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 nurse teaches a patient who uses crutches. Which statement shows a need for further teaching?

  1. A“I will lean on the crutch pads under my arms to rest.”
  2. B“I will remove loose rugs from the floor at home.”
  3. C“I will take my weight on my hands, not on my armpits.”
  4. D“I will keep the crutch tips in good condition.”
2.Prioritization & delegationHard

After a head injury, a patient has clear fluid dripping from the nose. Which action should the nurse avoid?

  1. AChecking the fluid for glucose or a halo sign on gauze
  2. BPlacing a loose gauze under the nose
  3. CInforming the provider about the drainage
  4. DInserting a tube or suction catheter through the nose
3.Infection control & patient safetyMedium

Which practice is safe when transferring a patient from a bed to a stretcher?

  1. ALower the stretcher side rails during transport
  2. BHave the patient slide across without help or a slide sheet
  3. CLock the wheels of both the bed and the stretcher before moving the patient
  4. DLeave the stretcher wheels unlocked so it can move with the patient
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 simple English and many hand gestures
  3. CUse a professional medical interpreter
  4. DGive written instructions in English only
5.Lab values & electrolytesMedium

Which instruction is correct for a patient starting oral iron tablets?

  1. ATake each tablet with milk to protect the stomach
  2. BYour stools may turn dark green or black
  3. CYour urine will turn bright orange while you take it
  4. DTake the tablet with an antacid to improve absorption
6.Lab values & electrolytesHard

Why can an HbA1c result be misleading in a patient who received a large blood transfusion two weeks ago?

  1. AHbA1c is accurate in every situation
  2. BHbA1c measures sugar on white cells, not red cells
  3. CMany red cells are donor cells, not exposed to the patient’s glucose
  4. DTransfusions always raise HbA1c to falsely high levels
7.Clinical nursingMedium

What is the recommended first aid for a thermal burn?

  1. AApply ice directly to the burn until the pain stops completely
  2. BBurst any blisters to release the fluid
  3. CCool it under cool running water for about 20 minutes
  4. DSpread butter or oil over the burn
8.Clinical nursingHard

A patient with myasthenia gravis develops increasing difficulty swallowing and weak, shallow breathing. What is the main danger?

  1. AA urinary tract infection
  2. BRespiratory failure from a myasthenic crisis
  3. CSevere hypertension from anxiety
  4. DA sudden rise in blood glucose from the stress
9.Med-surg: cardiovascular & respiratoryMedium

A patient has episodes of severe headache, sweating and palpitations with very high blood pressure. Which rare cause should be considered?

  1. APhaeochromocytoma
  2. BAsthma
  3. CAortic stenosis
  4. DStable angina
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

Why can a patient with an insulin pump develop DKA within hours if the pump stops working?

  1. AThe body becomes allergic to insulin when the pump stops
  2. BThe pump gives only rapid-acting insulin, so there is no long-acting reserve
  3. CThe pump gives long-acting insulin, which builds up and stops working all at once
  4. DThe battery in the pump releases chemicals into the blood
12.Med-surg: neuro, endocrine & renalHard

During haemodialysis, a patient's BP falls to 80/50 mmHg and they feel dizzy and sick. What is the most appropriate first nursing action?

  1. AGive the patient's usual antihypertensive dose straight away
  2. BSit the patient upright and encourage a short walk
  3. CIncrease the fluid removal rate so the session ends sooner
  4. DLie the patient flat, reduce fluid removal and get help
13.Med-surg: GI, perioperative & oncologyMedium

Why is IV hydration given with cisplatin?

  1. ATo make the drug less effective
  2. BTo raise the blood pressure during treatment
  3. CTo prevent hair loss
  4. DTo protect the kidneys from damage
14.Med-surg: GI, perioperative & oncologyHard

In recovery, an awake and anxious patient cannot lift their head, and their breaths are shallow and weak. What is the most likely cause?

  1. ANormal tiredness after surgery
  2. BOpioid overdose with pinpoint pupils
  3. CA simple panic attack
  4. DResidual neuromuscular blockade

3Solutions

1.Prioritization & delegation

Answer: A · “I will lean on the crutch pads under my arms to rest.”

