NCLEX-style Prioritization & Delegation: cram pack

On a pediatric unit, which child does the nurse assess first?

1. AA child with asthma who is now quiet with very little air movement
2. BA child in a new arm cast with pink, warm fingers and pain of 5/10
3. CA child with a temperature of 38.2 °C after vaccination
4. DA child with croup who has a barking cough but no stridor at rest

A nurse is supervising a new nursing assistant. When should the nurse check the assistant’s work most closely?

1. AOnly at the end of the shift, when the documentation is reviewed
2. BNever, because the assistant holds a certificate for the role
3. COnly when the assistant asks for help with a task they find difficult
4. DWhen the assistant is new to the task or the patient is less stable

A patient has received oral radioactive iodine therapy. Which precaution is usually taken?

1. APlace the patient on droplet precautions with a surgical mask
2. BLet the patient share a bathroom with other patients
3. CEncourage pregnant visitors to sit close to the patient to give emotional support
4. DLimit time close to the patient and handle body fluids per radiation policy

A patient’s blood splashes onto a nurse’s forearm. The skin is intact. What is the correct response?

1. AWash the area with soap and water, then follow the reporting policy
2. BScrub the area with undiluted bleach
3. CDo nothing, because intact skin cannot be contaminated
4. DStart HIV post-exposure prophylaxis right away, before any other step is taken

How often is the INR usually checked when warfarin is first started?

1. AOnly if bleeding occurs at home
2. BOnce a year, at a routine visit
3. CEvery few days, until it is stable
4. DEvery hour, during the first week

A patient with metastatic breast cancer has a calcium of 13.2 mg/dL (3.3 mmol/L), is confused and constipated. Which prescribed treatment would the nurse expect to start first?

1. AA thiazide diuretic
2. BOral calcium supplements
3. CIV 0.9% sodium chloride
4. DStrict bed rest

A patient with sickle cell disease is admitted with a painful crisis. What is a key early nursing priority?

1. AGiving prompt, effective analgesia
2. BApplying cold packs to the painful areas
3. CRestricting oral fluids
4. DDelaying pain relief until a diagnosis is confirmed

Which action is correct when caring for a chest drain with an underwater seal?

1. ARemove the water from the bottle to prevent spills
2. BClamp the tube routinely during every transfer or bed move
3. CLift the bottle above the patient to empty it
4. DKeep the drainage bottle below the level of the chest

Why must inspired air be humidified for a patient with a tracheostomy?

1. AHumidified air contains more oxygen than dry air at the same flow
2. BThe nose and upper airway, which warm and moisten air, are bypassed
3. CHumidification prevents the cuff from deflating
4. DDry air is needed to stop secretions forming in the trachea

After a car crash, a patient is severely breathless with absent breath sounds on the right, a deviated trachea, distended neck veins and BP 76/40 mmHg. What is the immediate management?

1. ALying the patient flat with the legs raised
2. BInsertion of a urinary catheter to monitor output
3. CA chest X-ray to confirm the diagnosis before any treatment
4. DUrgent needle or finger decompression of the right chest

After IV thrombolysis for stroke, which observations are most important in the first 24 hours?

1. AFrequent neurological checks and BP
2. BBowel sounds and abdominal girth hourly
3. CDaily weight and the fluid balance only
4. DHourly peak flow and oxygen saturation

At 03:00 a patient's glucose is 3.6 mmol/L, but before breakfast it is high. They take a long-acting insulin in the evening. What should the nurse do?

1. AStop all insulin permanently and monitor glucose four-hourly
2. BTreat the low and report the pattern so the evening dose is reviewed
3. CGive extra insulin at 03:00 because the morning value will be high
4. DIgnore the night reading and act on the morning value only

Which statement about pain in older adults is correct?

1. APain is a normal part of ageing and does not need any treatment at all
2. BThey may under-report pain, so active assessment is needed
3. COlder adults feel less pain because nerves wear out
4. DOpioids must never be used in people over 70

A nurse teaches a patient about a fentanyl skin patch. Which statement shows a need for further teaching?

1. A"I won't put a hot water bottle over the patch."
2. B"I'll fold used patches sticky sides together before disposal."
3. C"I'll put the new patch on a different area of skin."
4. D"I can cut the patch in half if I need less."