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
Which postoperative patient should the nurse see first?
- ADressing soaked with bright red blood and a heart rate rising to 118/min
- BAsking when the urinary catheter will be removed
- CPain of 4/10 one hour after an oral analgesic
- DWants help with washing her hair before her visitors arrive this afternoon
2.Prioritization & delegationHard
A nurse teaches a patient to inject enoxaparin at home. Which statement shows a need for further teaching?
- A“I will tell my doctor if I notice unusual bruising or bleeding.”
- B“I will inject into the fat of my abdomen, away from the navel.”
- C“I will rub the area after the injection to help it absorb.”
- D“I will change the injection site each time.”
3.Infection control & patient safetyMedium
How should the urethral meatus be cared for in a patient with an indwelling urinary catheter?
- AWith routine hygiene, using soap and water during daily washing
- BWith antiseptic cream applied to the meatus every shift
- CWith daily bladder irrigation using an antibiotic solution through the catheter
- DBy sliding the catheter in and out a little to clean it
4.Infection control & patient safetyHard
Ten minutes into a red blood cell transfusion, the patient reports chills and low back pain and has a new fever. What should the nurse do first?
- ASlow the transfusion and recheck vital signs in 15 minutes
- BCall the blood bank and let the transfusion continue
- CGive an antipyretic and continue the transfusion
- DStop the transfusion
5.Lab values & electrolytesMedium
The laboratory phones the ward with a critical potassium result of 6.9 mEq/L. What should the nurse do?
- AAsk the laboratory to repeat the test before telling anyone
- BRecord the value and hand it over to the next shift
- CRead back the value, assess the patient and inform the provider
- DWait for the written report to arrive before taking any action at all
6.Lab values & electrolytesHard
A patient with a round face, central weight gain and purple stretch marks has a glucose of 210 mg/dL (11.7 mmol/L) and a potassium of 3.1 mEq/L. Which condition fits best?
- ADiabetes insipidus
- BCushing syndrome
- CHypothyroidism
- DAdrenal insufficiency
7.Clinical nursingMedium
A pressure ulcer shows full-thickness tissue loss with exposed bone. Which category (stage) is this?
- ACategory 2
- BCategory 3
- CCategory 4
- DCategory 1
8.Clinical nursingHard
The fluid in an underwater seal chest drain has stopped swinging with breathing. What could this mean?
- AThe patient's breathing has become normal and the drain can be pulled out by the nurse
- BThe tube may be kinked or blocked, or the lung may have fully re-expanded
- CThe drain is working perfectly and needs no checks
- DThe water seal has been set up correctly for the first time
9.Med-surg: cardiovascular & respiratoryMedium
A patient choosing between a mechanical and a biological heart valve asks about the main difference. Which answer is accurate?
- AMechanical valves wear out within one year
- BBoth types need no medicines after surgery
- CBiological valves last longer but need lifelong warfarin
- DMechanical valves last longer but need lifelong anticoagulation
10.Med-surg: cardiovascular & respiratoryHard
A patient with asthma needs their reliever every three hours and their peak flow is falling well below their personal best. What does their action plan most likely advise?
- AStop the preventer inhaler for a few days to rest the lungs
- BWait two weeks to see whether it improves without any change
- CFollow the worsening-asthma steps and get a same-day review
- DDo extra exercise to open the airways
11.Med-surg: neuro, endocrine & renalMedium
A patient has a homonymous hemianopia after a stroke. How should the nurse help at first?
- APut the call bell and drinks on the side without vision, to train it
- BKeep the room dark to reduce visual stimulation
- CCover the eye on the affected side with a patch
- DApproach from the seeing side and teach head-turning to scan
12.Med-surg: neuro, endocrine & renalHard
Which patient with a spinal cord injury is at risk of autonomic dysreflexia?
- AA patient with an injury at T4
- BA patient with an injury at L3
- CA patient with an injury at L5
- DA patient with an injury at S2
13.Med-surg: GI, perioperative & oncologyMedium
How is an uncomplicated sigmoid volvulus often first treated?
- AEating a large high-fibre meal
- BDecompression with a flexible sigmoidoscope and flatus tube
- CA barium meal given by mouth to untwist the bowel slowly
- DHigh-dose laxatives taken by mouth
14.Med-surg: GI, perioperative & oncologyHard
A patient's long-standing groin hernia has become tender, red and irreducible, and they are vomiting. What should the nurse do?
- AKeep them nil by mouth and arrange urgent surgical review
- BAdvise the patient to wear a tight truss and rest
- CApply a hot water bottle and give a laxative
- DPush the hernia firmly back in, then discharge home
3Solutions
1.Prioritization & delegation
Answer: A · Dressing soaked with bright red blood and a heart rate rising to 118/min
Why this is the answer
Heavy fresh bleeding with a rising heart rate suggests hemorrhage and early shock. The other patients have routine needs that can wait.
