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

Which practice makes a shift handover safest?

  1. AA quick chat in the corridor with no notes taken
  2. BA structured format, such as SBAR, with time for questions
  3. CHanding over only the patients who had problems during the shift
  4. DLeaving a sticky note on the computer screen for the next nurse
2.Prioritization & delegationHard

A patient with diabetes is sweaty and confused, and no glucose meter is available. The patient can swallow. What should the nurse do?

  1. AAsk the patient to lie down and sleep it off
  2. BGive a dose of rapid-acting insulin in case the glucose is high
  3. CTreat for hypoglycemia with fast-acting oral carbohydrate
  4. DWithhold all food and fluids until a meter is found
3.Infection control & patient safetyMedium

Which dressing waste should be disposed of in clinical (biohazard) waste?

  1. AAn unused, still-sealed dressing past its date
  2. BA clean paper towel used to dry hands
  3. CA dressing soaked with fluid from an infected wound
  4. DThe outer paper wrapping of a sterile dressing pack
4.Infection control & patient safetyHard

A patient on a general ward for two days is found to have smear-positive pulmonary TB. What should the nurse do besides moving the patient to an airborne isolation room?

  1. AClose the ward to all new admissions for a full year
  2. BNothing more, because the patient has now been isolated
  3. CInform infection prevention so exposed patients and staff can be identified and followed up
  4. DTell all the exposed patients to start TB drugs at once, before any testing
5.Lab values & electrolytesMedium

How does IV calcium gluconate help a patient with severe hyperkalemia?

  1. AIt moves potassium from the blood into the cells
  2. BIt increases potassium excretion by the kidneys
  3. CIt stabilizes heart cell membranes without lowering potassium
  4. DIt binds potassium in the gut so that it is passed in the stool
6.Lab values & electrolytesHard

A patient on hemodialysis receives epoetin, but the hemoglobin has not risen in 2 months. Which results should be checked first?

  1. AAmylase and lipase levels
  2. BFerritin and transferrin saturation
  3. CTSH and the free T3 level
  4. DTroponin and creatine kinase
7.Clinical nursingMedium

A patient's abdomen is rigid and board-like, and they lie very still because movement worsens the pain. What does this suggest?

  1. AUrinary tract infection
  2. BPeritonitis
  3. CIndigestion
  4. DConstipation
8.Clinical nursingHard

A patient with known prostate cancer reports new back pain, leg weakness and difficulty passing urine. What should be suspected?

  1. AA urinary tract infection spreading to the back
  2. BMetastatic spinal cord compression
  3. CHypokalaemia
  4. DSimple mechanical back pain
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. BIV atropine and external pacing
  3. CRapid IV adenosine followed by a flush
  4. DSynchronised cardioversion under deep sedation
10.Med-surg: cardiovascular & respiratoryHard

A patient with an inferior myocardial infarction develops complete heart block with a heart rate of 38/min. What is the most likely reason?

  1. AThe left anterior descending artery supplies the SA node only
  2. BHeart block is caused by the thrombolytic drug
  3. CInferior infarcts always destroy the bundle of His permanently
  4. DThe right coronary artery usually supplies the AV node
11.Med-surg: neuro, endocrine & renalMedium

Which statement about hyperosmolar hyperglycaemic state (HHS) is correct?

  1. AIt mainly affects older people with type 2 diabetes, over days
  2. BIt develops within minutes and is less dangerous than DKA
  3. CIt is seen mainly in young children with type 1 diabetes
  4. DIt always causes high blood ketones and a severe metabolic acidosis
12.Med-surg: neuro, endocrine & renalHard

A patient with lung cancer is confused, dehydrated and constipated, with a corrected calcium of 3.4 mmol/L (about 13.6 mg/dL). What is usually the first treatment?

  1. AIV calcium gluconate and vitamin D
  2. BOral calcium tablets
  3. CIV fluids to rehydrate the patient
  4. DA fluid restriction
13.Med-surg: GI, perioperative & oncologyMedium

Which complication is more typical of Crohn's disease than of ulcerative colitis?

  1. ADisease that is cured by removing the colon
  2. BInflammation limited to the rectal lining
  3. CFistulas between the bowel and other organs
  4. DBleeding only from the rectum
14.Med-surg: GI, perioperative & oncologyHard

A patient taking oral capecitabine reports red, painful, peeling palms and soles. What should the nurse do?

  1. AReport it; this is hand-foot syndrome and treatment may need changing
  2. BTell the patient to take a double dose next time
  3. CReassure that it is a sign of an unrelated allergy to washing powder
  4. DAdvise hot soaks for the hands and feet

3Solutions

1.Prioritization & delegation

Answer: B · A structured format, such as SBAR, with time for questions

Why this is the answer

Handover is a high-risk moment for errors. A structured format and the chance to ask questions help the next nurse understand each patient’s condition and priorities.

