. DSystemic thrombolysis
11.Med-surg: neuro, endocrine & renalMedium

After IV thrombolysis for stroke, which observations are most important in the first 24 hours?

  1. AHourly peak flow and oxygen saturation
  2. BFrequent neurological checks and BP
  3. CBowel sounds and abdominal girth hourly
  4. DDaily weight and the fluid balance only
12.Med-surg: neuro, endocrine & renalHard

A patient with a long-term catheter has fever and rigors, and a catheter UTI is suspected. Which action is recommended before starting antibiotics?

  1. ARemove the catheter and leave it out permanently
  2. BTake a sample from the drainage bag and send it to the lab
  3. CReplace the catheter and take a sample from the new one
  4. DFlush the catheter with saline and continue
13.Med-surg: GI, perioperative & oncologyMedium

A patient on enteral feeding develops diarrhoea. What should the nurse review first?

  1. AThe patient's mobility aids and walking distance
  2. BThe patient's eye drops and skin creams
  3. CThe colour of the feeding bag label
  4. DThe medicine chart, including laxatives and antibiotics
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. AA stomach ulcer; give an antacid after meals only
  2. BA heart attack; give aspirin and arrange an ECG
  3. CNormal ageing; no action needed
  4. DRadiation oesophagitis; analgesia, soft food and nutrition support

3Solutions

1.Prioritization & delegation

Answer: C · Check the patient and the electrode leads

Why this is the answer

A talking patient has a pulse, so the flat line is almost certainly a lead or electrode problem. The nurse assesses the patient and fixes the leads. CPR and defibrillation are for patients who are actually in arrest.

Answer

C · Check the patient and the electrode leads
2.Prioritization & delegation

Answer: C · Place the child in a knee-to-chest position

Why this is the answer

In a hypercyanotic (“tet”) spell, the knee-chest position raises systemic vascular resistance and sends more blood to the lungs. Oxygen and prescribed medication follow.

Answer

C · Place the child in a knee-to-chest position
3.Infection control & patient safety

Answer: C · Looped cords on window blinds

Why this is the answer

Young children can become entangled in looped blind and curtain cords. Cordless blinds or cord tie-downs, and keeping cribs away from windows, prevent strangulation.

Answer

C · Looped cords on window blinds
4.Infection control & patient safety

Answer: B · Both nurses check the pump and bag against the prescription

Why this is the answer

A bedside check at handover, tracing the line from bag to patient and comparing the drug, concentration, dose and rate with the prescription, catches programming errors early.

Answer

B · Both nurses check the pump and bag against the prescription
6.Lab values & electrolytes

Answer: D · 9.2 mg/dL, within the normal range

Why this is the answer

Corrected calcium = 7.6 + 0.8 × (4.0 − 2.0) = 9.2 mg/dL, which is normal. Low albumin lowers the bound fraction of calcium; the correction is only an estimate, and an ionized calcium is more accurate when it matters.Checked against: Calcium blood test · MedlinePlus (NIH) (2025)

Answer

D · 9.2 mg/dL, within the normal range
7.Clinical nursing

Answer: A · To stop blood clots from blocking the catheter

Why this is the answer

Irrigation dilutes blood and flushes out clots so the catheter does not block. Output must be measured carefully and urine output calculated by subtracting the irrigation volume.

Answer

A · To stop blood clots from blocking the catheter
8.Clinical nursing

Answer: D · 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

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

Answer: A · An ankle–brachial pressure index (ABPI)

Why this is the answer

Compression helps venous return but can cause tissue necrosis if the arterial supply is inadequate. The ABPI compares ankle and arm systolic pressures; a value below about 0.8 (or above about 1.3, suggesting calcified vessels) needs specialist review before compression.

Answer

A · An ankle–brachial pressure index (ABPI)
10.Med-surg: cardiovascular & respiratory

Answer: D · Systemic thrombolysis

Why this is the answer

A PE causing sustained hypotension is high-risk and usually treated with thrombolysis to dissolve the clot quickly, unless contraindicated, when surgical or catheter removal may be used. Stable patients are usually treated with anticoagulation alone.

Answer

D · Systemic thrombolysis
11.Med-surg: neuro, endocrine & renal

Answer: B · Frequent neurological checks and BP

Why this is the answer

Neurological observations, blood pressure and checks for bleeding are done frequently after thrombolysis. A new headache, vomiting, falling GCS or rising blood pressure may indicate haemorrhage. Antiplatelets and anticoagulants are usually avoided for 24 hours.

Answer

B · Frequent neurological checks and BP
12.Med-surg: neuro, endocrine & renal

Answer: C · Replace the catheter and take a sample from the new one

Why this is the answer

Long-term catheters develop a biofilm that contaminates samples. Guidance usually advises replacing the catheter, collecting a sample from the new one and then starting antibiotics. Bag samples are not used.

Answer

C · Replace the catheter and take a sample from the new one
13.Med-surg: GI, perioperative & oncology

Answer: D · The medicine chart, including laxatives and antibiotics

Why this is the answer

Diarrhoea on enteral feeds is often caused by drugs such as antibiotics, laxatives and liquid medicines containing sorbitol, or by infection such as C. difficile. The feed is not stopped automatically; the cause is investigated.

Answer

D · The medicine chart, including laxatives and antibiotics
14.Med-surg: GI, perioperative & oncology

Answer: D · 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

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

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