A · Dressing soaked with bright red blood and a heart rate rising to 118/min
2.Prioritization & delegation
Answer: C · “I will rub the area after the injection to help it absorb.”
Why this is the answer
Rubbing the site after a low-molecular-weight heparin injection increases bruising. The abdomen away from the navel, rotating sites and reporting bleeding are correct.
C · “I will rub the area after the injection to help it absorb.”
3.Infection control & patient safety
Answer: A · With routine hygiene, using soap and water during daily washing
Why this is the answer
Routine perineal hygiene with soap and water is recommended. Antiseptic creams and routine irrigation do not reduce infection, and moving the catheter in and out carries organisms into the bladder.
A · With routine hygiene, using soap and water during daily washing
4.Infection control & patient safety
Answer: D · Stop the transfusion
Why this is the answer
These signs suggest an acute transfusion reaction, possibly hemolytic. The nurse stops the transfusion at once, keeps the IV open with normal saline through new tubing, assesses the patient and notifies the provider and blood bank.
5.Lab values & electrolytes
Answer: C · Read back the value, assess the patient and inform the provider
Why this is the answer
Reading back a verbal result prevents errors. A critical value is reported to the provider without delay, and the nurse assesses the patient, including heart rhythm. A repeat sample may be needed, but it must not delay the response.
C · Read back the value, assess the patient and inform the provider
6.Lab values & electrolytes
Answer: B · Cushing syndrome
Why this is the answer
Excess cortisol raises glucose, causes central obesity, a round face and purple striae, and has some mineralocorticoid effect that lowers potassium. Adrenal insufficiency causes low glucose and high potassium.Checked against: Hypercortisolism (Cushing Syndrome) · StatPearls (NCBI Bookshelf) (2025); Hypokalemia · StatPearls (NCBI Bookshelf) (2025)
7.Clinical nursing
Answer: C · Category 4
Why this is the answer
Category 4 involves full-thickness tissue loss with exposed bone, tendon or muscle. Category 3 is full-thickness skin loss without exposed bone or tendon. US (NPIAP) terminology calls these stages rather than categories.
8.Clinical nursing
Answer: B · The tube may be kinked or blocked, or the lung may have fully re-expanded
Why this is the answer
Loss of swing can mean a kinked, clamped or blocked tube, or re-expansion of the lung. The nurse checks the tubing and the patient and reports the finding.
B · The tube may be kinked or blocked, or the lung may have fully re-expanded
9.Med-surg: cardiovascular & respiratory
Answer: D · Mechanical valves last longer but need lifelong anticoagulation
Why this is the answer
Mechanical valves are very durable but are thrombogenic, so lifelong warfarin is needed. Biological (tissue) valves usually do not need long-term anticoagulation but wear out over time and may need replacement. Age, lifestyle and bleeding risk guide the choice.
D · Mechanical valves last longer but need lifelong anticoagulation
10.Med-surg: cardiovascular & respiratory
Answer: C · Follow the worsening-asthma steps and get a same-day review
Why this is the answer
Personal asthma action plans set steps based on symptoms and peak flow compared with the personal best. Increasing reliever need and a falling peak flow mean worsening asthma: treatment is increased as the plan says (sometimes with oral steroids) and urgent review is sought. Severe signs need emergency care.
C · Follow the worsening-asthma steps and get a same-day review
11.Med-surg: neuro, endocrine & renal
Answer: D · Approach from the seeing side and teach head-turning to scan
Why this is the answer
Initially, placing important items and approaching from the side with intact vision improves safety. Over time the patient is taught to scan by turning the head towards the lost field. Patching one eye does not help, because both eyes have lost the same half-field.
D · Approach from the seeing side and teach head-turning to scan
12.Med-surg: neuro, endocrine & renal
Answer: A · A patient with an injury at T4
Why this is the answer
Autonomic dysreflexia usually occurs with injuries at T6 or above. Below this level, the body can still control the sympathetic response to stimuli such as a full bladder. Lumbar and sacral injuries do not usually cause it.
A · A patient with an injury at T4
13.Med-surg: GI, perioperative & oncology
Answer: B · Decompression with a flexible sigmoidoscope and flatus tube
Why this is the answer
Endoscopic decompression often untwists a sigmoid volvulus. Recurrence is common, so elective surgery may follow. Signs of ischaemia or perforation need emergency surgery.
B · Decompression with a flexible sigmoidoscope and flatus tube
14.Med-surg: GI, perioperative & oncology
Answer: A · Keep them nil by mouth and arrange urgent surgical review
Why this is the answer
A tender, red, irreducible hernia with vomiting suggests strangulation and bowel obstruction. It needs emergency surgery; the nurse keeps the patient nil by mouth, gives analgesia, and starts IV access and fluids as prescribed.
A · Keep them nil by mouth and arrange urgent surgical review
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