NCLEX-style Prioritization & Delegation: cram pack

A pregnant nurse is on the unit. Which patient should the charge nurse avoid assigning to her?

1. AA patient with type 2 diabetes who needs insulin teaching before discharge
2. BA patient with a sealed radioactive implant for cervical cancer
3. CA patient after a hip replacement
4. DA patient with a fractured wrist

A patient had sudden difficulty speaking 45 minutes ago. Which action has the highest priority?

1. AGive aspirin by mouth straight away to limit the clot
2. BWait until the neurologist can assess the patient on the morning ward round
3. CGive water so the patient can take the usual morning medicines
4. DActivate the stroke team for urgent imaging, noting when last known well

A person in scrubs without a hospital ID badge asks to take a newborn to the nursery. What should the nurse do?

1. ALet the parents decide whether to hand the baby over
2. BAsk the person their name and then give them the baby
3. CRefuse, keep the baby with the mother and alert security
4. DHand over the baby if the person seems confident

A patient’s cardiac monitor alarms often because of artifact, and a colleague suggests turning the alarm off. What is the best response?

1. ATurn the alarm volume down as low as it will go
2. BTurn the alarm off and check the monitor screen at the nurses’ station every hour instead
3. CDisconnect the monitor overnight so the patient can sleep
4. DKeep the alarm on, fix the cause such as electrode placement, and adjust limits only per policy

A patient has a hot, swollen big toe. The serum uric acid is normal. Which statement is correct?

1. AGout is certain, as a normal urate proves the diagnosis
2. BGout is ruled out, as uric acid is always high in an attack
3. CGout can only be diagnosed with a CT scan of the foot
4. DGout is still possible, as urate can be normal in an attack

An 82-year-old woman without a catheter has a urine culture growing bacteria, but no fever, urinary symptoms or change in mental state. What is the best interpretation?

1. APyelonephritis, which needs admission and IV fluids today
2. BA urinary tract infection that needs urgent IV antibiotics
3. CAsymptomatic bacteriuria, usually not treated with antibiotics
4. DContamination, so the culture must be repeated every week

Which drug is first-line in an acute asthma attack?

1. AA nebulised or inhaled short-acting beta₂-agonist (salbutamol/albuterol)
2. BAn oral beta-blocker
3. CA long-acting inhaled corticosteroid, used alone at a higher dose
4. DAn oral antihistamine such as cetirizine taken every few hours

An older patient found on the floor after lying there for many hours has dark brown urine and a very high creatine kinase. What is the main risk?

1. AA stroke
2. BAcute kidney injury from rhabdomyolysis
3. CA urinary tract infection from lying in urine
4. DHypoglycaemia

Why should a beta-blocker not be stopped suddenly in a patient with ischaemic heart disease?

1. ASudden stopping causes severe and prolonged hypoglycaemia
2. BThe drug stays stored in the tissues for several months afterwards
3. CThe heart rate becomes permanently slow afterwards
4. DRebound tachycardia and hypertension can trigger angina or MI

During a severe asthma attack, a patient's PaCO₂ rises from low to normal while they look exhausted. What does this mean?

1. AThe patient is hyperventilating because of anxiety
2. BThe sample is probably venous and can be ignored
3. CThe patient is tiring and respiratory failure may follow
4. DThe attack is resolving and treatment can be reduced

A routine blood test shows a potassium of 6.4 mmol/L. The lab reports that the sample was haemolysed. The patient feels well. What should the nurse do?

1. AStart dialysis as soon as possible
2. BIgnore it, because haemolysis always gives a normal result
3. CGive oral potassium supplements straight away
4. DInform the doctor and arrange an urgent repeat sample

Which patient on a stroke unit is most at risk of falling?

1. AA patient with a right-hemisphere stroke who is impulsive and denies having weakness
2. BA patient with a left-hemisphere stroke who has expressive aphasia and waits for help
3. CA patient with a TIA whose symptoms resolved completely yesterday
4. DA patient with mild dysarthria who walks steadily with a frame

When breaking bad news, what is the first step in frameworks such as SPIKES?

1. ASet up a private setting with enough time
2. BGive the diagnosis as quickly as possible in the corridor
3. CAsk the family to decide what the patient should be told
4. DGive all treatment options before checking understanding

A patient has a category (stage) 2 pressure ulcer on the sacrum. Which plan is most appropriate?

1. ASit the patient upright in a chair for most of the day
2. BOffload the area, manage moisture, support nutrition and dress it
3. CMassage around the wound every hour to stimulate blood flow to the skin
4. DLeave it uncovered and dry it with a hair dryer