NCLEX-style Prioritization & Delegation: cram pack

Which task is most appropriate for the RN to delegate to an LPN/LVN?

1. AGiving discharge teaching to a patient newly started on insulin
2. BInserting an indwelling urinary catheter in a stable patient
3. CDoing the admission assessment of a new patient
4. DStarting the first unit of red blood cells

A nurse has a needlestick injury from a used needle. What should the nurse do first?

1. AFinish the shift and report it tomorrow
2. BScrub the area with bleach
3. CWash the area with soap and water
4. DSqueeze the wound hard and suck it

Which room lighting is safest at night for a patient at high risk of falls?

1. AComplete darkness so the patient sleeps more deeply
2. BA low night light that lights the path to the bathroom
3. COnly the light from the television screen
4. DBright overhead lights left on all night in the room

In US nursing practice, which task should the RN not assign to an LPN/LVN?

1. AGiving scheduled oral antibiotics to a stable patient
2. BReinforcing hand hygiene teaching that the RN has already given
3. CA dressing change on a healing surgical wound that has no signs of infection
4. DThe initial admission assessment of a new patient with suspected sepsis

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

A patient with a large, fast-growing lymphoma will start chemotherapy tomorrow. Which plan best prevents tumor lysis syndrome?

1. AIV hydration, a uric acid-lowering drug and frequent electrolytes
2. BNo special measures, because the risk starts only after a week
3. CFluid restriction and a high-potassium diet before the treatment
4. DCalcium supplements and a high-phosphate diet during treatment

Why are older adults at higher risk of dehydration?

1. ATheir body water content increases with age
2. BTheir kidneys hold on to too much water
3. CThey always drink large amounts of tea
4. DTheir sense of thirst is often reduced

Soon after starting chemotherapy for a high-grade lymphoma, a patient has rising potassium, phosphate and uric acid with falling urine output. What is the most likely cause?

1. ARefeeding syndrome
2. BTumour lysis syndrome
3. CSyndrome of inappropriate ADH secretion
4. DAdrenal insufficiency

A patient with asthma uses their reliever inhaler more than three times a week. What does this suggest?

1. AAsthma control is poor and treatment needs review
2. BAsthma is well controlled with the current plan
3. CThe preventer inhaler is no longer needed
4. DThe reliever no longer works and should be stopped

A healthcare assistant (unlicensed assistive personnel) reports four observations. Which one needs the nurse's attention first?

1. AA patient with a DVT whose leg is less swollen today
2. BA patient with COPD whose SpO₂ is 90% on 1 L/min, which is usual for him
3. CA patient with heart failure who is newly confused, with SpO₂ 89%
4. DA patient after a PCI asking for a cup of tea

A patient has a nephrostomy tube. Which finding needs urgent action?

1. ASteady urine drainage into the bag
2. BA dry, intact dressing at the site
3. CLight pink urine on the first day after insertion
4. DDrainage that stops suddenly with new loin pain

During haemodialysis, a patient suddenly becomes breathless with chest pain, and air is seen in the line. What should the nurse do first?

1. ASpeed up the pump to clear the air into the patient
2. BSit the patient upright and give a drink of water
3. CClamp the lines and lay the patient left side down, head low
4. DContinue the session and recheck in 30 minutes

Why is the time a surgical limb tourniquet is inflated carefully recorded?

1. ALong inflation can cause nerve and muscle damage
2. BThe surgeon is paid per minute of use
3. CIt shows how long the anaesthetic gas was used
4. DThe tourniquet slowly loses all its air after one minute

A patient with lung cancer develops facial swelling, distended neck veins and breathlessness that worsens when lying down. Which emergency is likely?

1. AMassive pulmonary embolism
2. BHypercalcaemia of malignancy
3. CSuperior vena cava obstruction
4. DSpinal cord compression