NCLEX-style Prioritization & Delegation: cram pack

An older adult asks for something to help them sleep. Which drug is most likely to cause confusion and falls in this age group?

1. AAcetaminophen (paracetamol)
2. BDiphenhydramine
3. CA warm milky drink
4. DMelatonin

A child with sickle cell disease in a pain crisis develops chest pain, fever and an SpO₂ of 89%. What does this most likely mean?

1. AAcute chest syndrome, which needs urgent escalation and oxygen
2. BAn ordinary pain crisis that will improve with rest
3. CA minor chest infection that can safely wait until the morning round
4. DAnxiety that will settle with reassurance

A nurse finds a used needle in a patient’s bed linen. What should the nurse do?

1. ARecap it with two hands before throwing it away
2. BPick it up by the hub or with forceps, put it in a sharps container and report it
3. CLeave it where it is for the housekeeping staff to remove later in the day
4. DFold it into the linen and send it to the laundry

A nurse notices that the pharmacy has sent the wrong dose and corrects it before giving it. Should the event be reported?

1. AYes, near misses are reported so system weaknesses can be fixed
2. BNo, because reporting near misses only blames the pharmacy staff for nothing
3. COnly if the same error happens three times
4. DNo, because the patient was not harmed

After pituitary surgery, a patient passes about 400 mL of pale urine per hour with a specific gravity of 1.002, and the sodium has risen to 149 mEq/L. Which condition is most likely?

1. AHyperglycemia with ketoacidosis
2. BAcute kidney injury with oliguria
3. CSIADH
4. DDiabetes insipidus

A patient’s total calcium is 7.9 mg/dL (2.0 mmol/L), with an albumin of 2.4 g/dL (24 g/L) and no symptoms. Which test would best clarify whether true hypocalcemia is present?

1. AAn ionized calcium
2. BA serum sodium
3. CAn HbA1c
4. DA urine specific gravity

Which features suggest Cushing's syndrome?

1. AWeight gain around the trunk, a rounded face and thin, easily bruised skin
2. BWeight loss, heat intolerance, tremor and protruding eyes
3. CCoarse facial features and very large hands and feet
4. DDark skin, low blood pressure, salt craving and a low blood sodium level

A patient with full mental capacity decides against a treatment that the team thinks is best. What does the Mental Capacity Act 2005 (England and Wales) say?

1. AThe family may make the decision instead if they disagree with the patient's choice
2. BThe patient must be assessed by a psychiatrist before refusing
3. CThe team may override any decision that it disagrees with if it is serious
4. DA person is not treated as lacking capacity just because they make an unwise decision

Why must anti-embolism stockings be measured and fitted correctly?

1. ALoose stockings make the patient's legs too warm at night
2. BCorrect fit is needed only to improve the appearance
3. CPoorly fitting stockings can cause pressure damage
4. DTight stockings work better, so the smallest size is always best

After intubation, breath sounds are heard on the right side of the chest but not the left. What is the most likely cause?

1. AThe left lung has completely filled with fluid
2. BThe tube has entered the right main bronchus
3. CThe tube has entered the oesophagus
4. DThe tube cuff has burst during insertion

A patient with primary adrenal insufficiency has a fever. What is the usual sick-day advice for steroid replacement?

1. AHalve the dose to reduce the side effects
2. BIncrease the glucocorticoid dose, often doubling it
3. CStop the steroid until the fever has settled
4. DKeep the usual dose and avoid drinking extra fluids for now

A nurse teaches a patient about peritoneal dialysis. Which statement shows a need for further teaching?

1. A"If the fluid is cloudy, I'll see if it clears next time."
2. B"I will check my exit site every day."
3. C"I will weigh myself daily and record my fluid balance."
4. D"I will wash my hands carefully before each exchange."

What does "neoadjuvant" treatment mean?

1. ATreatment that is given instead of any surgery
2. BTreatment given only for pain relief
3. CTreatment that is given only after the cancer has already spread
4. DTreatment before the main treatment, often to shrink the tumour

On day 5 after bowel resection, a patient has a fever, tachycardia and worsening abdominal pain, and the drain contains brown, faeculent fluid. What is most likely?

1. AA normal day 5 recovery
2. BAn anastomotic leak
3. CA urinary tract infection
4. DPostoperative constipation