تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

A patient’s chest tube becomes disconnected from the drainage system. What should the nurse do first?

1. ARemove the tube and cover the site
2. BClamp the tube for the rest of the shift
3. CPlace the end of the tube in a bottle of sterile water
4. DWait for the provider to arrive before doing anything else

A severely malnourished patient started nutrition two days ago and now has weakness and confusion. Which laboratory result should the nurse check first?

1. ASerum phosphate
2. BSerum amylase
3. CSerum cholesterol
4. DThyroid hormone

The laboratory calls with a critical lab result by phone. What should the nurse do?

1. ARemember the value and enter it in the chart at the end of the shift
2. BWait for the printed report to arrive before telling the provider about it
3. CWrite it down, read it back to confirm and report it to the provider promptly
4. DTell the patient the result first and then call the provider

A nurse teaches an older adult about preventing falls at home. Which statement shows a need for further teaching?

1. A“I use night lights between my bedroom and the bathroom.”
2. B“I had grab bars put in next to the toilet.”
3. C“I wear shoes with non-slip soles around the house.”
4. D“I keep small rugs in the hall so my feet stay warm.”

A patient with central diabetes insipidus starts desmopressin. Which laboratory result is most important to monitor for an adverse effect?

1. ASerum sodium, which may fall too low
2. BSerum calcium, which may rise too high
3. CSerum glucose, which may rise very high
4. DSerum potassium, which may rise too high

The nurse teaches a patient about the HbA1c test. Which statement shows a need for further teaching?

1. A"I must not eat anything for 12 hours before the HbA1c test"
2. B"The test shows my average glucose over the past few months"
3. C"A lower result means less risk of damage to my eyes and kidneys"
4. D"My daily finger-stick readings still matter between the tests"

Why is continuous bladder irrigation used after a transurethral resection of the prostate (TURP)?

1. ATo give antibiotics directly into the kidneys
2. BTo stop blood clots from blocking the catheter
3. CTo stretch the bladder back to its normal size
4. DTo measure the patient's kidney function

Which task is most appropriate for a registered nurse to delegate to a trained healthcare assistant (unlicensed assistive personnel)?

1. AGiving a dose of intravenous antibiotic
2. BAssessing a patient who has just reported new chest pain
3. CMeasuring and recording vital signs on a stable patient
4. DTeaching a patient to inject insulin for the first time

A patient stops ramipril because of a troublesome dry cough. Which drug class is a common alternative?

1. AAn angiotensin II receptor blocker such as losartan
2. BA loop diuretic such as furosemide
3. CA non-selective beta-blocker such as propranolol
4. DA nitrate such as isosorbide mononitrate

A patient with an inferior myocardial infarction develops complete heart block with a heart rate of 38/min. What is the most likely reason?

1. AInferior infarcts always destroy the bundle of His permanently
2. BThe left anterior descending artery supplies the SA node only
3. CThe right coronary artery usually supplies the AV node
4. DHeart block is caused by the thrombolytic drug

A patient taking sodium valproate becomes tired and is vomiting, and the nurse notices yellowing of the eyes. What is the main concern?

1. AA sign that the dose is too low
2. BDehydration from drinking too little
3. CA normal adjustment reaction to the drug
4. DLiver toxicity from valproate

A student has fever, a severe headache, a spreading non-blanching rash and a BP of 85/50 mmHg. A lumbar puncture is planned. What is the priority?

1. AGive paracetamol (acetaminophen) and recheck observations in an hour
2. BArrange a CT scan of the head before any treatment
3. CWait until after the lumbar puncture before giving antibiotics
4. DGive IV antibiotics at once and start sepsis treatment

Patients on immune checkpoint inhibitors may develop immune-related side effects. Which symptom should they report promptly?

1. ASlight hair thinning over months
2. BA small bruise after a knock
3. CMild tiredness after a busy day
4. DNew diarrhoea or abdominal pain

A 76-year-old with a past peptic ulcer needs long-term anti-inflammatory treatment for arthritis. Which plan best reduces GI bleeding risk?

1. ATake the NSAID with a glass of milk instead of food
2. BCombine two different NSAIDs at lower doses
3. CUse the highest NSAID dose to shorten the course
4. DConsider an alternative; if an NSAID is needed, add a PPI