1Formulas and methods
Prioritization & delegation
Method
- Ask what will harm the patient soonest if nothing is done.
- Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
- Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
- Assess before you act unless it is an emergency; then choose the step the others depend on.
- 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
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Lab values & electrolytes
Method
- Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
- Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
- Link the value to its typical signs and to the drugs and conditions that cause it.
- Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
- 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
- Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
- Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
- Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
- Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
- Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
- Check the glucose in every patient with new confusion, weakness or a seizure.
- Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
- For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
- For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
- For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
- Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
- Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
- For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
- For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
- 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’s peripheral IV site is swollen, pale and cool, and the infusion has slowed. What should the nurse do first?
- AApply a tight bandage over the site to reduce swelling
- BFlush the cannula hard to clear the blockage
- CIncrease the infusion rate to overcome the resistance
- DStop the infusion and remove the cannula
2.Prioritization & delegationHard
A charge nurse notices that a nurse smells of alcohol and is slurring words at the start of the shift. What is the priority?
- AWait until the end of the shift and then discuss the concern with the nurse privately
- BLet the nurse work, but only with stable patients
- CAsk the nurse to drink coffee and then start work
- DRemove the nurse from patient care and report it according to policy
3.Infection control & patient safetyMedium
Many intensive care units bathe patients daily with chlorhexidine. What is the main purpose?
- ATo treat existing wound infections without the need for antibiotics
- BTo reduce skin bacteria and bloodstream infections linked to central lines
- CTo moisturize dry skin in older patients
- DTo lower the patient’s body temperature
4.Infection control & patient safetyHard
A nurse teaches the daughter of a patient with moderate Alzheimer’s disease about home safety. Which statement shows a need for further teaching?
- A“We put locks high up on the outside doors.”
- B“She wears an ID bracelet in case she gets lost.”
- C“I keep her medicines locked away and give each dose to her myself.”
- D“I let Mom cook alone on the gas stove because she enjoys it.”
5.Lab values & electrolytesMedium
A patient with sickle cell disease takes hydroxyurea. Which laboratory test is monitored regularly for an adverse effect?
- ASerum lithium level
- BSerum amylase level
- CUrine ketone level
- DComplete blood count
6.Lab values & electrolytesHard
Which cerebrospinal fluid (CSF) pattern most strongly suggests bacterial meningitis?
- AClear fluid, normal glucose, normal protein, no white cells
- BClear fluid, normal glucose, mildly raised protein, lymphocytes
- CCloudy fluid, low glucose, high protein, many neutrophils
- DClear fluid, high glucose, low protein, many red cells
7.Clinical nursingMedium
Which side effects are common after high doses of salbutamol (albuterol)?
- AHair loss and weight gain
- BTremor and a fast heart rate
- CBradycardia and drowsiness
- DConstipation and urinary retention
8.Clinical nursingHard
Which finding most strongly suggests a pulmonary embolism in a postoperative patient?
- ASudden breathlessness and pleuritic chest pain with tachycardia
- BSlow heart rate with high blood pressure
- CGradual onset of cough with yellow sputum and mild fever over a week
- DWheeze that improves with salbutamol
9.Med-surg: cardiovascular & respiratoryMedium
A patient has exercise-induced asthma. Which advice is most appropriate?
- ATake a beta-blocker before exercise
- BAvoid all forms of exercise permanently to prevent attacks
- CUse the reliever inhaler shortly before exercise and warm up
- DExercise only in cold, dry air to toughen the airways
10.Med-surg: cardiovascular & respiratoryHard
A nurse has four cardiac patients. Which one should be seen first?
- AA patient after a radial angiogram asking when they can eat
- BA patient with angina whose chest pain has not eased with rest and who is sweating
- CA patient with AF and a heart rate of 86/min who is due an apixaban dose this morning
- DA patient with heart failure whose weight is 0.3 kg up on yesterday's morning weight
11.Med-surg: neuro, endocrine & renalMedium
After IV thrombolysis for stroke, which observations are most important in the first 24 hours?
- AHourly peak flow and oxygen saturation
- BBowel sounds and abdominal girth hourly
- CDaily weight and the fluid balance only
- DFrequent neurological checks and BP
12.Med-surg: neuro, endocrine & renalHard
A patient with raised intracranial pressure needs endotracheal suctioning. Which approach is most appropriate?
- ALie the patient flat with the head turned during suctioning
- BSuction every 15 minutes as a routine, even without secretions
- CPre-oxygenate, keep each pass short and limit the number of passes
- DSuction for at least 30 seconds to clear all secretions at once
13.Med-surg: GI, perioperative & oncologyMedium
Why is the time a surgical limb tourniquet is inflated carefully recorded?
- AThe tourniquet slowly loses all its air after one minute
- BThe surgeon is paid per minute of use
- CIt shows how long the anaesthetic gas was used
- DLong inflation can cause nerve and muscle damage
14.Med-surg: GI, perioperative & oncologyHard
A patient with bone metastases is starting regular zoledronic acid. Which advice is important?
