NCLEX-style Prioritization & Delegation: cram pack

When making patient assignments, what should the charge nurse consider first?

1. ALetting staff choose the patients they prefer
2. BMatching each patient’s needs to staff competence
3. CGiving each nurse patients in rooms next to each other
4. DGiving the newest staff the most complex patients

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. AHypoglycemia caused by the stored blood product
2. BAn expected effect of the first unit
3. CA mild allergic reaction with hives
4. DTransfusion-associated circulatory overload

A patient with poorly controlled seizures asks about activities at home. Which advice is most important?

1. ASleep sitting up in a chair
2. BAvoid all forms of exercise
3. CNever swim or bathe alone
4. DAvoid drinking water before bed

A patient in the emergency waiting room has a cough for six weeks, night sweats, weight loss and blood in the sputum. What should the nurse do first?

1. AAsk the patient to wait in the waiting room until called
2. BPlace the patient in a shared cubicle with the curtain closed
3. CMask the patient and move them to an airborne isolation room
4. DStart contact precautions with a gown and gloves for staff

A breathless patient in the emergency department has a BNP below 100 pg/mL. What does this suggest?

1. ASevere heart failure is certainly the cause of the problem
2. BThe kidneys are failing and the patient needs dialysis
3. CThe patient has had a myocardial infarction in the past day
4. DHeart failure is an unlikely cause of the breathlessness

Which set of results is most typical of iron-deficiency anemia?

1. ALow hemoglobin, large red cells (high MCV) and high ferritin
2. BLow hemoglobin, small red cells (low MCV) and low ferritin
3. CHigh hemoglobin and high hematocrit
4. DNormal hemoglobin with a high platelet count only

A patient receiving warfarin has an INR far above the target range and bruising. Which drug may be prescribed to reverse the effect?

1. AProtamine sulfate
2. BVitamin K
3. CAspirin
4. DNaloxone

A nurse teaches a patient with a new ileostomy. Which statement shows a need for further teaching?

1. A"My stoma should look pink or red and moist."
2. B"I will empty the bag when it is about a third to half full."
3. C"I will drink extra fluids when it is hot."
4. D"My output will be firm and formed like before."

Which advice is most helpful for a patient with Raynaud's phenomenon?

1. ASoak the hands in cold water to toughen the vessels
2. BKeep the whole body warm, wear gloves and stop smoking
3. CRub the fingers hard with snow during an attack
4. DTake a decongestant tablet before going outdoors

A patient receiving weeks of IV antibiotics through a PICC line in the left arm develops swelling and aching of that arm and neck veins that look fuller on the left. What should the nurse suspect?

1. AAn expected effect of the antibiotic
2. BA local skin allergy to the dressing
3. CLymphoedema from lying in bed
4. DA catheter-related deep vein thrombosis

For which patient would the nurse question an order for pioglitazone?

1. AA patient with asthma
2. BA patient with an allergy to latex
3. CA patient with heart failure
4. DA patient with hypothyroidism

A patient with an external ventricular drain sat up in bed without help. The drain stayed at its old height, and the drainage bag filled quickly. The patient now has a headache. What is the concern?

1. AOverdrainage of CSF, so act per protocol and inform the team
2. BUnderdrainage, so the drain should be lowered further
3. CNo concern, because more drainage always lowers the ICP safely
4. DAn infected drain, so the dressing should be removed

Why are urinary catheters removed as early as possible after surgery?

1. ABecause patients cannot drink normally while a catheter is in place
2. BBecause catheters always cause kidney stones
3. CTo reduce the risk of catheter-associated infection
4. DBecause the catheter stops the bowel working

On the ward after surgery, a patient has a red, blistered area of skin under where the diathermy plate was. What should the nurse do?

1. AApply a hot water bottle to improve the circulation
2. BWash it with alcohol and leave it uncovered
3. CTreat it as a possible burn, report it and complete an incident form
4. DIgnore it because skin changes after surgery are normal and expected to fade