Answer

B · A structured format, such as SBAR, with time for questions
2.Prioritization & delegation

Answer: C · Treat for hypoglycemia with fast-acting oral carbohydrate

Why this is the answer

When in doubt, treat as hypoglycemia. A little sugar will not harm a patient with high glucose, but untreated hypoglycemia can cause brain injury within minutes, and insulin could be fatal.

Answer

C · Treat for hypoglycemia with fast-acting oral carbohydrate
3.Infection control & patient safety

Answer: C · A dressing soaked with fluid from an infected wound

Why this is the answer

Items contaminated with blood or infectious body fluids go into clinical waste according to local rules. Clean packaging goes into general or recycling waste, so the volume of clinical waste stays as small as possible.

Answer

C · A dressing soaked with fluid from an infected wound
4.Infection control & patient safety

Answer: C · Inform infection prevention so exposed patients and staff can be identified and followed up

Why this is the answer

Infection prevention and public health carry out a contact investigation to identify and screen people exposed while the patient was not isolated. Treatment of contacts depends on their test results.

Answer

C · Inform infection prevention so exposed patients and staff can be identified and followed up
5.Lab values & electrolytes

Answer: C · It stabilizes heart cell membranes without lowering potassium

Why this is the answer

Calcium counteracts the effect of high potassium on the heart’s electrical activity within minutes. The potassium must still be lowered by shifting it into cells (insulin with glucose) and removing it (binders, diuretics or dialysis).Checked against: High potassium level · MedlinePlus (NIH) (2025)

Answer

C · It stabilizes heart cell membranes without lowering potassium
6.Lab values & electrolytes

Answer: B · Ferritin and transferrin saturation

Why this is the answer

Iron deficiency is the most common reason for a poor response to erythropoiesis-stimulating agents, because the marrow needs iron to make hemoglobin. Ferritin and transferrin saturation are checked, and IV iron is often given in dialysis patients. Infection and inflammation can also blunt the response.Checked against: Anemia of Chronic Kidney Disease · StatPearls (NCBI Bookshelf) (2024); Erythropoietin Stimulating Agents · StatPearls (NCBI Bookshelf) (2024)

Answer

B · Ferritin and transferrin saturation
7.Clinical nursing

Answer: B · Peritonitis

Why this is the answer

Peritonitis, often from perforation, causes guarding, rigidity and pain worsened by movement. It is a surgical emergency.

Answer

B · Peritonitis
8.Clinical nursing

Answer: B · Metastatic spinal cord compression

Why this is the answer

Back pain with neurological symptoms in a patient with cancer suggests metastatic spinal cord compression. It is an oncological emergency needing urgent MRI and treatment to preserve function.

Answer

B · Metastatic spinal cord compression
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: D · The right coronary artery usually supplies the AV node

Why this is the answer

In most people the right coronary artery supplies the inferior wall and the AV node, so inferior MI can cause AV block. It is often temporary and may respond to atropine, but symptomatic or persistent block may need temporary pacing.

Answer

D · The right coronary artery usually supplies the AV node
11.Med-surg: neuro, endocrine & renal

Answer: A · It mainly affects older people with type 2 diabetes, over days

Why this is the answer

HHS develops over days, often triggered by infection, with extreme hyperglycaemia, very high osmolality and profound dehydration, frequently with confusion. Enough insulin is present to prevent marked ketosis. Mortality is higher than in DKA, and there is a high risk of thrombosis.

Answer

A · It mainly affects older people with type 2 diabetes, over days
12.Med-surg: neuro, endocrine & renal

Answer: C · IV fluids to rehydrate the patient

Why this is the answer

Hypercalcaemia causes polyuria and dehydration, which worsen the high calcium. IV fluids are the first step, followed by a bisphosphonate to reduce bone resorption. Calcium is rechecked regularly.

Answer

C · IV fluids to rehydrate the patient
13.Med-surg: GI, perioperative & oncology

Answer: C · Fistulas between the bowel and other organs

Why this is the answer

Transmural inflammation in Crohn's disease can create fistulas, abscesses and strictures. Ulcerative colitis is mucosal, and removing the colon and rectum is curative.

Answer

C · Fistulas between the bowel and other organs
14.Med-surg: GI, perioperative & oncology

Answer: A · Report it; this is hand-foot syndrome and treatment may need changing

Why this is the answer

Palmar-plantar erythrodysaesthesia (hand-foot syndrome) is common with capecitabine and fluorouracil. It is graded and may need a treatment break or dose reduction; emollients and avoiding heat and friction help.

Answer

A · Report it; this is hand-foot syndrome and treatment may need changing

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