NCLEX-style Prioritization & Delegation: cram pack

Which scheduled medication is the most time-critical?

1. AA daily multivitamin tablet due at 08:00
2. BRapid-acting insulin due with a breakfast tray that has arrived
3. CA daily cholesterol-lowering statin tablet due with breakfast at 08:00
4. DA daily stool softener due with breakfast

A patient with diabetic ketoacidosis is about to start an IV insulin infusion. The serum potassium is 3.0 mEq/L. What should the nurse do?

1. AReport the result before starting, because insulin will push potassium even lower
2. BGive the insulin as a fast bolus to bring the potassium up
3. CStart the insulin at once, because the glucose is the bigger problem
4. DIgnore the result, since potassium is always high in this condition and will correct itself

Before helping a patient from bed into a wheelchair, what should the nurse do with the wheelchair?

1. ALock the brakes and place it close to the bed on the patient’s stronger side
2. BPlace it at the foot of the bed, facing away
3. CLeave the brakes off so the chair can move along with the patient during the pivot
4. DPlace it on the patient’s weaker side so that side is supported

A nurse teaches the daughter of a patient with moderate Alzheimer’s disease about home safety. Which statement shows a need for further teaching?

1. A“We put locks high up on the outside doors.”
2. B“I keep her medicines locked away and give each dose to her myself.”
3. C“She wears an ID bracelet in case she gets lost.”
4. D“I let Mom cook alone on the gas stove because she enjoys it.”

During a red cell transfusion, when are serious acute reactions most likely, so the nurse stays with the patient?

1. AAfter the last drop is given
2. BIn the first 15 minutes
3. CAfter about 2 hours
4. DThe next morning

The nurse teaches a patient starting lithium. Which statement shows a need for further teaching?

1. A"I will cut out salt from my diet completely to stay healthy"
2. B"I will check with the pharmacist before taking ibuprofen"
3. C"I will drink plenty of fluids, especially in hot weather"
4. D"I will tell my doctor if I have vomiting or diarrhea"

For a patient in skin traction on the leg, which is correct?

1. AThe rope is tied to the bed frame to keep it still
2. BThe weights hang freely and do not rest on the bed or floor
3. CThe weights rest on the floor overnight
4. DThe weights are removed whenever the patient feels uncomfortable

Why should potassium chloride concentrate never be given as a rapid intravenous injection?

1. AIt crystallises in the vein and blocks the cannula
2. BIt has no effect when given fast
3. CIt can cause fatal cardiac arrhythmias
4. DIt causes immediate kidney failure

Which ECG finding is typical of atrial flutter?

1. AP waves with no relationship to the QRS complexes
2. BA chaotic baseline with no clear P waves and irregular QRS
3. CWide, bizarre QRS complexes at 180/min
4. DRegular sawtooth flutter waves between QRS complexes

A patient on spironolactone and an ACE inhibitor has a potassium of 6.8 mmol/L (6.8 mEq/L) with peaked T waves. What is usually given first to protect the heart?

1. AAn IV furosemide bolus as the only treatment
2. BIntravenous calcium gluconate or chloride
3. COral potassium supplements
4. DA dose of digoxin

Why might a patient taking a beta-blocker not notice a hypoglycaemic episode?

1. ABeta-blockers make the patient sleep through every hypo
2. BBeta-blockers block the effect of all diabetes medicines
3. CBeta-blockers raise blood glucose, so hypos cannot happen
4. DBeta-blockers can mask the tremor and racing heart of a hypo

Which task for a stroke patient can a registered nurse safely delegate to a healthcare assistant (nursing assistant)?

1. ACarrying out the first bedside water swallow screen after admission
2. BAssessing a new weakness the patient reports in the leg
3. CRepositioning the patient every two hours as set out in the care plan
4. DTeaching the patient how to take a new anticoagulant

A day after a spinal anaesthetic, a patient has a headache that is worse when sitting up and better when lying flat. What is the most likely cause?

1. ARaised blood pressure from pain
2. BMigraine caused by hospital lighting
3. CPost-dural puncture headache
4. DA side effect of the antibiotic

Six hours after surgery, a patient has not passed urine, has lower abdominal discomfort and a bladder scan shows 750 mL. What should the nurse do?

1. AWait another twelve hours before acting
2. BGive a diuretic to increase urine flow
3. CCatheterise as per protocol or prescription
4. DRestrict fluids until the urge returns