NCLEX-style Prioritization & Delegation: cram pack

Which patient can the nurse safely see last?

1. AA patient two hours after surgery with a heart rate rising from 88 to 118/min
2. BA patient with a sudden severe headache
3. CA patient with new crackles and pink, frothy sputum
4. DA patient with COPD on 1 L/min oxygen, SpO₂ 90% (target 88–92%), talking in full sentences

A patient with raised intracranial pressure is being nursed on the ward. Which position is best?

1. AHead down with the legs raised above the heart
2. BFlat on the back with the head turned well over to one side
3. CHead of the bed at about 30 degrees with the neck straight
4. DSitting forward with the chin on the chest

Which practice reduces back strain when a nurse moves a patient or heavy object?

1. AKeep the load close to the body and avoid twisting
2. BHold the load at arm’s length to keep it steady
3. CBend at the waist and keep both knees straight
4. DStand with the feet close together for balance

During a disaster, the hospital needs to free beds quickly. Which patient is the best candidate for early discharge?

1. AA patient on an IV heparin infusion that is still being adjusted
2. BA patient admitted overnight for observation who is now stable with normal tests
3. CA patient with ongoing chest pain awaiting cardiac tests
4. DA patient on a ventilator in the intensive care unit who is slowly improving

A patient has macrocytic anemia with numbness and tingling of the feet and poor balance. Which deficiency is most likely?

1. AVitamin C (ascorbic acid)
2. BIron (low ferritin)
3. CFolate (folic acid)
4. DVitamin B₁₂

A patient taking apixaban asks why they do not need regular INR tests like their neighbor on warfarin. What is the best explanation?

1. AThe INR is checked secretly together with the other routine blood tests
2. BApixaban is monitored with an aPTT every day instead
3. CIts effect is predictable, so routine clotting tests are not needed
4. DApixaban does not actually thin the blood

Compared with a colostomy, a patient with an ileostomy is at greater risk of:

1. AHard stools, straining and constipation from slow transit
2. BDehydration and electrolyte loss from liquid output
3. CUrinary retention
4. DLow blood glucose after meals

A patient is taught to self-inject low-molecular-weight heparin. Which statement shows a need for further teaching?

1. A"I will inject into the fatty tissue of my abdomen."
2. B"I will report any unusual bleeding or bruising."
3. C"I will rub the area firmly after the injection."
4. D"I will change the injection site each time."

Which exercise advice is recommended for intermittent claudication?

1. AComplete bed rest until the leg pain has gone for at least a month
2. BStopping walking at the very first twinge of pain each time
3. CSupervised walking until pain is near maximal, then rest and repeat
4. DWalking only on days when the legs feel warm and painless

A patient has sudden severe chest pain spreading to the back between the shoulder blades. Which finding most supports aortic dissection rather than myocardial infarction?

1. AA heart rate of 104/min and a respiratory rate of 22/min
2. BPain that started at rest
3. CA large difference in blood pressure between the arms
4. DSweating, nausea and pallor that started with the pain

Which statement about hyperosmolar hyperglycaemic state (HHS) is correct?

1. AIt develops within minutes and is less dangerous than DKA
2. BIt is seen mainly in young children with type 1 diabetes
3. CIt mainly affects older people with type 2 diabetes, over days
4. DIt always causes high blood ketones and a severe metabolic acidosis

A patient with a T4 spinal cord injury has a pounding headache, BP 210/110 mmHg, flushed sweaty skin above the injury and a pulse of 50/min. After sitting the patient up, what is the next priority?

1. ALie the patient flat again and raise the legs on pillows
2. BGive a sedative and recheck the blood pressure in an hour
3. CFind and remove the trigger, starting with the bladder
4. DGive a rapid IV fluid bolus to support the circulation

Why is a urinary catheter usually inserted in a patient with a major burn?

1. AHourly urine output guides fluid resuscitation
2. BIt is needed to give medicines into the bladder
3. CThe catheter prevents wound infection
4. DBurns always cause the bladder to rupture

A patient with gallstones has a temperature of 39 °C with rigors, jaundice and right upper abdominal pain. What should the nurse suspect?

1. ASimple biliary colic
2. BAscending cholangitis
3. CUncomplicated reflux
4. DAcute hepatitis A