تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

Which patient is most suitable for the nurse to assign to a nurse who has just finished orientation?

1. AA patient on a continuous heparin infusion with rising aPTT values
2. BA patient with stable cellulitis on scheduled IV antibiotics
3. CA patient with sepsis whose blood pressure is falling
4. DA patient with a new tracheostomy who needs frequent suctioning

A patient with COPD on 2 L/min oxygen becomes drowsy and hard to wake. The SpO₂ is 93%. What is the priority?

1. AGive the as-needed sedative so the patient rests comfortably
2. BLet the patient sleep, because the saturation is above target
3. CIncrease the oxygen to 6 L/min so that the saturation goes even higher than now
4. DAssess breathing and escalate for a blood gas, as carbon dioxide may be rising

How is a urine specimen for culture obtained from an indwelling catheter?

1. AFrom the urine already collected in the drainage bag at the bedside
2. BBy disconnecting the catheter from the drainage tubing
3. CBy removing the catheter and sending its tip for culture
4. DFrom the sampling port, after cleaning it, using aseptic technique

A patient’s cardiac monitor alarms often because of artifact, and a colleague suggests turning the alarm off. What is the best response?

1. ATurn the alarm volume down as low as it will go
2. BKeep the alarm on, fix the cause such as electrode placement, and adjust limits only per policy
3. CDisconnect the monitor overnight so the patient can sleep
4. DTurn the alarm off and check the monitor screen at the nurses’ station every hour instead

After surgery for colon cancer, a patient's CEA had fallen to normal, but it has been rising over the last two checks. What does this most likely suggest?

1. APossible recurrence that needs further assessment
2. BA sign of iron deficiency from the earlier bleeding
3. CA normal change after surgery that needs no follow-up
4. DA sure sign that the cancer has been fully cured

Ten minutes into a red cell transfusion, a patient develops fever, chills, low back pain and dark urine. After stopping the transfusion, what should the nurse do next?

1. AFlush the remaining blood through the line with the IV fluid to finish it
2. BRestart the transfusion more slowly after giving an antipyretic drug
3. CKeep the IV open with normal saline using new tubing and call the provider
4. DDiscard the blood bag and tubing in the clinical waste to stop exposure

Why does a patient with a suspected TIA need urgent specialist assessment?

1. AThe patient needs urgent surgery on the brain
2. BThe symptoms will come back permanently within an hour
3. CA TIA always turns into a brain tumour unless it is treated
4. DThe risk of a full stroke is highest in the days after a TIA

أي مريض يجب أن تقيّمه ممرضة الجناح أولًا في بداية المناوبة؟

1. Aمريض ينتظر الخروج وعلاماته مستقرة
2. Bمريض لديه تشوش حديث البدء ومعدل تنفس 28/min
3. Cمريض يطلب ملينًا
4. Dمريض لديه ألم ظهر مزمن بدرجة 4/10

لماذا تُستخدم النترات بحذر شديد في احتشاء البطين الأيمن؟

1. Aلأن البطين الأيمن يعتمد على الحمل القبلي، فقد ينخفض الضغط بشدة
2. Bلأن النترات لا تُمتص عندما يكون البطين الأيمن مصابًا
3. Cلأن النترات تسبب فرط بوتاسيوم الدم الخطير في هذا النوع من الاحتشاء
4. Dلأن النترات تجعل الاحتشاء ينتشر إلى البطين الأيسر

A patient who injects drugs has a fever, a new heart murmur and splinter haemorrhages. Before antibiotics are started, what is most important?

1. AWait for an echocardiogram before taking any samples
2. BArrange an exercise ECG test
3. CTake a single blood culture from the cannula
4. DTake several sets of blood cultures from separate sites

Which blood gas pattern is typical of acute kidney injury?

1. ALow pH and low bicarbonate
2. BHigh pH and high bicarbonate
3. CLow pH and high carbon dioxide only
4. DHigh pH and low carbon dioxide

A day after a total thyroidectomy, a patient has tingling lips, a positive Chvostek's sign and a corrected calcium of 1,85 mmol/L (about 7,4 mg/dL). What does the nurse expect?

1. AIV potassium chloride and a fluid restriction
2. BIV calcium gluconate and monitoring for laryngospasm
3. CA loop diuretic to remove the extra calcium
4. DOral levothyroxine, with a recheck of the calcium in a month

A nasogastric feeding tube appears blocked. What is usually the first step?

1. APush the guidewire back in to clear it
2. BUse a small 5 mL syringe with firm pressure
3. CFlush gently with warm water in a 50 mL enteral syringe
4. DCut the end of the tube to release the blockage inside it

A patient admitted for an elective general anaesthetic mentions that they ate a slice of toast 3 hours ago. What should the nurse do?

1. AAsk the patient to try to vomit to empty the stomach
2. BGive a large drink to wash the food through
3. CSay nothing, since toast is a light food
4. DInform the anaesthetist, as surgery may be delayed