تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

On the first day after abdominal surgery, a patient has a temperature of 37,9 °C and reduced breath sounds at the lung bases. Which nursing action is most helpful?

1. ARestrict oral fluids so that the lungs do not fill up with extra fluid
2. BGive a cough suppressant so that the incision is not strained
3. CKeep the patient lying flat in bed to rest the incision fully
4. DEncourage deep breathing, coughing and use of the incentive spirometer

في وحدة جراحية، أي مريض بعد الجراحة ينبغي أن تراه الممرضة أولًا؟

1. Aبعد 6 ساعات من استئصال باطنة السباتي: تورم الرقبة يزداد، ويقول إن البلع صعب
2. Bبعد جراحة البروستات مع غسل المثانة: بول وردي فاتح، بلا خثرات
3. Cبعد يومين من استبدال الورك: ألم 5/10 عند الحركة، أُعطي المسكن قبل ساعة
4. Dبعد يومين من تشكيل فغر القولون: الفغرة رطبة وردية، وكمية مطروح صغيرة

Which nursing care reduces the risk of ventilator-associated pneumonia?

1. ARegular oral care to reduce bacteria in the mouth
2. BLeaving secretions in the mouth to protect the airway
3. CLying the patient flat for most of the day
4. DChanging the ventilator circuit every few hours

A nurse who is not immune to chickenpox was exposed to a patient with varicella before precautions began. What usually happens?

1. AThe nurse is assessed and kept from patient contact during the incubation period per policy
2. BThe nurse only needs to wear gloves for the next month
3. CThe nurse continues working with all patients as usual, including newborns
4. DThe nurse must take a two-week course of antibiotics to prevent the infection

A stable adult who is not bleeding receives one unit of packed red cells. By about how much is the hemoglobin expected to rise?

1. AAbout 1 g/dL (10 g/L)
2. BAbout 5 g/dL (50 g/L)
3. CAbout 3 g/dL (30 g/L)
4. DAbout 0,1 g/dL (1 g/L)

Which patient's result should the nurse act on first?

1. APlatelets 140 × 10³/µL in a patient with mild chronic liver disease
2. BFerritin 15 ng/mL in a well patient with known iron-deficiency anemia on oral iron
3. CHemoglobin 6,4 g/dL (64 g/L) with new chest pain and a pulse of 124/min
4. DHemoglobin 9,6 g/dL (96 g/L) in a patient with stable chronic kidney disease

Why are patients asked to fast before a general anaesthetic?

1. ATo make the surgery shorter
2. BTo prevent postoperative constipation and abdominal bloating
3. CTo lower the blood glucose before surgery
4. DTo reduce the risk of aspirating stomach contents

An older patient with delirium is trying to leave the ward at night, saying he must go home. What is the best initial approach?

1. ALet him leave, because adults can always do as they wish whatever their state
2. BCalmly reassure and redirect him while the team assesses his capacity and safety
3. CPhysically restrain him in bed until the morning so that he cannot fall
4. DGive a sedative straight away without a prescription

During airway suctioning, when should suction be applied?

1. ABefore the catheter enters the airway
2. BOnly while withdrawing the catheter
3. COnly while inserting the catheter
4. DContinuously for at least 30 seconds

A healthcare assistant (unlicensed assistive personnel) reports four observations. Which one needs the nurse's attention first?

1. AA patient with a DVT whose leg is less swollen today
2. BA patient after a PCI asking for a cup of tea
3. CA patient with COPD whose SpO₂ is 90% on 1 L/min, which is usual for him
4. DA patient with heart failure who is newly confused, with SpO₂ 89%

مريض يتناول الكاربيمازول لفرط نشاط الغدة الدرقية يبلغ عن التهاب حلق وحمى. ماذا ينبغي أن تفعل الممرضة؟

1. Aطمأنة المريض لأن الدواء ليس له آثار جانبية خطيرة على الدم
2. Bنصحه بالغرغرة بالماء المالح ومواصلة الدواء أسبوعًا
3. Cترتيب تعداد دم كامل عاجل للبحث عن ندرة المحببات
4. Dمضاعفة الجرعة لضبط الغدة الدرقية بسرعة أكبر

A patient on warfarin starts levothyroxine for hypothyroidism. What should the nurse expect to monitor more closely?

1. AThe blood glucose, because it may fall
2. BThe urine output, because it may stop
3. CThe potassium, because it may rise
4. DThe INR, because it may rise

Aspirate from a nasogastric tube has a pH of 7. What should the nurse do?

1. ADo not use it; re-test later or arrange an X-ray as per policy
2. BStart the feed slowly and watch the patient closely for coughing
3. CGive the medicines but not the feed
4. DFlush with 50 mL of air and start the feed

After surgery, a patient says they have "no pain" but grimaces, breathes shallowly and refuses to move or cough. What should the nurse do?

1. ATell the patient firmly that they must stop hiding their pain from staff
2. BInsist they walk without any analgesia
3. CExplore their beliefs and explain how analgesia aids recovery
4. DAccept the statement and record a pain score of 0