NCLEX-style Prioritization & Delegation: cram pack

Which instruction to a nursing assistant is the clearest?

1. A“Measure Mr Lee’s blood pressure at 10:00 and tell me at once if the systolic is below 100.”
2. B“Keep an eye on Mr Lee this morning and let me know how he is doing.”
3. C“Let me know if anything seems wrong with Mr Lee while you are in there.”
4. D“Do Mr Lee’s vital signs sometime before lunch and write them on the chart for me.”

During a power cut, which patient is the nurse’s first priority?

1. AA patient whose call light is not working
2. BA patient watching television when it switched off
3. CA patient whose bed will not raise electrically
4. DA patient who depends on a ventilator

Two patients infected with the same organism are admitted, and no single room is available. What is an accepted option?

1. APlacing them in the corridor
2. BPlacing each with a patient who has a weakened immune system
3. CCohorting them in the same room, according to infection control advice
4. DStopping contact precautions

A nurse has raised a safety concern about an order with the prescriber, who dismissed it without addressing it. What should the nurse do next?

1. ADiscuss the concern with the patient and let them decide
2. BRefuse to care for the patient for the rest of the shift until the prescriber apologizes
3. CCarry out the order as written, because the prescriber has heard the concern
4. DState the concern clearly a second time and, if still unresolved, use the chain of command

A patient on hemodialysis has an arteriovenous (AV) fistula in the left arm. Where should the nurse draw routine blood samples?

1. AFrom the right arm
2. BFrom the left hand
3. CFrom the fistula
4. DFrom the left wrist

A child with sickle cell disease and a recent viral illness is pale and tired. The hemoglobin has fallen sharply, and the reticulocyte count is very low. What is the most likely problem?

1. AA vaso-occlusive pain crisis in the bones
2. BIron deficiency from a poor diet over months
3. CA normal finding in sickle cell disease
4. DAn aplastic crisis, often caused by parvovirus B19

A patient on the ward has shingles with open blisters. Which people are most at risk from contact?

1. APregnant women and immunocompromised people who have not had chickenpox
2. BPeople who have already had chickenpox in childhood and are now healthy
3. CNo one, because shingles cannot spread
4. DOnly people over 80 who have already had shingles themselves

In triage, which patient should be seen first?

1. AA patient with a two-day history of sore throat
2. BA patient with noisy breathing and swollen lips after eating peanuts
3. CA patient asking for a repeat prescription
4. DA patient with a sprained ankle and mild swelling

After an above-knee amputation, which measure helps prevent a hip flexion contracture?

1. ASitting in a chair for most of the day with the hips bent
2. BLying prone for periods and avoiding pillows under the stump
3. CKeeping a pillow under the stump at all times, day and night
4. DKeeping the hip bent to reduce stump swelling

A patient taking apixaban for atrial fibrillation is booked for elective surgery. Which statement reflects correct practice?

1. AStop it two weeks before surgery and replace it with warfarin
2. BIt is always continued up to the morning of the operation
3. CPause it for a set time, based on bleeding risk and kidney function
4. DIt is stopped and then reversed with oral vitamin K

A patient on peritoneal dialysis has gained weight and has higher glucose levels. Which part of the treatment is the likely cause?

1. AGlucose absorbed from the dialysis fluid
2. BAir entering the abdomen during exchanges
3. CProtein lost into the dialysis fluid
4. DSodium lost into the dialysis fluid

A patient received IV insulin and glucose for hyperkalaemia an hour ago. What must the nurse monitor over the next few hours?

1. AUrine colour, for blood in the urine
2. BCapillary glucose, for hypoglycaemia
3. CSkin, for a drug rash
4. DPupils, for raised intracranial pressure

Which measures help prevent tumour lysis syndrome in high-risk patients?

1. AStopping all IV and oral fluids during the chemotherapy
2. BIV hydration with allopurinol or rasburicase
3. CFluid restriction with potassium tablets
4. DCalcium and phosphate supplements daily

After signing the consent form, a patient tells the nurse, "I don't really understand what they are going to do." What should the nurse do?

1. AIgnore the comment because the form is already signed
2. BInform the surgeon so that the procedure can be explained again
3. CReassure the patient that the surgeon knows best
4. DExplain the surgical risks in detail without involving the surgeon