تحديد الأولويات والتفويض بأسلوب NCLEX: حزمة المراجعة المكثفة

On day 3 after hip surgery, a patient suddenly becomes short of breath with sharp chest pain and an SpO₂ of 88%. What should the nurse do first?

1. AEncourage the patient to walk to improve the circulation
2. BRaise the head of the bed, give oxygen and call for urgent help
3. CMassage the patient’s calves to ease any muscle cramp
4. DGive the next dose of oral analgesia and reassess the patient in an hour

After handover on a medical unit, which patient should the nurse see first?

1. APneumonia on 2 L/min oxygen, SpO₂ 93%, talking in full sentences
2. BDeep vein thrombosis on a heparin infusion, aPTT in the target range
3. CDay 2 after a hernia repair, pain 6/10, oral analgesic due in 20 minutes, wants it now
4. DNew atrial fibrillation, heart rate 150/min, blood pressure 86/50 mmHg, dizzy

How does a nurse add a sterile gauze pack to a sterile field that is already set up?

1. AOpen the wrapper away from the field and drop the item on it without reaching over
2. BTip the item onto the field and push it into place with the wrapper
3. CReach across the field with clean gloves to place the item
4. DPlace the whole wrapped pack on the field and open it there with sterile gloves

A patient asks for a pain tablet. The record shows none has been given, but the patient says, “The other nurse gave me one earlier.” What should the nurse do?

1. AGive the tablet, because the record shows none was given
2. BCheck with the other nurse and the records before giving another dose
3. CGive half a tablet now, to be safe, and the other half later if needed
4. DTell the patient they must be confused

مستوى القاع (trough) للفانكومايسين أعلى من المدى المستهدف. ما الأثر الضار الذي يمثل الشاغل الرئيسي؟

1. Aالإمساك والانتفاخ
2. Bتلف الكلى (السمية الكلوية)
3. Cارتفاع تعداد الصفائح (كثرة الصفائح)
4. Dانخفاض سكر الدم (نقص سكر الدم)

A patient with schizophrenia drinks very large amounts of water each day. Sodium is 121 mEq/L, and the urine is very dilute (urine osmolality 70 mOsm/kg). Which explanation fits best?

1. ACentral diabetes insipidus
2. BSyndrome of inappropriate ADH
3. CPrimary (psychogenic) polydipsia
4. DHyperosmolar hyperglycemic state

Which is a first-line nursing measure to help prevent constipation in hospital?

1. AEncouraging fluids, fibre and mobility
2. BKeeping the patient in bed
3. CRestricting fluids to reduce urine output
4. DGiving an enema to every patient on admission

The fluid in an underwater seal chest drain has stopped swinging with breathing. What could this mean?

1. AThe tube may be kinked or blocked, or the lung may have fully re-expanded
2. BThe patient's breathing has become normal and the drain can be pulled out by the nurse
3. CThe water seal has been set up correctly for the first time
4. DThe drain is working perfectly and needs no checks

The telemetry monitor suddenly shows a chaotic waveform resembling ventricular fibrillation, but the patient is talking and brushing their teeth. What should the nurse do first?

1. ADeliver an immediate defibrillation shock before checking anything
2. BGive IV amiodarone as a bolus
3. CStart chest compressions straight away and call the arrest team
4. DCheck the patient and the electrodes, as this is likely artefact

A patient receiving noradrenaline (norepinephrine) through a peripheral cannula has pale, cold skin around the site. What should the nurse do?

1. AIncrease the rate so the drug enters the vein faster and leaks less
2. BMassage the area firmly to spread the drug out into the surrounding tissue
3. CStop it at that site, inform the team and follow the extravasation policy
4. DContinue the infusion, as this is expected

A patient with advanced CKD asks how to manage indigestion. Which option should they avoid?

1. AAvoiding large meals late in the evening
2. BRaising the head of the bed at night
3. CMagnesium-containing antacids
4. DEating smaller, more frequent meals

A 74-year-old falls forward and hits their chin. Their arms are much weaker than their legs, and they have burning pain in the hands. Which injury is most likely?

1. ACauda equina syndrome
2. BA complete lumbar cord injury
3. CBrown-Séquard syndrome
4. DCentral cord syndrome

لماذا قد لا تعمل الأقراص ممتدة المفعول أو المغلفة معويًا جيدًا لدى مريض الفغر اللفائفي؟

1. Aلأن الفغر يمتص الدواء إلى الدم بسرعة كبيرة جدًا
2. Bلأن أنزيمات الفغر اللفائفي تتلف كل أنواع الأدوية الفموية
3. Cلأن مرضى الفغر اللفائفي لا يستطيعون تناول أي أدوية فموية
4. Dلأن العبور السريع يعني أنها قد تمر قبل أن تطلق الدواء

A bag of parenteral nutrition runs out and the next one will not arrive for several hours. Which risk should the nurse anticipate?

1. AAcute urinary retention
2. BSevere hyperkalaemia
3. CRaised intracranial pressure
4. DRebound hypoglycaemia