تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

A patient with a valid do-not-resuscitate order (DNR; called DNACPR in the UK) stops breathing and has no pulse. What should the nurse do?

1. AStart CPR and stop when the family arrives
2. BStart chest compressions but not rescue breaths
3. CFollow the DNR order and do not start CPR
4. DCall the cardiac arrest team and let them decide

After a cervical spinal cord injury, a patient has a blood pressure of 80/50 mmHg, a heart rate of 48/min and warm, dry skin. What is most likely?

1. ANeurogenic shock
2. BCardiac tamponade
3. CSeptic shock
4. DHypovolemic shock

أيّ عبارة عن استخدام وسائل التقييد الجسدي صحيحة؟

1. Aتأتي البدائل أولًا، ويلزم أمر محدد المدة
2. Bتُفحص وسائل التقييد مرة واحدة في نهاية كل وردية
3. Cأوامر التقييد الدائمة «عند الحاجة» ممارسة جيدة
4. Dيمكن استخدام وسائل التقييد كلما نقص عدد التمريض في القسم

A patient rescued from a house fire has a headache and confusion, but the pulse oximeter reads 99%. Why might this reading be misleading?

1. AThe reading is accurate, so carbon monoxide poisoning is ruled out
2. BPulse oximeters always read falsely low after any kind of smoke exposure
3. CPulse oximetry cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin
4. DConfusion and headache make pulse oximetry readings inaccurate in every patient

A healthy patient's result is slightly outside the laboratory reference range, and all other results are normal. Which statement best explains why this can happen?

1. AReference ranges are the same in every laboratory worldwide
2. BAny result outside the range always means disease is present
3. CRanges cover about 95% of healthy people, so some fall outside
4. DReference ranges include every healthy person without exception

A patient on long-term amiodarone has fatigue and weight gain. TSH is 11 mIU/L and the free T₄ is low. What is the most likely explanation?

1. ASecondary hypothyroidism from pituitary failure
2. BAmiodarone-induced hypothyroidism
3. CAmiodarone-induced hyperthyroidism
4. DA normal response to amiodarone needing no action

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

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

Four call bells ring at the same time. Which patient should the nurse see first?

1. AA patient asking for pain relief for chronic back pain that they rate as 3/10
2. BA patient who has just become breathless after starting an IV antibiotic
3. CA patient who needs help to go to the toilet and has rung twice
4. DA patient asking what time they will be discharged

A patient is starting doxazosin, an alpha-blocker, for hypertension. Which advice is most important?

1. ATake the first dose at bedtime, as dizziness and fainting can occur
2. BTake it with a large glass of grapefruit juice to improve absorption
3. CAvoid all potassium-containing foods
4. DStop it suddenly if the heart rate rises after the first few doses

A patient with a valid, documented do-not-attempt-CPR decision (DNACPR in the UK, DNR or DNAR in the US) is found in cardiac arrest. What should the nurse do?

1. AStart CPR but use only chest compressions
2. BCall the arrest team and let them decide whether to resuscitate
3. CStart full CPR because the patient's family is not present
4. DNot start CPR, call for support, and provide dignity and comfort

A patient with Conn's syndrome starts spironolactone. Which blood test should the nurse watch most closely?

1. APotassium
2. BGlucose
3. CCalcium
4. DAmylase

Weeks after starting insulin, a patient with newly diagnosed type 1 diabetes needs much less insulin and has frequent mild hypos. What is the most likely explanation?

1. AThe patient actually has type 2 diabetes
2. BThe diabetes has been cured, so insulin can stop
3. CThe insulin has gone off and should be replaced
4. DA honeymoon phase, but insulin is still needed

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

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

في اليوم الثالث بعد جراحة الورك، يصاب مسنّ بتشوش حاد مع تذبذب الانتباه وهياج. ماذا ينبغي أن تفعل الممرضة أولًا؟

1. Aافتراض أنه خرف ومواصلة خطة الرعاية دون تغيير
2. Bتقييد المريض وإعطاؤه جرعة كبيرة من مهدئ فورًا
3. Cالبحث عن أسباب مثل نقص الأكسجة أو العدوى أو الألم أو الأدوية، والتصعيد
4. Dأن تطلب من الأسرة أخذ المريض إلى المنزل ليهدأ