NCLEX-style Prioritization & Delegation: cram pack

During a blood transfusion, a patient develops chills, back pain and a fever. What is the nurse’s first action?

1. ASlow the transfusion and recheck in an hour
2. BFinish the unit quickly through a pressure bag so that the reaction does not last long
3. CStop the transfusion and keep the IV open with normal saline via new tubing
4. DGive an antipyretic and continue the transfusion

A patient with severe sepsis starts oozing blood from IV sites and the gums, and bruises appear on the skin. What should the nurse suspect?

1. AVitamin C deficiency
2. BDisseminated intravascular coagulation (DIC)
3. CNormal bruising from blood tests
4. DAn allergic reaction to the adhesive tape

A patient with active pulmonary tuberculosis must go to the radiology department. How should the patient be transported?

1. AWithout a mask, because the corridor is well ventilated and short
2. BWearing gloves and a gown, with no mask needed
3. CWearing a surgical mask, with radiology warned in advance
4. DWearing an N95 respirator that has not been fit-tested

A bag of chemotherapy drug leaks onto the floor. What is the first step?

1. ALeave it to dry, then clean it up at the end of the shift
2. BPut on the spill kit’s protective equipment and contain the spill
3. CWipe it up quickly with paper towels and bare hands
4. DAsk the cleaner to mop it up with the usual mop

A patient’s hemoglobin is 7.8 g/dL (78 g/L). Which findings would the nurse expect?

1. AA slow heart rate, flushed skin and a high blood pressure
2. BFatigue, pallor, a fast heart rate and breathlessness on exertion
3. CHeadache, nosebleeds and a red face
4. DItching, yellow skin and dark urine

A patient with thalassemia major has received regular red cell transfusions for years. The ferritin is now very high. What does this most likely show, and what treatment is used?

1. AIron overload, treated with iron chelation therapy
2. BAcute infection, treated with broad-spectrum antibiotics
3. CLiver failure, treated with a liver transplant at once
4. DIron deficiency, treated with IV iron supplements

Which is a major risk factor for Clostridioides difficile infection?

1. ARecent broad-spectrum antibiotic use
2. BA diet high in fibre and fresh fruit
3. CTaking regular paracetamol
4. DRegular exercise

Why are liquid medicines for nasogastric tubes drawn up in dedicated enteral (oral) syringes rather than IV syringes?

1. AEnteral syringes measure doses less accurately
2. BEnteral syringes keep the medicine sterile
3. CIV syringes cannot hold liquid medicines
4. DTo prevent accidental intravenous administration

Virchow's triad describes three factors that promote venous thrombosis. Which patient factor represents venous stasis?

1. ADamage to a vein during hip surgery
2. BTaking an oestrogen-containing pill
3. CImmobility after major surgery
4. DAn inherited clotting disorder

After six weeks of treatment for tuberculosis, a patient has nausea, dark urine and yellow eyes. What should the nurse do?

1. AReassure the patient that the urine colour is due to rifampicin
2. BAdvise taking the tablets with an alcoholic drink to settle the stomach
3. CDouble the isoniazid dose to clear the infection faster
4. DWithhold the next doses and report urgently for liver tests

Why may a person with long-standing diabetes have a heart attack without typical chest pain?

1. APeople with diabetes do not have heart attacks
2. BHigh glucose protects the heart from pain
3. CInsulin acts as a strong painkiller
4. DNerve damage can blunt the pain signals

The nurse has four patients. Which one needs to be seen first?

1. AA patient with stable CKD waiting for a renal diet review
2. BA patient with hypothyroidism asking when to take levothyroxine
3. CA patient on insulin for DKA whose potassium is now 2.9 mmol/L
4. DA patient with Parkinson's disease whose next dose is due in two hours

A routine wound swab grows bacteria, but the wound shows no signs of infection. What does this usually mean?

1. AThe wound must be closed with sutures again
2. BThe swab result means the wound is infected
3. CThe patient needs IV antibiotics straight away, whatever the wound looks like
4. DThe wound is colonised; antibiotics are not usually needed

While a central line is disconnected, a patient suddenly becomes breathless with chest pain and hypotension. Air embolism is suspected. What should the nurse do first?

1. AClamp the line, lie the patient left side down, head low; give oxygen
2. BGive the patient a drink and observe for an hour
3. CRemove the central line straight away and leave the site open to the air
4. DSit the patient fully upright and flush the line