NCLEX-style Prioritization & Delegation: cram pack

A patient uses patient-controlled analgesia (PCA) after surgery. Which statement by a family member shows a need for further teaching?

1. A“I will tell the nurse if she becomes very sleepy or hard to wake.”
2. B“I will press the button for her while she is asleep so she stays comfortable.”
3. C“The pump has limits set by the nurse so she cannot get too much at once.”
4. D“Only she should press the button when she needs pain relief.”

A 2-month-old infant has a spiral fracture of the femur. The parents say the baby rolled off the sofa. What should the nurse recognize?

1. AA spiral fracture in an infant is always caused by birth trauma
2. BThe injury does not fit the infant’s development, so possible abuse must be reported
3. CInfants of this age often roll off furniture and break bones in this way
4. DNo further action is needed once the fracture is treated

A nurse receives a verbal order by telephone. What is the safest practice?

1. AWrite it down and read it back to the prescriber
2. BAsk a colleague to listen in and remember it as well
3. CCarry it out without recording it
4. DRemember it and write it down at the end of the shift

A nurse has a needlestick from a patient known to have hepatitis C. Which statement about management is correct?

1. AThe hepatitis C vaccine series is started at once, with a booster dose six months later
2. BNo follow-up is needed because hepatitis C does not spread by needles
3. CThere is no preventive drug, so baseline and follow-up testing are done to detect infection early
4. DHepatitis C immune globulin is given within 24 hours, followed by a booster dose

A patient had a right mastectomy with removal of axillary lymph nodes. Where is the best place to draw blood?

1. AThe right arm
2. BThe right hand
3. CEither arm equally
4. DThe left arm

An RN cares for a patient on a 24-hour urine collection. Which task can be delegated to unlicensed assistive personnel (UAP), such as a nursing or healthcare assistant?

1. ADeciding whether to restart the collection after a missed sample
2. BSaving all urine in the collection container as instructed
3. CInterpreting the creatinine clearance result when it comes back
4. DTeaching the patient why the 24-hour collection is needed

Which side effect of regular opioids usually needs preventive treatment from the start?

1. ADiarrhoea
2. BConstipation
3. CExcessive hunger
4. DHigh blood pressure

An acutely ill patient without COPD is on 15 L/min oxygen, and their SpO₂ is now 100% and stable. What should be done?

1. AReduce the oxygen to keep the SpO₂ within the prescribed target range
2. BStop the oxygen and the saturation monitoring because the patient is now well
3. CIncrease the oxygen further to build up a reserve
4. DKeep the oxygen at 15 L/min for at least a week to be on the safe side

Which features best describe an arterial leg ulcer?

1. AWeeping ulcer on the shin with pitting oedema of the leg
2. BPainless ulcer under the ball of the foot with thick callus around it
3. CShallow, moist ulcer above the inner ankle with brown skin
4. DPainful, pale, punched-out ulcer on the toes with weak foot pulses

Two days after a coronary stent, a patient on aspirin and ticagrelor has black, tarry stools and feels faint on standing. What should the nurse do?

1. AGive a laxative and repeat the observations tomorrow
2. BReassure the patient that iron tablets cause black stools
3. CStop both antiplatelet drugs permanently on the nurse's own decision
4. DCheck vital signs, report urgently and anticipate a blood count

For which patient would the nurse question an order for pioglitazone?

1. AA patient with heart failure
2. BA patient with asthma
3. CA patient with an allergy to latex
4. DA patient with hypothyroidism

At 03:00 a patient's glucose is 3.6 mmol/L, but before breakfast it is high. They take a long-acting insulin in the evening. What should the nurse do?

1. AStop all insulin permanently and monitor glucose four-hourly
2. BGive extra insulin at 03:00 because the morning value will be high
3. CIgnore the night reading and act on the morning value only
4. DTreat the low and report the pattern so the evening dose is reviewed

Why is IV hydration given with cisplatin?

1. ATo raise the blood pressure during treatment
2. BTo protect the kidneys from damage
3. CTo make the drug less effective
4. DTo prevent hair loss

Two days after surgery, a patient on regular ibuprofen has a low urine output and a rising creatinine, and intake has been poor. What should the nurse do?

1. AChange to a higher-strength NSAID tablet
2. BWithhold the next dose and report to the prescriber
3. CIncrease the dose to treat the pain better and encourage fluids
4. DGive the next dose with extra food