تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

A drowsy patient has an arterial blood gas with pH 7,30, PaCO₂ 58 mmHg (7,7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?

1. ALoss of bicarbonate from the bowel through severe diarrhea
2. BHyperventilation caused by anxiety
3. CPoor ventilation causing carbon dioxide to build up
4. DToo much bicarbonate from antacids

A charge nurse notices that a nurse smells of alcohol and is slurring words at the start of the shift. What is the priority?

1. AAsk the nurse to drink coffee and then start work
2. BLet the nurse work, but only with stable patients
3. CRemove the nurse from patient care and report it according to policy
4. DWait until the end of the shift and then discuss the concern with the nurse privately

A family member tells the nurse, “My father is not himself. Something is wrong.” The hospital has a family-activated rapid response system. What is correct?

1. AOnly doctors may call the rapid response team
2. BThe family should call emergency services from outside the hospital
3. CThe family must wait for the next scheduled ward round to raise the concern with a doctor
4. DThe family can call the rapid response team if they are worried and staff have not responded

صباح يوم الجراحة، يقول المريض إن العملية في الركبة اليسرى، بينما تنص استمارة الموافقة على الركبة اليمنى. ماذا ينبغي أن تفعل الممرضة؟

1. Aاتباع كلام المريض، لأنه أدرى بجسده
2. Bالتوقف وإبلاغ الجراح ليتأكد الموضع أولًا
3. Cوسم الركبتين معًا ليجوز إجراء العملية على أيٍّ منهما
4. Dاتباع استمارة الموافقة، لأنها موقَّعة

A patient with a low clinical probability of deep vein thrombosis has a normal (negative) D-dimer. What is the best interpretation?

1. AA DVT is confirmed and anticoagulation is needed
2. BA pulmonary embolism is now certain to be present
3. CThe test is useless and should always be ignored
4. DA DVT is unlikely and can usually be ruled out

A patient stopped long-term prednisone suddenly a week ago. Now: blood pressure 78/46 mm Hg, sodium 128 mEq/L, potassium 4,6 mEq/L, glucose 58 mg/dL (3,2 mmol/L). Which condition is most likely?

1. ACushing syndrome from steroid excess
2. BSyndrome of inappropriate ADH (SIADH)
3. CPrimary hyperaldosteronism (Conn syndrome)
4. DAcute adrenal insufficiency (adrenal crisis)

Which drug is first-line in an acute asthma attack?

1. AAn oral beta-blocker
2. BA nebulised or inhaled short-acting beta₂-agonist (salbutamol/albuterol)
3. CAn oral antihistamine such as cetirizine taken every few hours
4. DA long-acting inhaled corticosteroid, used alone at a higher dose

Why are patients with nephrotic syndrome at increased risk of blood clots?

1. AThey lose most of their platelets in the urine every day
2. BThey lose all their red cells in the urine, which thickens the remaining blood
3. CTheir blood pressure is always very low
4. DAnticoagulant proteins are lost in the urine and clotting factors rise

A peripheral cannula site is red, warm, tender and swollen along the vein. What should the nurse do?

1. AFlush the cannula hard to clear it
2. BCover the site and keep using it until it blocks
3. CLeave it in place, as this is normal after 24 hours
4. DRemove the cannula, document and monitor the site

بعد أربع ساعات من التدخل التاجي عبر الجلد (PCI) من الشريان الفخذي، تشرّب ضماد الأربية بالدم وينمو تورم صلب. ما الإجراء الفوري؟

1. Aمساعدة المريض على الجلوس والمشي إلى المرحاض للتبول
2. Bنزع الضماد وترك الموضع مكشوفًا للهواء
3. Cالضغط بقوة فوق موضع الوخز مباشرةً وطلب المساعدة
4. Dزيادة معدل تسريب الهيبارين كي لا تتكون خثرة في الموضع

A patient with diabetic neuropathy has an ulcer on the ball of the foot. Which measure is most important for healing?

1. ACovering it and checking it in a month
2. BSoaking the foot in hot water daily
3. CTaking pressure off the ulcer
4. DWalking more to improve blood flow

A patient with Guillain–Barré syndrome has a blood pressure that swings between 80/50 and 190/100 mmHg and a heart rate that changes suddenly. What does this suggest?

1. AAnxiety that will settle with reassurance alone
2. BA faulty blood pressure cuff that should be replaced and the readings ignored
3. CA drug reaction that means all medicines must stop
4. DAutonomic dysfunction, which needs continuous cardiac monitoring

أيّ علامات توحي بالتهاب بنكرياس حاد شديد مع نزف في الأنسجة؟

1. Aتلون أصفر في أظافر الأصابع
2. Bطفح أرجواني على راحتي اليدين وأخمصي القدمين
3. Cكدمات حول السرة أو الخاصرتين
4. Dتورم الشفتين واللسان والوجه

مريض يتلقى الفيلغراستيم (G-CSF) بعد العلاج الكيميائي يسأل عن الأثر الجانبي المتوقع. أيّ أثر جانبي هو الأشيع؟

1. Aانخفاض سريع في عدد الكريات البيض
2. Bتساقط كامل للشعر خلال أيام من أول حقنة
3. Cفقدان سمع دائم
4. Dألم عظمي مؤلم، لأن نقي العظم يُحفَّز