NCLEX-style Prioritization & Delegation: cram pack

A nursing assistant tells the RN that a patient’s IV pump is alarming. What is the best response?

1. A“Silence the alarm and I will check it at the end of the shift.”
2. B“Turn the pump off and on again until it stops.”
3. C“I will come and check the pump and the IV site now.”
4. D“Increase the rate a little so the alarm clears.”

An older patient with heart failure is receiving a second unit of blood. She becomes breathless, with crackles in both lungs and a rising blood pressure. What is most likely happening?

1. AA mild allergic reaction with hives
2. BTransfusion-associated circulatory overload
3. CAn expected effect of the first unit
4. DHypoglycemia caused by the stored blood product

Which practice is safe when transferring a patient from a bed to a stretcher?

1. ALeave the stretcher wheels unlocked so it can move with the patient
2. BLower the stretcher side rails during transport
3. CLock the wheels of both the bed and the stretcher before moving the patient
4. DHave the patient slide across without help or a slide sheet

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

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

Why do patients with chronic kidney disease often have anemia?

1. AHigh potassium in kidney disease breaks down red cells
2. BThe damaged kidneys filter out and destroy red blood cells
3. CThe kidneys make less erythropoietin, which drives red cell production
4. DUremic toxins make the bone marrow produce white cells instead of red cells

The nurse prepares a patient for a 2-hour oral glucose tolerance test tomorrow morning. Which statement shows a need for further teaching?

1. A"I'll fast overnight but can drink plain water"
2. B"I can have a light breakfast before the test"
3. C"I'll avoid smoking until the test is over"
4. D"I'll stay seated during the test if I can"

How should a nurse communicate with a patient who has impaired hearing?

1. AShout loudly from the end of the bed so they can hear
2. BFace the patient, speak clearly and reduce background noise
3. CTalk to the patient's relative instead of to the patient directly
4. DSpeak very quickly to save time

A patient with known cirrhosis suddenly vomits large amounts of bright red blood and becomes tachycardic. What is the most likely cause?

1. AA Mallory-Weiss tear from a small amount of vomiting
2. BSwallowed blood from a nosebleed
3. CBleeding from ruptured oesophageal varices
4. DA lower GI bleed from diverticular disease

Why are patients with severe COPD encouraged to eat small, frequent meals?

1. AA full stomach limits the diaphragm and eating is tiring
2. BFrequent meals prevent chest infections directly
3. CSmall meals reduce how often the inhalers are needed
4. DLarge meals cause the airways to narrow permanently

A patient with asthma has a peak flow of 40% of their best, a respiratory rate of 28/min and cannot complete sentences. SpO₂ is 94%. How should this attack be classified?

1. AModerate asthma exacerbation
2. BLife-threatening asthma
3. CNear-fatal asthma
4. DAcute severe asthma

A patient taking dapagliflozin (an SGLT2 inhibitor) is vomiting, with blood ketones of 4.5 mmol/L but a glucose of only 11 mmol/L. What should be suspected?

1. AHyperosmolar hyperglycaemic state
2. BEuglycaemic diabetic ketoacidosis
3. CA normal side effect needing no action
4. DHypoglycaemia caused by the vomiting

A nurse teaches foot care to a patient with diabetic neuropathy. Which statement shows a need for further teaching?

1. A"I will buy corn plasters from the pharmacy for my corn."
2. B"I will check my feet every day, using a mirror for the soles."
3. C"I will check that the bath water is not too hot using my elbow."
4. D"I will wear socks and shoes that fit well and do not rub."

Which check is routinely made for a patient with a burn wound?

1. ATetanus immunisation status
2. BVisual acuity in both eyes
3. CBlood group of the next of kin
4. DMeasles vaccination status

A patient with known oesophageal varices is vomiting large amounts of fresh blood. Which treatments should the nurse anticipate before endoscopy?

1. AOctreotide or terlipressin, plus IV antibiotics, during resuscitation
2. BRapid saline infusion to a high blood pressure
3. CAn urgent barium swallow before any drug treatment
4. DOral NSAID for pain and a high-protein meal