NCLEX-style Prioritization & Delegation: cram pack

Which patient on an addiction unit should the nurse see first?

1. ALast drink two days ago; now shaking, sweating, heart rate 124/min and seeing insects
2. BLast drink this morning; asking when lunch will arrive
3. CLast drink one week ago; asking about support groups
4. DIn recovery for a year; came to the clinic today for a routine check and a repeat prescription

Six hours after surgery, a patient has not passed urine, feels the urge to go and has a firm swelling above the pubic bone. What is the most likely problem?

1. AUrinary retention
2. BA normal effect of the anesthetic
3. CDehydration from fasting before surgery
4. DAcute kidney injury with no urine made

Sterile saline is spilled on a sterile drape that lies on a non-sterile table. What does this mean?

1. AThe field is contaminated, because moisture can carry organisms through the drape
2. BThe field becomes sterile again when it dries
3. CThe field stays sterile, because saline is sterile
4. DOnly the wet part is contaminated, so items can be moved to the dry part

A nurse teaches a patient about home oxygen safety. Which statement shows a need for further teaching?

1. A“I can light candles at dinner if my oxygen is turned down low.”
2. B“I will keep my oxygen away from the stove.”
3. C“I will put a ‘no smoking’ sign on my front door for visitors.”
4. D“I will keep my spare cylinders upright and secured.”

Which factor is most likely to raise a patient’s lithium level?

1. ADehydration or a sudden drop in sodium intake
2. BDrinking more fluid than usual in hot weather
3. CEating more salt than usual for several days
4. DTaking each dose with a meal instead of before

A lithium level of 1.0 mEq/L was drawn 2 hours after the patient’s morning dose, and the prescriber plans to raise the dose. What should the nurse point out?

1. AThe level is toxic, so lithium should be stopped for good
2. BLithium levels can be drawn at any time of day without affecting the result
3. CThe level is too low, so a large increase is clearly safe
4. DThe sample was taken too soon after the dose, so it is not a valid level

Under the Mental Capacity Act 2005 (England and Wales), which principle applies?

1. ACapacity is decided by the next of kin, who must sign a form for every decision
2. BA diagnosis of dementia means the person lacks capacity for all decisions
3. CEveryone over 75 is assumed to lack capacity
4. DA person must be assumed to have capacity unless it is shown that they lack it

A patient on an anticoagulant falls and hits their head but appears well. What is the correct action?

1. AEncourage the patient to sleep without observations
2. BArrange medical review and likely CT scan, with neurological observations
3. CNo action, because the patient appears well
4. DGive an extra dose of anticoagulant

After varicose vein surgery, which advice is usually given?

1. AWear the compression stockings as advised and walk regularly
2. BStay in bed for two weeks with the legs hanging down
3. CStand still for long periods to help the veins heal
4. DAvoid all walking until the bruising has gone

A patient taking ramipril and indapamide for hypertension starts regular ibuprofen for back pain. A week later, creatinine has risen sharply. What is the most likely cause?

1. ABack pain causing kidney damage
2. BAn ACE inhibitor, diuretic and NSAID together reducing kidney perfusion
3. CAn allergic reaction to the diuretic causing inflammation of the kidney
4. DIbuprofen raising the blood pressure to levels that damage the kidneys

A patient has acute low back pain with no red flags. Which advice is most appropriate?

1. AAvoid all movement until an MRI scan has been done
2. BWear a rigid back brace all day and night for at least three months
3. CStay in bed for two weeks until the pain is gone
4. DStay as active as possible and use simple pain relief

A patient with acute glomerulonephritis has a BP of 190/115 mmHg, a severe headache and blurred vision. Which is the priority?

1. ARecheck the BP at the next routine round
2. BEncourage a walk to relieve the headache
3. CGive extra oral fluids to correct the low urine output
4. DUrgent escalation for BP control and close neuro checks

Why are urinary catheters removed as early as possible after surgery?

1. ABecause patients cannot drink normally while a catheter is in place
2. BTo reduce the risk of catheter-associated infection
3. CBecause the catheter stops the bowel working
4. DBecause catheters always cause kidney stones

On day 2 of nasogastric feeding, a severely malnourished patient becomes weak and breathless with ankle swelling. Phosphate is 0.4 mmol/L. What is most likely?

1. AAn allergy to the feed formula
2. BToo little calorie intake
3. CNormal adjustment to the new feed
4. DRefeeding syndrome