NCLEX-style Prioritization & Delegation: cram pack

A patient uses patient-controlled analgesia (PCA) after surgery. Which statement by a family member shows a need for further teaching?

1. A“I will press the button for her while she is asleep so she stays comfortable.”
2. B“The pump has limits set by the nurse so she cannot get too much at once.”
3. C“Only she should press the button when she needs pain relief.”
4. D“I will tell the nurse if she becomes very sleepy or hard to wake.”

An RN has five patients and a nursing assistant. One patient has just become short of breath. Which task should the RN delegate so that the RN can go to that patient?

1. AMorning vital signs on the four stable patients
2. BGiving the breathless patient’s IV furosemide
3. CExplaining the new diagnosis to the breathless patient’s family
4. DAssessing the breathless patient’s lung sounds

A nurse has been fit-tested for an N95 respirator. What should the nurse do each time it is put on?

1. AWear a surgical mask underneath it
2. BPerform a user seal check
3. CArrange a new fit test
4. DMoisten the edges so it seals better

During a power cut in a US hospital, a ventilator must stay powered. Where should it be plugged in?

1. AInto an extension cord from the corridor
2. BInto any white outlet in the room
3. CInto a red outlet connected to the emergency generator
4. DInto the outlet that is closest to the bed, whatever its color

After surgery for colon cancer, a patient's CEA had fallen to normal, but it has been rising over the last two checks. What does this most likely suggest?

1. AA normal change after surgery that needs no follow-up
2. BPossible recurrence that needs further assessment
3. CA sure sign that the cancer has been fully cured
4. DA sign of iron deficiency from the earlier bleeding

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. AA urinary tract infection that needs urgent IV antibiotics
2. BContamination, so the culture must be repeated every week
3. CPyelonephritis, which needs admission and IV fluids today
4. DAsymptomatic bacteriuria, usually not treated with antibiotics

What should a nurse do during a generalised tonic-clonic seizure?

1. AGive the patient a drink of water
2. BHold the limbs firmly to stop the jerking and prevent injury
3. CPut a tongue depressor between the teeth so that the tongue is not bitten
4. DProtect the head, time the seizure and do not put anything in the mouth

A patient with severe asthma becomes quiet, with a "silent chest", exhaustion and a falling respiratory rate. What does this indicate?

1. ALife-threatening asthma with impending respiratory arrest
2. BImprovement of the attack as the bronchospasm settles and the airways relax
3. CAnxiety only
4. DNormal recovery after a nebuliser

A patient on ramipril is to start sacubitril/valsartan for heart failure. What is the key safety point?

1. AThe ACE inhibitor must be stopped first, with a gap before starting
2. BThe ACE inhibitor dose should be doubled during the change
3. CSacubitril/valsartan is safe to start on the same morning
4. DBoth drugs should be taken together each day for the best effect

A patient with pneumonia on high-flow nasal oxygen at 50 L/min with FiO₂ 0.6 has SpO₂ 90%, RR 34/min and is using accessory muscles. What is the most appropriate action?

1. AEscalate urgently to critical care for review of respiratory support
2. BLay the patient flat so they can rest the breathing muscles
3. CContinue the same support and recheck in four hours
4. DChange to a nasal cannula at 4 L/min to reduce nasal dryness

After a change in the levothyroxine dose, when is the TSH usually rechecked?

1. AAfter 24 hours
2. BAfter about 2 years of treatment
3. CAfter about 6–8 weeks
4. DAfter 3 days

A patient is being assessed for brain death (brainstem death). Which condition must be excluded before testing?

1. AEffects of sedative drugs or severe hypothermia
2. BA haemoglobin of 110 g/L (11 g/dL)
3. CA previous episode of migraine
4. DA history of high blood pressure

During which period after surgery is wound dehiscence most likely?

1. AMore than a year after surgery
2. BOnly during the operation
3. CWithin the first hour
4. DAbout 5–10 days after surgery

A patient's long-standing groin hernia has become tender, red and irreducible, and they are vomiting. What should the nurse do?

1. AApply a hot water bottle and give a laxative
2. BAdvise the patient to wear a tight truss and rest
3. CPush the hernia firmly back in, then discharge home
4. DKeep them nil by mouth and arrange urgent surgical review