Why this is the answer

Leaning on the axillary pads can compress the nerves in the armpit. Weight should be taken through the hands, and the home should be made safe from trip hazards.

Answer

A · “I will lean on the crutch pads under my arms to rest.”
2.Prioritization & delegation

Answer: D · Inserting a tube or suction catheter through the nose

Why this is the answer

Clear nasal drainage after a head injury can be cerebrospinal fluid from a basal skull fracture. Nasal tubes could enter the brain and introduce infection, so they are avoided.

Answer

D · Inserting a tube or suction catheter through the nose
3.Infection control & patient safety

Answer: C · Lock the wheels of both the bed and the stretcher before moving the patient

Why this is the answer

Both surfaces are locked and at the same height before the transfer, a slide sheet is used and enough staff help. Side rails are raised on the stretcher during transport.

Answer

C · Lock the wheels of both the bed and the stretcher before moving the patient
4.Infection control & patient safety

Answer: C · 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

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

Answer: B · Your stools may turn dark green or black

Why this is the answer

Oral iron commonly darkens the stools, which is harmless, but black tarry stools with abdominal pain should be reported. Milk, antacids and tea reduce absorption; vitamin C or orange juice can improve it.Checked against: Ferrograd C patient information leaflet (ferrous sulfate + vitamin C) · electronic medicines compendium (eMC), UK (2018)

Answer

B · Your stools may turn dark green or black
6.Lab values & electrolytes

Answer: C · Many red cells are donor cells, not exposed to the patient’s glucose

Why this is the answer

HbA1c forms as glucose attaches to hemoglobin over the life of a red cell. Transfused donor cells and conditions that shorten red cell life give falsely low values, so a glucose log or other markers are used instead.

Answer

C · Many red cells are donor cells, not exposed to the patient’s glucose
7.Clinical nursing

Answer: C · Cool it under cool running water for about 20 minutes

Why this is the answer

Cooling with running water for around 20 minutes limits tissue damage and pain. Ice can cause further injury, and the patient should be kept warm while the burn is cooled.

Answer

C · Cool it under cool running water for about 20 minutes
8.Clinical nursing

Answer: B · Respiratory failure from a myasthenic crisis

Why this is the answer

In a myasthenic crisis, weakness of respiratory and bulbar muscles can cause aspiration and respiratory failure. Breathing function is monitored closely and ventilation may be needed.

Answer

B · Respiratory failure from a myasthenic crisis
9.Med-surg: cardiovascular & respiratory

Answer: A · Phaeochromocytoma

Why this is the answer

Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. Classic features are paroxysmal headache, sweating, palpitations and hypertension. It is diagnosed with plasma or urine metanephrines.

Answer

A · Phaeochromocytoma
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: B · The pump gives only rapid-acting insulin, so there is no long-acting reserve

Why this is the answer

Insulin pumps deliver a continuous flow of rapid-acting insulin. If delivery stops, there is no depot of long-acting insulin, so ketones can rise within a few hours. Patients carry pens or syringes as a backup.

Answer

B · The pump gives only rapid-acting insulin, so there is no long-acting reserve
12.Med-surg: neuro, endocrine & renal

Answer: D · Lie the patient flat, reduce fluid removal and get help

Why this is the answer

Intradialytic hypotension is common. Positioning, reducing or pausing ultrafiltration and giving a small saline bolus as per protocol usually restore the blood pressure. Antihypertensives are often held before dialysis in patients prone to hypotension, as prescribed.

Answer

D · Lie the patient flat, reduce fluid removal and get help
13.Med-surg: GI, perioperative & oncology

Answer: D · To protect the kidneys from damage

Why this is the answer

Cisplatin is nephrotoxic, so hydration and electrolyte replacement (especially magnesium) are given. It can also cause ototoxicity, neuropathy and severe nausea.

Answer

D · To protect the kidneys from damage
14.Med-surg: GI, perioperative & oncology

Answer: D · Residual neuromuscular blockade

Why this is the answer

Remaining muscle relaxant causes weakness, poor head lift and shallow breathing in an awake patient. The nurse supports breathing, gives oxygen and calls the anaesthetist, who may give a reversal agent.

Answer

D · Residual neuromuscular blockade

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