NCLEX-style Prioritization & Delegation: cram pack

An older patient becomes confused over a few hours, with attention that comes and goes. What does this suggest?

1. ALong-standing dementia that is expected
2. BDelirium, which needs the cause found quickly
3. CA personality change that is permanent and expected
4. DNormal aging that needs no action

Two days after starting haloperidol, a patient suddenly develops painful neck twisting and the eyes roll upwards. What should the nurse anticipate?

1. APhysical restraint until the spasm passes
2. BA higher dose of haloperidol to calm the patient and stop the movements quickly
3. CAn anticholinergic drug, such as benztropine or procyclidine, as prescribed
4. DNo action, because the spasm is a sign of improvement

When should a nurse use an extinguisher on a fire?

1. AOnly if the fire is small, the alarm is raised and the exit is clear
2. BNever; only firefighters may use fire extinguishers
3. CWhenever there is smoke, even if the exit is blocked
4. DAlways, even before the alarm has been raised, to save time

A nurse teaches new parents how to cope with an infant’s crying. Which statement shows a need for further teaching?

1. A“I can call a friend or family member to help when I am tired.”
2. B“If he won’t stop crying, a quick shake will get his attention.”
3. C“I will check whether he is hungry, wet or too warm.”
4. D“If I get frustrated, I will put him safely in the crib and take a short break.”

An older adult takes lisinopril and furosemide and recently started daily ibuprofen for knee pain. The creatinine has risen from 1.0 to 1.8 mg/dL (88 to 159 µmol/L). What is the most likely cause?

1. AThe NSAID reduces kidney blood flow on top of the other two drugs
2. BNormal aging of the kidneys over a period of a few weeks
3. CMore activity has increased the patient's muscle mass quickly
4. DA laboratory error, since ibuprofen has no effect on the kidney

A patient with severe hypertriglyceridemia has a measured sodium of 128 mEq/L, but a measured serum osmolality is normal, and the patient has no symptoms. What is the most likely explanation?

1. AHyponatremia caused by drinking far too much water
2. BHyponatremia caused by severe hyperglycemia in diabetes
3. CPseudohyponatremia, an artifact caused by very high lipids
4. DTrue hyponatremia from SIADH that needs fluid restriction

Which of these is one of the "4 Hs", the reversible causes of cardiac arrest?

1. AHyperthyroidism
2. BHypertension
3. CHyperventilation
4. DHypoxia

A patient with myasthenia gravis develops increasing difficulty swallowing and weak, shallow breathing. What is the main danger?

1. AA sudden rise in blood glucose from the stress
2. BA urinary tract infection
3. CRespiratory failure from a myasthenic crisis
4. DSevere hypertension from anxiety

A patient in cardiac rehabilitation asks how hard to exercise. Which simple guide is commonly taught?

1. AExercise until chest pain starts, then stop
2. BExercise until they are too breathless to speak at all
3. CExercise only until the heart rate rises even slightly
4. DExercise so they are a little breathless but can still talk

The stump of a recent below-knee amputation suddenly bleeds heavily through the dressing. What should the nurse do first?

1. AEncourage the patient to walk on crutches to ease the pressure
2. BApply a warm compress to the stump
3. CApply firm direct pressure and call for urgent surgical help
4. DRemove all the dressings and wait for the bleeding to stop by itself

Several hours after a carotid endarterectomy, which finding needs the most urgent action?

1. AAn expanding neck swelling with noisy breathing
2. BA small amount of dried blood on the dressing
3. CA blood pressure slightly above the baseline
4. DMild pain at the incision site

Why may HbA1c be unreliable in a patient with haemolytic anaemia or a recent large blood transfusion?

1. AAnaemia always makes the HbA1c very high
2. BIt depends on how long red blood cells survive in the blood
3. CThe test only measures the glucose in the plasma, not in the cells
4. DBlood transfusions contain large amounts of glucose

Why are many patients screened for MRSA before planned surgery?

1. ASo that carriers can be decolonised to reduce infection
2. BTo check whether the patient has had a flu vaccine
3. CTo decide which anaesthetic drug to use
4. DSo that surgery can be cancelled for all positive patients

Which preoperative task can a registered nurse usually delegate to a healthcare assistant (nursing assistant)?

1. ARecording baseline vital signs
2. BAssessing the patient's understanding of the surgery
3. CDeciding whether abnormal results need reporting
4. DTeaching the patient how to use a PCA pump