تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

An older patient with dementia is restless at night and keeps trying to get out of bed. Which measure should the nurse try first?

1. AApply wrist restraints for the rest of the night
2. BGive a sedative from the as-needed list without first assessing the patient
3. CRaise all four bed rails so the patient cannot climb out
4. DCheck for pain, thirst or a full bladder, and offer toileting

Four laboratory results come back at once. Which one should the nurse report first?

1. AGlucose 180 mg/dL after a meal in a patient with diabetes
2. BPotassium 3,4 mEq/L in a patient on a diuretic
3. CHemoglobin 6,5 g/dL (65 g/L) in a patient with a GI bleed
4. DCreatinine 1,3 mg/dL in an older adult, unchanged from last week

Which toy is safest for a toddler?

1. AA balloon to play with when an adult is out of the room
2. BA large toy with no small parts that can come off
3. CA toy with small magnets that come out easily
4. DA bag of marbles to sort by color

A patient receiving chemotherapy has an absolute neutrophil count of 400/mm³ (0,4 × 10⁹/L) and a new temperature of 38,3 °C (100,9 °F). What should the nurse do?

1. ARecheck the temperature in four hours before calling anyone about it
2. BEncourage oral fluids and record the result in the chart
3. CReport it at once, because fever with severe neutropenia is an emergency
4. DGive an antipyretic and reassess at the next routine round

A patient has started parenteral nutrition (PN) through a central line. Which test is monitored most frequently in the first days?

1. AHemoglobin A1c
2. BThyroid hormones
3. CSerum lipase
4. DBlood glucose

A patient receiving IV magnesium sulfate has a respiratory rate of 9/min and absent patellar reflexes. After stopping the infusion, which medication should the nurse expect to give?

1. ACalcium gluconate
2. BProtamine sulfate
3. CSodium bicarbonate
4. DPotassium chloride

Which equipment must always be kept at the bedside of a patient with a tracheostomy?

1. ASpare tracheostomy tubes, including one a size smaller, and working suction
2. BA blood pressure cuff and a spare nasal cannula and oxygen mask only
3. CA peak flow meter and a nebuliser
4. DA blood glucose meter and a spare urinary catheter of the same size

A nurse teaches a patient with reflux disease. Which statement shows a need for further teaching?

1. A"I will raise the head of my bed with blocks."
2. B"A big meal just before bed is fine if I take my tablet."
3. C"I will try to lose some weight over the next months."
4. D"I will cut down on alcohol."

A patient with stable angina is afraid nicotine patches will harm their heart. Which reply is most accurate?

1. ANicotine patches are much more harmful to the heart than cigarettes
2. BPeople with angina must stop smoking without any help
3. CNicotine replacement is much safer than smoking and is recommended
4. DNicotine replacement only works if smoking continues

A patient with stable severe COPD has a blood gas showing pH 7,37, a raised PaCO₂ and a raised bicarbonate. How should this be interpreted?

1. ARespiratory alkalosis from hyperventilation
2. BA normal blood gas with no abnormality
3. CAcute respiratory acidosis needing emergency intubation
4. DChronic respiratory acidosis with metabolic compensation

Why are patients with an acute spinal cord injury at high risk of deep vein thrombosis?

1. AThe injury makes the blood too thin to clot properly in the veins
2. BThey usually take oestrogen as part of their treatment
3. CParalysed leg muscles no longer pump blood back to the heart
4. DSpinal injuries always damage the large veins of the legs

The nurse has four patients. Which one needs to be seen first?

1. AA patient with Parkinson's disease whose next dose is due in two hours
2. BA patient with stable CKD waiting for a renal diet review
3. CA patient on insulin for DKA whose potassium is now 2,9 mmol/L
4. DA patient with hypothyroidism asking when to take levothyroxine

A patient with a new colostomy asks what to eat at home. Which advice is most appropriate?

1. ADrink as little fluid as possible to reduce output
2. BAvoid all fruit and vegetables for the rest of their life
3. CEat only liquids until the stoma is removed
4. DEat a normal, balanced diet and introduce foods gradually

A competent adult who is a Jehovah's Witness refuses blood transfusion before major surgery. What should the nurse do?

1. ARespect the decision, document it and inform the team
2. BPlan to transfuse secretly during the operation if it becomes needed
3. CAsk the family to override the decision
4. DCancel the surgery without discussing it