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 patient is at the highest risk of falling?

  1. AA 30-year-old after an appendectomy who walks with steady steps
  2. BA 60-year-old admitted for chest pain that has since been ruled out by tests
  3. CA 45-year-old with asthma who is alert and independent
  4. DAn 84-year-old taking a diuretic who has fallen before and gets up at night
2.Prioritization & delegationHard

Two call lights go on at the same time. One patient has pain of 7/10 after surgery. The other is a confused patient at high risk of falls who is climbing out of bed alone. Who does the nurse go to first?

  1. AThe confused patient climbing out of bed
  2. BThe patient whose call light went on first
  3. CWhichever patient’s room is closer to the station
  4. DThe patient in pain after surgery
3.Infection control & patient safetyMedium

A patient wants to use their own electric hair dryer in the hospital. What is correct?

  1. AIt can be used straight away if it looks new
  2. BIt is checked for electrical safety according to hospital policy before use
  3. CIt can be plugged into an extension lead under the bed
  4. DIt can be used in the bathroom near the sink if the patient is careful
4.Infection control & patient safetyHard

A nurse calls a provider using SBAR about a patient with falling blood pressure. Which statement is the “Recommendation”?

  1. A“He is 72 and had a bowel resection yesterday.”
  2. B“I am calling about Mr. Jansen in room 12, who is hypotensive.”
  3. C“I think he needs to be assessed now. Can you come within the next 15 minutes?”
  4. D“His blood pressure has fallen from 130/80 to 88/50 over the last two hours.”
5.Lab values & electrolytesMedium

A test has very high sensitivity for a disease. What does a negative result mean?

  1. AThe patient must have a different disease instead
  2. BThe disease is unlikely, so it helps rule it out
  3. CThe result cannot be used, because sensitivity is high
  4. DThe disease is certain, so treatment should begin
6.Lab values & electrolytesHard

A patient taking an SGLT2 inhibitor has nausea and fast breathing. Glucose 190 mg/dL (10.5 mmol/L), pH 7.15, bicarbonate 10 mEq/L, blood ketones high. What is the most likely diagnosis?

  1. AHyperosmolar hyperglycemic state
  2. BEuglycemic diabetic ketoacidosis
  3. CRespiratory acidosis from COPD
  4. DSimple fasting ketosis only
7.Clinical nursingMedium

Which features suggest Cushing's syndrome?

  1. ADark skin, low blood pressure, salt craving and a low blood sodium level
  2. BWeight gain around the trunk, a rounded face and thin, easily bruised skin
  3. CCoarse facial features and very large hands and feet
  4. DWeight loss, heat intolerance, tremor and protruding eyes
8.Clinical nursingHard

Why must severe chronic hyponatraemia be corrected slowly?

  1. AFast correction makes the kidneys stop producing urine
  2. BSodium given quickly causes immediate cardiac arrest
  3. CToo-rapid correction can cause osmotic demyelination in the brain
  4. DFast correction causes severe hypoglycaemia and seizures in most patients
9.Med-surg: cardiovascular & respiratoryMedium

What is pulmonary rehabilitation in COPD?

  1. AA lung function test repeated every six months
  2. BSurgery to remove the most damaged areas of lung
  3. CA course of oral steroids and antibiotics given at home each winter
  4. DSupervised exercise and education that ease breathlessness
10.Med-surg: cardiovascular & respiratoryHard

A patient on warfarin for atrial fibrillation has an INR of 8.5 but no bleeding. What is the most likely management?

  1. AGive IV protamine sulfate immediately to reverse it
  2. BWithhold warfarin, inform the prescriber and recheck the INR soon
  3. CContinue the usual dose and recheck the INR in a month
  4. DGive prothrombin complex concentrate and a blood transfusion
11.Med-surg: neuro, endocrine & renalMedium

Before checking a capillary glucose, why should the patient wash their hands with soap and water?

  1. AWashing lowers the glucose in the blood
  2. BSoap makes the blood flow faster from the finger
  3. CSugar on the skin can give a falsely high reading
  4. DWashing prevents all infection from the lancet
12.Med-surg: neuro, endocrine & renalHard

A patient's potassium is 7.1 mmol/L, and the ECG shows peaked T waves and broad QRS complexes. What is the first treatment?

  1. AIV furosemide
  2. BOral potassium binder
  3. CIV calcium gluconate
  4. DOral sodium bicarbonate
13.Med-surg: GI, perioperative & oncologyMedium

Which wound drain observation should be reported immediately?

  1. AA sudden large volume of fresh red blood
  2. BDrainage slowly falling each day
  3. CA little dried blood around the drain site
  4. DSmall amounts of pink serous fluid
14.Med-surg: GI, perioperative & oncologyHard

Two days after a PEG insertion, a patient reports pain on feeding, and feed is leaking around the site. What should the nurse do?

  1. AGive the next medicines through the tube as usual
  2. BContinue feeding and apply a thicker dressing
  3. CStop the feed at once and seek urgent medical advice
  4. DIncrease the feed rate to improve nutrition

3Solutions

1.Prioritization & delegation

Answer: D · An 84-year-old taking a diuretic who has fallen before and gets up at night

Why this is the answer

A previous fall is one of the strongest risk factors. Older age, diuretics and getting up at night to urinate add further risk, so this patient needs fall precautions.

