NCLEX-style Prioritization & Delegation: cram pack

Which patient can the nurse safely see last?

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

Four patients arrive at the emergency department at the same time. Who should be seen first?

1. AA young adult with a swollen, painful ankle after a fall on the stairs
2. BAn older adult with weakness on one side that began 40 minutes ago
3. CAn adult with kidney stone pain of 9/10 and stable vital signs
4. DA child with a temperature of 39 °C who is alert and drinking

Which measure is part of the bundle for inserting a central venous catheter to prevent bloodstream infection?

1. ARoutine replacement of the catheter on a fixed schedule, such as every three days
2. BGiving antibiotics to every patient before insertion
3. CChoosing the femoral vein as the first site in adults
4. DChlorhexidine-alcohol skin antisepsis and maximal sterile barrier precautions

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

1. AHelping the patient bathe while wearing a gown and gloves
2. BDeciding when the precautions can be stopped
3. CAssessing the wound for new signs of infection during the bath
4. DTeaching the family how to follow the precautions

How should a patient collect a clean-catch midstream urine sample?

1. ACollect the very first urine of the stream directly in the sterile cup
2. BFill the cup completely, then add tap water if there is not enough
3. CClean the area, start voiding into the toilet, then catch the middle part
4. DCollect urine from the toilet bowl after voiding into the toilet

Two sets of blood cultures were taken from separate sites. Only one bottle in one set grows coagulase-negative staphylococci, and the patient has no line or implant. What is the most likely interpretation?

1. AInfection with a resistant organism such as MRSA
2. BCertain bloodstream infection needing treatment
3. CProof that the patient has infective endocarditis
4. DProbable skin contamination of the sample

Why should a urinary catheter drainage bag be kept below the level of the bladder?

1. ATo prevent urine flowing back into the bladder
2. BTo keep the urine warm
3. CTo make the bag easier for the nurse to empty
4. DTo stop the catheter from falling out

In triage, which patient should be seen first?

1. AA patient asking for a repeat prescription
2. BA patient with noisy breathing and swollen lips after eating peanuts
3. CA patient with a two-day history of sore throat
4. DA patient with a sprained ankle and mild swelling

After varicose vein surgery, which advice is usually given?

1. AStand still for long periods to help the veins heal
2. BAvoid all walking until the bruising has gone
3. CStay in bed for two weeks with the legs hanging down
4. DWear the compression stockings as advised and walk regularly

A patient who started an ACE inhibitor yesterday develops swelling of the lips and tongue and a hoarse voice. What should the nurse do first?

1. AGive the next dose early, as this will settle the swelling quickly
2. BAssess the airway, call for urgent help and hold further doses
3. CApply ice to the lips and review again in the morning
4. DExplain that this is an expected, harmless side effect

A patient with AKI has a urinary catheter that drains nothing. Which quick bedside check helps rule out a post-renal cause?

1. AEncourage the patient to drink two litres of water
2. BCheck the catheter for kinks or blockage and do a bladder scan
3. CSend a urine sample for culture and wait for the laboratory result
4. DGive a large bolus of IV fluid straight away

Six weeks after a kidney transplant, a patient has a fever, tenderness over the graft, less urine and a rising creatinine. What is most likely?

1. AAcute rejection, needing urgent transplant team review
2. BDehydration that needs only more oral fluids and rest
3. CA side effect of sun exposure
4. DA normal finding as the kidney settles in

When is cold therapy most useful for pain?

1. AOver numb areas where sensation is lost
2. BFor long-term muscle stiffness, applied continuously for several hours
3. CDirectly on skin with poor circulation
4. DSoon after an acute soft tissue injury, to reduce swelling

An 80 kg adult has 30% TBSA partial- and full-thickness burns. Using the Parkland formula, how much crystalloid is planned for the first 8 hours from the time of the burn?

1. A9600 mL
2. B2400 mL
3. C3200 mL
4. D4800 mL