NCLEX-style Prioritization & Delegation: cram pack

A patient had a colostomy formed yesterday. Which stoma appearance should be reported straight away?

1. ASlightly swollen
2. BMoist and pink-red
3. CDark purple or black
4. DA little bleeding when cleaned

At the end of a shift, the nurse’s relief has not arrived and the patients are acutely ill. What should the nurse do?

1. AAsk a nursing assistant to watch the patients until someone comes
2. BStay and tell the charge nurse, and hand over before leaving
3. CLeave on time, because the shift has officially ended
4. DLeave a written note at the station and go home

Which practice makes shift handoff safer?

1. AUsing a standard format such as SBAR or I-PASS, with time for questions
2. BLeaving written notes only, without a chance for questions
3. CGiving handoff from memory without any structure
4. DGiving handoff in a busy corridor so that the outgoing nurse can leave on time

The laboratory reports that a blood sample labeled with one patient’s name has a blood group different from that patient’s previous result. What is the most likely problem and response?

1. AA wrong-patient sample, so the test is repeated and the event reported
2. BA laboratory machine fault, so no action is needed
3. CThe previous result was wrong, so it is deleted
4. DA normal change in the patient’s blood group over the years since the last test

A patient's potassium is unexpectedly 5.8 mEq/L. The sample was taken after the tourniquet was on for several minutes while the patient pumped their fist. What is the best interpretation?

1. ATourniquet time affects only the glucose result, not the potassium
2. BThe result may be falsely high and should be repeated with better technique
3. CFist pumping lowers potassium, so the true level is even higher
4. DThe result confirms true hyperkalemia and needs no further checking

A patient without symptoms has a finger-stick glucose of 340 mg/dL (18.9 mmol/L). The previous values were normal, and the patient has just peeled an orange. What should the nurse do first?

1. AAsk the laboratory to measure HbA1c from the same drop of blood
2. BReport the result as a new diagnosis of diabetes mellitus
3. CHave the patient wash and dry their hands, then repeat the test
4. DGive a correction dose of insulin for a glucose of 340 mg/dL

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

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

Four call bells ring at the same time. Which patient should the nurse see first?

1. AA patient asking for pain relief for chronic back pain that they rate as 3/10
2. BA patient who needs help to go to the toilet and has rung twice
3. CA patient asking what time they will be discharged
4. DA patient who has just become breathless after starting an IV antibiotic

After a permanent pacemaker is inserted, which instruction is commonly given for the first few weeks?

1. AMassage the wound firmly twice a day
2. BKeep the arm completely still in a sling for six months or more
3. CDo not shower or wash at all for six weeks
4. DAvoid raising the arm on that side above shoulder height

A patient with a confirmed type A aortic dissection is hypertensive and tachycardic while awaiting surgery. Which drug class is usually given first to lower the heart rate and blood pressure?

1. AAn intravenous thrombolytic
2. BAn intravenous beta-blocker
3. COral aspirin
4. DAn intravenous fluid bolus

Why is metformin usually withheld during acute kidney injury or around iodinated contrast in at-risk patients?

1. AIt can accumulate and raise the risk of lactic acidosis
2. BIt causes hyperkalaemia when the kidneys are injured
3. CIt causes severe hypoglycaemia when given together with contrast
4. DIt blocks the contrast so the scan cannot be read

Four patients had a minor head injury with no loss of consciousness and a GCS of 15. Which one most needs a CT scan of the head?

1. AA 25-year-old with a small scalp graze after a fall
2. BA 30-year-old who bumped their head on a cupboard door
3. CA 78-year-old who takes warfarin for atrial fibrillation
4. DA 40-year-old with a mild headache that is improving

What is a Curling's ulcer?

1. AA stress ulcer of the stomach or duodenum after a major burn
2. BA pressure ulcer under a splint that has been left on too long
3. CA leg ulcer caused by venous disease after long bed rest
4. DA burn on the sole of the foot

A patient has an implanted port for chemotherapy. Which needle is used to access it?

1. AA non-coring (Huber) needle
2. BA standard hollow needle used for venepuncture
3. CA wide-bore cannula with a steel stylet
4. DAn intramuscular injection needle