تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

في وحدة طبية مختلطة، أي مريض ينبغي أن تراه الممرضة أولًا؟

1. Aمريض ارتفاع ضغط ضغطه 136/84 mmHg
2. Bمريض بصداع توتري خفيف يطلب الأسيتامينوفين
3. Cمريض يطلب معلومات مكتوبة عن خروج الغد
4. Dمريض مكتئب تبرع بممتلكاته ولديه خطة انتحار

An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?

1. ANormal aging that needs no assessment
2. BAn infection, such as a urinary tract infection, presenting atypically
3. CA sudden worsening of long-standing dementia that needs no tests
4. DBoredom from not having enough activities

Which measure reduces errors caused by interruptions during medication preparation?

1. APreparing medications at the busiest place on the ward
2. BPreparing medications for all patients at once
3. CAnswering phone calls and pages while counting tablets, to save time
4. DA quiet “no interruption” zone or signal while preparing medications

خُزنت قارورتان متشابهتان لدواءين مختلفين جنبًا إلى جنب، وكادت ممرضة تلتقط القارورة الخطأ. أيّ ردّ يعكس ثقافة العدالة على أفضل وجه؟

1. Aالتكتم على الحادث حفاظًا على سمعة القسم
2. Bالإبلاغ وإصلاح النظام، مثلًا بفصل القارورتين
3. Cمعاقبة الممرضة التي كادت تلتقط القارورة الخطأ
4. Dإخبار الممرضة بأن تكون أكثر حذرًا وعدم فعل شيء آخر

لماذا قد يكون INR مرتفعًا لدى مريض مصاب بفشل الكبد دون أن يتناول الوارفارين؟

1. Aتتوقف الكليتان عن تصفية عوامل التخثر من الدم
2. Bيصنع الكبد معظم عوامل التخثر، فينخفض إنتاجها
3. Cالألبومين من عوامل التخثر، وينخفض مستواه
4. Dيدمر البيليروبين عوامل التخثر مباشرة

A patient on IV gentamicin has a trough level above the target, and the creatinine has risen since yesterday. The next dose is due. What is the best action?

1. AGive the dose now and recheck the levels next week
2. BGive half of the dose and document the reason for it
3. CHold the dose and report the results to the prescriber
4. DGive the dose with extra oral fluids to protect the kidneys

قبل إعطاء حاصر بيتا، أي علامة هي الأهم للتحقق منها؟

1. Aسكر الدم فقط
2. Bحركة الأمعاء
3. Cمعدل ضربات القلب وضغط الدم
4. Dدرجة الحرارة فقط

An acutely ill patient without COPD is on 15 L/min oxygen, and their SpO₂ is now 100% and stable. What should be done?

1. AReduce the oxygen to keep the SpO₂ within the prescribed target range
2. BStop the oxygen and the saturation monitoring because the patient is now well
3. CIncrease the oxygen further to build up a reserve
4. DKeep the oxygen at 15 L/min for at least a week to be on the safe side

Why is aspirin chewed rather than swallowed whole in a suspected acute coronary syndrome?

1. AChewing stops the aspirin from irritating the lining of the stomach
2. BWhole aspirin tablets cannot be absorbed at all from the gut
3. CChewing changes aspirin into an anticoagulant
4. DChewing speeds absorption, giving a faster antiplatelet effect

An older ex-smoker has a dry cough and worsening breathlessness over a year, finger clubbing and fine "Velcro-like" crackles at both bases at the end of inspiration. Which condition is most likely?

1. AAn acute asthma attack
2. BIdiopathic pulmonary fibrosis
3. CSpontaneous pneumothorax
4. DCommunity-acquired pneumonia

A patient has a nephrostomy tube. Which finding needs urgent action?

1. AA dry, intact dressing at the site
2. BDrainage that stops suddenly with new loin pain
3. CSteady urine drainage into the bag
4. DLight pink urine on the first day after insertion

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

1. AA patient with a glucose of 14 mmol/L (252 mg/dL) who feels well and is eating
2. BA newly diagnosed patient asking about which foods to eat
3. CA patient with a glucose of 2,8 mmol/L (50 mg/dL) who is sweaty and confused
4. DA patient waiting for a routine HbA1c test

In the UK National Early Warning Score (NEWS2), what does an aggregate score of 5 or more usually trigger?

1. ADischarge planning for the next day
2. BNo change unless the patient complains
3. CRoutine observations once every 12 hours, with no other change in care
4. DAn urgent review by a clinician skilled in acute illness

A patient finds daily wound dressing changes very painful. What is the most effective nursing approach?

1. AGive analgesia timed so it works during the dressing change
2. BChange the dressing less often than the plan says
3. CDo the dressing quickly and give analgesia afterwards
4. DAvoid analgesia so the patient can report any problems during the change