NCLEX-style Prioritization & Delegation: cram pack

Which action by a nursing assistant needs the nurse to step in?

1. ALowering the bed to its lowest position and locking the wheels after care
2. BCleaning hands before entering the room
3. CPutting the call light within the patient’s reach
4. DTaking an oral temperature just after the patient drank cold water

Two days after starting haloperidol, a patient suddenly develops painful neck twisting and the eyes roll upwards. What should the nurse anticipate?

1. AAn anticholinergic drug, such as benztropine or procyclidine, as prescribed
2. BNo action, because the spasm is a sign of improvement
3. CA higher dose of haloperidol to calm the patient and stop the movements quickly
4. DPhysical restraint until the spasm passes

A patient has shingles (herpes zoster) on one area of the chest, has a normal immune system and the lesions can be fully covered. Which precautions are usually needed?

1. AAirborne precautions in a negative-pressure room
2. BDroplet precautions only
3. CStandard precautions, with the lesions covered
4. DProtective environment with positive pressure

A nurse finds that a patient has been taking their own sleeping pills from a bedside drawer while also receiving a hypnotic from the ward. What should the nurse do?

1. ASecure the home medication per policy and inform the provider
2. BStop giving the hospital hypnotic without telling the provider or the pharmacy
3. CLet the patient keep them, since they are the patient’s own
4. DThrow the patient’s pills away in the bin

Which treatment lowers serum potassium by moving it into the cells?

1. AIV calcium gluconate given over 10 minutes
2. BIV 0.45% sodium chloride infusion
3. CIV regular insulin given with glucose
4. DOral potassium chloride supplements

A patient with a serum albumin of 1.9 g/dL (19 g/L) has signs of phenytoin toxicity, although the total phenytoin level is in the usual range. What is the most likely explanation?

1. ALow albumin stops phenytoin from crossing into the brain
2. BLow albumin makes the liver clear phenytoin much faster
3. CLow albumin raises the free (active) fraction of phenytoin
4. DLow albumin makes the total level falsely high in all cases

A patient after a road accident has severe breathlessness, absent breath sounds on one side, low blood pressure and the trachea shifted to the other side. What is the likely diagnosis?

1. AAsthma
2. BPneumonia
3. CTension pneumothorax
4. DPulmonary oedema

Which drug group is first-line for a prolonged convulsive seizure?

1. ABeta-blockers, such as bisoprolol or atenolol
2. BBenzodiazepines, such as buccal midazolam or IV lorazepam
3. COpioids, such as morphine or diamorphine, given intravenously
4. DAntihistamines, such as chlorphenamine

Why should chest drain tubing generally not be clamped?

1. AClamping makes the fluid drain out of the chest much too quickly
2. BTrapped air can build up and cause a tension pneumothorax
3. CClamping permanently weakens and cracks the tubing
4. DClamping causes the water in the seal to evaporate

A patient with an inferior myocardial infarction develops complete heart block with a heart rate of 38/min. What is the most likely reason?

1. AInferior infarcts always destroy the bundle of His permanently
2. BThe left anterior descending artery supplies the SA node only
3. CThe right coronary artery usually supplies the AV node
4. DHeart block is caused by the thrombolytic drug

Which statement about storing insulin is correct?

1. AInsulin should be kept on a sunny windowsill to stay warm
2. BUnopened insulin goes in the fridge and must never be frozen
3. CInsulin that has been frozen can be used once it has thawed
4. DAll insulin must be stored in the freezer to keep it stable

A 66-year-old smoker has had two episodes of painless red urine. Urine cultures are negative. Which plan is most appropriate?

1. AReassure him, because the blood has stopped
2. BAnother course of antibiotics for a UTI
3. CUrgent referral for cystoscopy and imaging
4. DAdvise more fluids and review in a year

Why is a pregnancy test often done before surgery in women who could be pregnant?

1. AIt is needed to calculate the anaesthetic drug dose
2. BAnaesthesia, drugs and some tests may harm a fetus
3. CPregnant women cannot sign consent forms
4. DPregnancy always makes surgery impossible

An incontinent patient has diffuse, shiny, red and broken skin in the natal cleft and buttocks with irregular edges, not over a bony prominence. What is most likely?

1. AIncontinence-associated dermatitis
2. BAn arterial ulcer caused by poor circulation
3. CA category 4 pressure ulcer over the sacrum
4. DA full-thickness burn