Answer

D · An 84-year-old taking a diuretic who has fallen before and gets up at night
2.Prioritization & delegation

Answer: A · The confused patient climbing out of bed

Why this is the answer

A confused patient climbing out of bed could fall and be badly injured within moments. Pain needs prompt treatment, but the immediate safety risk comes first.

Answer

A · The confused patient climbing out of bed
3.Infection control & patient safety

Answer: B · It is checked for electrical safety according to hospital policy before use

Why this is the answer

Electrical items from home can be faulty and cause shocks or fires. Policies usually require them to be inspected before use, and extension cords near patients are avoided.

Answer

B · It is checked for electrical safety according to hospital policy before use
4.Infection control & patient safety

Answer: C · “I think he needs to be assessed now. Can you come within the next 15 minutes?”

Why this is the answer

In SBAR, the situation names the problem, the background gives the history, the assessment shares the nurse’s findings and judgement, and the recommendation states a clear request with a time frame.

Answer

C · “I think he needs to be assessed now. Can you come within the next 15 minutes?”
5.Lab values & electrolytes

Answer: B · The disease is unlikely, so it helps rule it out

Why this is the answer

Sensitivity is the proportion of people with the disease who test positive. A highly sensitive test has few false negatives, so a negative result helps rule the disease out (the D-dimer is an example). Specificity relates to ruling in.

Answer

B · The disease is unlikely, so it helps rule it out
6.Lab values & electrolytes

Answer: B · Euglycemic diabetic ketoacidosis

Why this is the answer

SGLT2 inhibitors can cause DKA with only mildly raised glucose because glucose is lost in the urine. Ketones and acidosis must be checked in any unwell patient on these drugs, even with a near-normal glucose.Checked against: Ketones blood test · MedlinePlus (NIH) (2025)

Answer

B · Euglycemic diabetic ketoacidosis
7.Clinical nursing

Answer: B · Weight gain around the trunk, a rounded face and thin, easily bruised skin

Why this is the answer

Excess cortisol causes central obesity, a moon face, thin skin, purple striae, muscle weakness and high glucose. The other options describe hyperthyroidism, Addison's disease and acromegaly.

Answer

B · Weight gain around the trunk, a rounded face and thin, easily bruised skin
8.Clinical nursing

Answer: C · Too-rapid correction can cause osmotic demyelination in the brain

Why this is the answer

In chronic hyponatraemia brain cells adapt to the low tonicity. A rapid rise in sodium draws water out too fast and can cause osmotic demyelination, so the correction rate is limited and sodium is checked often.

Answer

C · Too-rapid correction can cause osmotic demyelination in the brain
9.Med-surg: cardiovascular & respiratory

Answer: D · Supervised exercise and education that ease breathlessness

Why this is the answer

Pulmonary rehabilitation combines individually tailored exercise training, education and breathing techniques. It improves exercise capacity, breathlessness and quality of life and reduces hospital admissions. It is recommended for people with COPD who are limited by breathlessness and after an exacerbation.

Answer

D · Supervised exercise and education that ease breathlessness
10.Med-surg: cardiovascular & respiratory

Answer: B · Withhold warfarin, inform the prescriber and recheck the INR soon

Why this is the answer

A very high INR without bleeding is usually managed by withholding warfarin, informing the prescriber and repeating the INR. Low-dose oral vitamin K may also be prescribed depending on the INR and local protocol (UK guidance gives it above an INR of 8; US guidance mainly above 10 or with high bleeding risk). Prothrombin complex concentrate and IV vitamin K are used for major bleeding. Protamine reverses heparin. The reason for the rise (new drugs, illness, diet) should be explored.

Answer

B · Withhold warfarin, inform the prescriber and recheck the INR soon
11.Med-surg: neuro, endocrine & renal

Answer: C · Sugar on the skin can give a falsely high reading

Why this is the answer

Traces of sugar on the fingers can falsely raise the reading. Hands are washed and dried before testing. The side of the fingertip is used, and lancets are single use.

Answer

C · Sugar on the skin can give a falsely high reading
12.Med-surg: neuro, endocrine & renal

Answer: C · IV calcium gluconate

Why this is the answer

ECG changes mean the heart is at risk. IV calcium is given first to stabilise the myocardium, followed by insulin with glucose (and often nebulised salbutamol) to shift potassium into cells. Binders or dialysis then remove it.

Answer

C · IV calcium gluconate
13.Med-surg: GI, perioperative & oncology

Answer: A · A sudden large volume of fresh red blood

Why this is the answer

A sudden increase in bright red drainage suggests active haemorrhage. The nurse checks vital signs and informs the surgical team urgently. Gradually decreasing serosanguinous drainage is expected.

Answer

A · A sudden large volume of fresh red blood
14.Med-surg: GI, perioperative & oncology

Answer: C · Stop the feed at once and seek urgent medical advice

Why this is the answer

Pain on feeding, external leakage or new bleeding soon after PEG insertion may mean feed is leaking into the peritoneum. Feeding and medicines are stopped immediately and senior review is arranged to exclude peritonitis.

Answer

C · Stop the feed at once and seek urgent medical advice

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