- AHave a dental check and report jaw pain or loose teeth
- BAvoid all physical activity for six months
- CStop drinking all fluids on the day of each infusion
- DTake extra calcium only on the day of infusion
3Solutions
1.Prioritization & delegation
Answer: D · Stop the infusion and remove the cannula
Why this is the answer
A cool, pale, swollen site suggests infiltration. The nurse stops the infusion, removes the cannula, elevates the limb and restarts the IV at another site as needed.
D · Stop the infusion and remove the cannula
2.Prioritization & delegation
Answer: D · Remove the nurse from patient care and report it according to policy
Why this is the answer
A nurse who appears impaired must not care for patients. The charge nurse removes them from duty and follows policy for reporting; support, such as an assistance program, can follow.
D · Remove the nurse from patient care and report it according to policy
3.Infection control & patient safety
Answer: B · To reduce skin bacteria and bloodstream infections linked to central lines
Why this is the answer
Daily chlorhexidine bathing lowers the number of organisms on the skin, reducing central line-associated bloodstream infections and the spread of resistant bacteria in ICUs.
B · To reduce skin bacteria and bloodstream infections linked to central lines
4.Infection control & patient safety
Answer: D · “I let Mom cook alone on the gas stove because she enjoys it.”
Why this is the answer
People with moderate dementia may forget a lit stove, causing fires or burns. Cooking should be supervised, or stove knobs removed or controls disabled. The other statements show good safety planning.
D · “I let Mom cook alone on the gas stove because she enjoys it.”
5.Lab values & electrolytes
Answer: D · Complete blood count
Why this is the answer
Hydroxyurea increases fetal hemoglobin and reduces sickling crises, but it can suppress the bone marrow. The CBC, including neutrophils and platelets, is monitored regularly, and doses are adjusted if counts fall.Checked against: Sickle cell disease · MedlinePlus (NIH) (2026)
6.Lab values & electrolytes
Answer: C · Cloudy fluid, low glucose, high protein, many neutrophils
Why this is the answer
Bacterial meningitis typically gives cloudy CSF with many neutrophils, high protein and low glucose, because bacteria and white cells use glucose. Viral meningitis usually shows lymphocytes with a normal glucose; option C is normal CSF.Checked against: CSF glucose test · MedlinePlus (NIH) (2025); CSF cell count · MedlinePlus (NIH) (2025); CSF total protein · MedlinePlus (NIH) (2025)
C · Cloudy fluid, low glucose, high protein, many neutrophils
7.Clinical nursing
Answer: B · Tremor and a fast heart rate
Why this is the answer
Salbutamol is a beta2-agonist and can cause tremor, tachycardia and palpitations. High doses can also lower serum potassium.
B · Tremor and a fast heart rate
8.Clinical nursing
Answer: A · Sudden breathlessness and pleuritic chest pain with tachycardia
Why this is the answer
PE typically presents with sudden dyspnoea, chest pain on breathing, tachycardia, low oxygen saturation and sometimes haemoptysis or collapse.
A · Sudden breathlessness and pleuritic chest pain with tachycardia
9.Med-surg: cardiovascular & respiratory
Answer: C · Use the reliever inhaler shortly before exercise and warm up
Why this is the answer
A short-acting bronchodilator taken shortly before exercise, a gradual warm-up and covering the mouth in cold air help prevent symptoms. Frequent exercise symptoms may mean asthma is poorly controlled and preventer treatment needs review.
C · Use the reliever inhaler shortly before exercise and warm up
10.Med-surg: cardiovascular & respiratory
Answer: B · A patient with angina whose chest pain has not eased with rest and who is sweating
Why this is the answer
Chest pain that does not settle with rest, especially with sweating, suggests an acute coronary syndrome and needs immediate assessment and a 12-lead ECG. A controlled heart rate in AF, a very small weight change and a question about eating are not urgent.
B · A patient with angina whose chest pain has not eased with rest and who is sweating
11.Med-surg: neuro, endocrine & renal
Answer: D · 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.
D · Frequent neurological checks and BP
12.Med-surg: neuro, endocrine & renal
Answer: C · Pre-oxygenate, keep each pass short and limit the number of passes
Why this is the answer
Suctioning raises ICP through coughing, hypoxia and hypercapnia. It is done only when needed, with pre-oxygenation, passes of no more than about 10–15 seconds, few passes and the head kept elevated and midline. Sedation or lidocaine may be used in some units.
C · Pre-oxygenate, keep each pass short and limit the number of passes
13.Med-surg: GI, perioperative & oncology
Answer: D · Long inflation can cause nerve and muscle damage
Why this is the answer
A tourniquet creates a bloodless field but causes limb ischaemia. Inflation time and pressure are recorded and the surgeon is told at set intervals, as long inflation can damage nerves and muscle.
D · Long inflation can cause nerve and muscle damage
14.Med-surg: GI, perioperative & oncology
Answer: A · Have a dental check and report jaw pain or loose teeth
Why this is the answer
Bisphosphonates can cause osteonecrosis of the jaw, especially after dental extractions. A dental check before starting, good oral hygiene and reporting jaw symptoms are advised. Kidney function and calcium are also monitored.
A · Have a dental check and report jaw pain or loose teeth
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.