تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

في وحدة طبية مختلطة، أي مريض ينبغي أن تراه الممرضة أولًا؟

1. Aمريض ارتفاع ضغط ضغطه 136/84 mmHg
2. Bمريض مكتئب تبرع بممتلكاته ولديه خطة انتحار
3. Cمريض بصداع توتري خفيف يطلب الأسيتامينوفين
4. Dمريض يطلب معلومات مكتوبة عن خروج الغد

Which finding most suggests a tension pneumothorax rather than a simple pneumothorax?

1. ATrachea shifted away from the affected side, with low blood pressure
2. BMild breathlessness with reduced breath sounds on one side of the chest only
3. CA small air leak seen on a routine chest X-ray
4. DSharp chest pain that is worse on deep breathing

Sputum specimens are ordered to look for acid-fast bacilli (TB). How are they usually collected?

1. AThree deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
2. BOne saliva sample collected at any convenient time of day
3. CThree specimens collected after an antiseptic mouthwash
4. DOne specimen of sputum collected straight after the evening meal, when coughing is easiest

An 84-year-old resident with an indwelling catheter suddenly becomes confused but has no fever. What should the nurse consider?

1. AAn infection may present as confusion in older adults, so assess further and report
2. BA sedative is needed to keep the resident calm
3. CInfection can be ruled out because there is no fever
4. DThe confusion is part of normal aging at this age and needs no further action

Why is a blood β-hydroxybutyrate level often preferred to a urine ketone dipstick in DKA?

1. AThe urine dipstick only detects ketones in people without diabetes
2. BIt is the only test that can measure glucose and ketones together
3. CIt measures the main ketone in DKA, and the dipstick may miss it
4. DIt shows the average ketone level over the past three months

A patient without symptoms has a TSH of 7,5 mIU/L on two occasions with a normal free T₄. Which term fits best?

1. ASecondary hypothyroidism
2. BSubclinical hyperthyroidism
3. COvert primary hypothyroidism
4. DSubclinical hypothyroidism

A patient is admitted with cellulitis of the leg. Why might the nurse mark the edge of the redness on the skin?

1. ATo help the patient find the sore area
2. BTo mark the site for an injection
3. CTo monitor whether the infection is spreading or improving
4. DTo show the surgeon exactly where to make the incision

Which feature suggests moisture-associated skin damage rather than a pressure ulcer?

1. AA deep wound over the sacrum with exposed bone and a dark base
2. BDiffuse, superficial redness in a skin fold, not over a bony prominence
3. CA round area of necrosis over the heel
4. DNon-blanching redness directly over the hip bone after lying on one side

Which exercise advice is recommended for intermittent claudication?

1. AComplete bed rest until the leg pain has gone for at least a month
2. BSupervised walking until pain is near maximal, then rest and repeat
3. CWalking only on days when the legs feel warm and painless
4. DStopping walking at the very first twinge of pain each time

During CPR on an adult, a nurse notices a colleague compressing at about 140/min and leaning on the chest between compressions. Which correction is most appropriate?

1. ASpeed up to about 160/min to improve the blood flow
2. BSlow to 100–120/min and allow full chest recoil
3. CPress more gently, to a depth of about 2 cm
4. DStop compressions until a pulse is felt

Before checking a capillary glucose, why should the patient wash their hands with soap and water?

1. AWashing prevents all infection from the lancet
2. BWashing lowers the glucose in the blood
3. CSoap makes the blood flow faster from the finger
4. DSugar on the skin can give a falsely high reading

مريض يتناول البريدنيزولون بجرعة عالية طويلة الأمد بعد ثلاثة أيام من جراحة الأمعاء. يبلغ فقط عن ألم بطني خفيف، لكن معدل القلب ارتفع إلى 115/min والحرارة 37,4 °C. لماذا ينبغي أن تكون الممرضة قلقة بوجه خاص؟

1. Aلأن الستيرويدات قد تخفي الحمى والألم وعلامات التهاب الصفاق، فتحجب المضاعفات
2. Bلأن الألم الخفيف يدل على أن الأمعاء تلتئم كما هو متوقع
3. Cلأن الستيرويدات تحمي من العدوى، فالإنتان مستبعد جدًا
4. Dلأن الستيرويدات تسبب تسرع القلب لدى جميع المرضى، فلا حاجة إلى إجراء

أيّ نهج لنقل الكريات الحمراء لدى مريض مستقر مصاب بنزف في السبيل الهضمي يتوافق مع البيّنات الحالية؟

1. Aعدم النقل أبدًا مهما كان الهيموغلوبين أو الأعراض
2. Bنقل وحدتين روتينيًا قبل كل تنظير
3. Cنقل الدم للجميع للإبقاء على الهيموغلوبين فوق 150 g/L دائمًا
4. Dعتبة مقيِّدة، غالبًا نحو 70 g/L، لدى معظم المرضى المستقرين

A patient with advanced cancer who has capacity decides to stop chemotherapy. The family insists that treatment must continue. What should the nurse do?

1. AAsk the family to sign a new consent form
2. BSupport the patient's decision and help the team talk with the family
3. CContinue treatment because the family has asked for it
4. DTell the patient that stopping is not allowed