NCLEX-style Prioritization & Delegation: cram pack

Which patient can the nurse safely see last?

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

A patient has a wrist restraint. The nurse finds the fingers on that hand pale, cool and tingling. What should the nurse do first?

1. ALoosen the restraint and assess the circulation
2. BTighten the restraint so the patient moves less
3. CDocument the finding and continue with the medication round
4. DRaise the arm on a pillow and check again in two hours

A nurse finds an unlabeled syringe of clear fluid on the medication counter. What should the nurse do?

1. ADiscard it, because its contents cannot be confirmed
2. BAsk nearby staff and use it if someone recognizes it
3. CGive it to the patient whose medication is due
4. DLabel it with the most likely drug name

A patient with pneumonia has low blood pressure and a raised serum lactate. What does the raised lactate suggest?

1. ARecovery from the infection is beginning
2. BMild dehydration from poor intake, with no further concern
3. CA normal response to having a fever
4. DPoor tissue perfusion, a sign of sepsis-related shock

A patient has a calcium of 11.8 mg/dL (2.95 mmol/L) from bone metastases. Which nursing measure is appropriate?

1. AGive calcium carbonate antacids for nausea
2. BOffer extra milk and cheese at each meal
3. CEncourage bed rest and limit oral fluids
4. DEncourage fluids and mobility as tolerated

A patient on stable digoxin starts amiodarone. A week later, the patient has nausea and visual changes, and the digoxin level is above the range. What is the most likely explanation?

1. AAmiodarone has lowered potassium only
2. BThe patient has started a viral illness
3. CDigoxin has raised the amiodarone level
4. DAmiodarone has raised the digoxin level

Which signs suggest a blood transfusion reaction in the first minutes?

1. AMild hunger
2. BFever, chills, back pain and low blood pressure
3. CSlow, steady rise in haemoglobin over the next day
4. DImproved colour and energy

A patient with a tracheostomy suddenly cannot breathe and the tube appears blocked. What is the first action?

1. AGive oxygen through the mouth only
2. BWait for the doctor before doing anything
3. CDeflate the cuff and leave the patient
4. DRemove the inner tube (cannula) and check whether it is blocked

A patient with chest pain has a first troponin result within the normal range one hour after the pain started. Why is a repeat test arranged?

1. ATroponin falls during an MI, so a lower value confirms it
2. BTroponin may take a few hours to rise after muscle damage
3. CThe repeat test is only needed for patients over 80
4. DThe first sample is always contaminated

On day 6 of a heparin infusion, the platelet count has fallen by more than half and the patient has a new swollen arm. What should the nurse anticipate?

1. AStopping all heparin and starting a non-heparin anticoagulant
2. BStopping all anticoagulation for two weeks
3. CSwitching to LMWH because it is a different drug
4. DContinuing the heparin and giving a platelet transfusion

What is the main purpose of continuous bladder irrigation after a transurethral resection of the prostate (TURP)?

1. ATo stop blood clots from blocking the catheter
2. BTo measure the size of the bladder
3. CTo treat a urinary infection after the operation
4. DTo give the patient extra fluids

A patient has erratic glucose readings. The nurse finds a soft, rubbery lump where they always inject. What is the most important teaching?

1. AKeep injecting into the lump, because it hurts less there
2. BDouble the insulin dose because the lump blocks the insulin
3. CMassage the lump firmly after every injection
4. DUse healthy sites and check glucose often, as less insulin may be needed

Why is a gastrostomy tube with an internal bumper usually advanced and rotated regularly once the tract has healed?

1. ATo remove any feed left in the stomach
2. BTo stop the inner bumper becoming buried in the stomach wall
3. CTo check that the patient is still hungry
4. DTo make the tube longer as the patient grows or gains weight

A patient with known prostate cancer reports new, worsening back pain and leg weakness. What is the most important action?

1. AAdvise rest at home with paracetamol and review at the next clinic visit
2. BPossible cord compression: escalate, steroids as prescribed, urgent MRI
3. CReassure the patient that back pain is common and not serious
4. DArrange routine physiotherapy for the back pain in the next month