تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

Which patient on an addiction unit should the nurse see first?

1. ALast drink one week ago; asking about support groups
2. BLast drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
3. CLast drink this morning; asking when lunch will arrive
4. DIn recovery for a year; came to the clinic today for a routine check and a repeat prescription

An older adult with type 2 diabetes is confused and very dehydrated. The glucose is 900 mg/dL (50 mmol/L), and blood and urine show no significant ketones. What is the most likely problem?

1. AHypoglycemia with rebound
2. BDiabetic ketoacidosis
3. CHyperosmolar hyperglycemic state
4. DStress-induced mild hyperglycemia

Which measure reduces errors caused by interruptions during medication preparation?

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

A patient’s blood splashes onto a nurse’s forearm. The skin is intact. What is the correct response?

1. AWash the area with soap and water, then follow the reporting policy
2. BDo nothing, because intact skin cannot be contaminated
3. CStart HIV post-exposure prophylaxis right away, before any other step is taken
4. DScrub the area with undiluted bleach

A patient with HIV on antiretroviral therapy has an undetectable viral load. What does this mean?

1. AThe treatment can now be stopped without any risk
2. BThe treatment is suppressing the virus very well
3. CThe virus has been completely cured and removed
4. DThe CD4 count must now be dangerously low too

يسأل مريض يتناول أبيكسابان لماذا لا يحتاج إلى فحوص INR منتظمة مثل جاره الذي يتناول الوارفارين. ما أفضل تفسير؟

1. Aأبيكسابان لا يُميّع الدم فعلًا
2. Bيُراقب أبيكسابان بـ aPTT يوميًا بدلًا من ذلك
3. Cتأثيره متوقع، فلا حاجة إلى فحوص تخثر روتينية
4. Dيُفحص INR سرًا مع فحوص الدم الروتينية الأخرى

When a patient returns to the ward from theatre, what should the nurse assess first?

1. AAirway, breathing, circulation and level of consciousness
2. BThe discharge date
3. CThe patient's dietary preferences for the next meal
4. DWhether visitors are waiting to see the patient

Why can sepsis be missed in older adults?

1. ABlood tests are not useful in older people
2. BThey may have no fever and present with confusion, falls or reduced mobility
3. COlder adults always have a very high fever
4. DOlder adults cannot develop sepsis because their immune system is weaker

Why must anti-embolism stockings be measured and fitted correctly?

1. ACorrect fit is needed only to improve the appearance
2. BTight stockings work better, so the smallest size is always best
3. CPoorly fitting stockings can cause pressure damage
4. DLoose stockings make the patient's legs too warm at night

A woman starting rifampicin (rifampin) for tuberculosis uses a combined oral contraceptive pill. What advice is correct?

1. AStop all contraception during TB treatment, as pregnancy cannot occur
2. BUse another reliable method, as rifampicin reduces the pill's effect
3. CContinue the pill as usual, because there is no interaction with TB drugs
4. DTake two pills a day to make up for the drug

A patient is starting lamotrigine. Which teaching point is most important?

1. ADouble the dose if a seizure happens
2. BReport any skin rash promptly, especially in the first weeks
3. CExpect an orange tint to tears and urine
4. DTake it with a glass of grapefruit juice to improve its absorption

An 89-year-old with stage 5 CKD and severe heart failure, who has capacity, decides not to start dialysis. What is the nurse's best response?

1. AAsk the family to change the patient's mind
2. BRespect the decision and support symptom-focused care
3. CStop all care, because nothing more can be done
4. DTell the patient they must start dialysis by law

Why is blood lactate measured when sepsis is suspected?

1. AA raised level suggests poor tissue perfusion
2. BIt replaces the need for blood cultures
3. CIt shows which bacteria are causing the infection
4. DIt measures the effect of antibiotics on the kidney

A patient arrives in the anaesthetic room without an identity band. What should the nurse do?

1. AStop and confirm identity, then apply a band
2. BProceed and add a band once in recovery
3. CUse the spare identity band from the front of the patient's notes folder
4. DProceed because the patient can say their name