NCLEX-style Prioritization & Delegation: cram pack

Which patient can the nurse safely see last?

1. AA patient with new crackles and pink, frothy sputum
2. BA patient with a sudden severe headache
3. CA patient two hours after surgery with a heart rate rising from 88 to 118/min
4. DA patient with COPD on 1 L/min oxygen, SpO₂ 90% (target 88–92%), talking in full sentences

Which patient’s planned discharge should the nurse question?

1. AA patient with pneumonia who has been without fever for 48 hours on oral antibiotics
2. BA patient after a hernia repair who is passing urine and eating
3. CA patient two days after surgery with a new heart rate of 112/min and a temperature of 38.4 °C
4. DA patient with a stable cast who is walking safely with crutches

Which measure reduces errors caused by interruptions during medication preparation?

1. APreparing medications for all patients at once
2. BAnswering phone calls and pages while counting tablets, to save time
3. CA quiet “no interruption” zone or signal while preparing medications
4. DPreparing medications at the busiest place on the ward

A nurse teaches the daughter of a patient with moderate Alzheimer’s disease about home safety. Which statement shows a need for further teaching?

1. A“I keep her medicines locked away and give each dose to her myself.”
2. B“We put locks high up on the outside doors.”
3. C“She wears an ID bracelet in case she gets lost.”
4. D“I let Mom cook alone on the gas stove because she enjoys it.”

How should a blood sample for serum ammonia be handled?

1. AKept warm and sent with the next routine batch
2. BPlaced on ice and sent to the laboratory at once
3. CLeft at room temperature for several hours first
4. DShaken firmly to mix it before it is sent away

A middle-aged man has fatigue, joint pain, a raised ALT and new diabetes. His ferritin is very high and his transferrin saturation is above 60%. Which condition is most likely?

1. AAnemia of chronic disease
2. BAcute viral hepatitis A
3. CIron-deficiency anemia
4. DHereditary hemochromatosis

A patient on the ward has shingles with open blisters. Which people are most at risk from contact?

1. APregnant women and immunocompromised people who have not had chickenpox
2. BOnly people over 80 who have already had shingles themselves
3. CPeople who have already had chickenpox in childhood and are now healthy
4. DNo one, because shingles cannot spread

A patient on metformin with reduced kidney function is due a CT scan with IV contrast. Why might metformin be withheld?

1. AMetformin causes severe bleeding during scans
2. BThere is a risk of lactic acidosis if kidney function worsens
3. CMetformin makes the images blurry
4. DMetformin reacts with the contrast to cause severe hyperglycaemia

Suspected pulmonary TB is being investigated. How are sputum samples usually collected?

1. AOne sample of saliva collected at any time of the day
2. BA swab from the nose only
3. CSeveral samples, ideally including early-morning sputum
4. DA single sample after the first week of treatment

A ventilated patient is coughing, and the high-pressure alarm sounds. Coarse sounds are heard over the trachea. What should the nurse do first?

1. ADeflate the endotracheal tube cuff fully
2. BAssess the patient and suction if secretions are present
3. CIncrease the tidal volume on the ventilator to overcome it
4. DTurn the alarm off and reassess the patient in an hour

During DKA treatment, glucose falls below about 14 mmol/L (around 250 mg/dL) but ketones are still raised. What usually happens?

1. AThe insulin infusion is stopped straight away
2. BThe patient eats a meal and IV treatment stops
3. CGlucose is added to the fluids; insulin continues
4. DAll IV fluids are stopped to avoid fluid overload

A patient had a witnessed tonic-clonic seizure. Afterwards their left arm is weak, and the weakness improves over the next few hours. What is the best interpretation?

1. ANormal postictal tiredness that needs no further assessment or imaging at all
2. BCertainly a stroke, so the seizure can be ignored
3. CA sign that the patient is pretending to be weak
4. DPossible postictal (Todd's) paresis, but a stroke must still be excluded

Which statement correctly describes physical dependence on opioids?

1. AThe drug no longer has any side effects
2. BThe patient is allergic to opioids
3. CWithdrawal occurs if the drug is stopped suddenly
4. DThe patient always craves the drug and misuses it despite harm

During burn resuscitation, an 80 kg adult's urine output is 15 mL/h for 2 hours. What does this indicate?

1. AFluid overload; all IV fluids should be stopped now
2. BUnder-resuscitation; the fluid rate usually needs increasing
3. CA normal urine output for a patient with burns
4. DA blocked catheter that should simply be removed