NCLEX-style Prioritization & Delegation: cram pack

During an IV vancomycin infusion, a patient develops flushing and itching of the face and neck. What should the nurse do first?

1. AApply a warm compress to the face and neck
2. BIgnore it, because flushing is always harmless and passes
3. CStop or slow the infusion and inform the provider
4. DSpeed up the infusion to finish it quickly

Which patient finding is unexpected and needs action after a transurethral resection of the prostate with continuous bladder irrigation?

1. ALight pink urine that becomes clearer over the day
2. BA feeling of needing to pass urine despite the catheter
3. CBright red urine with clots and reduced flow out of the catheter
4. DMild bladder spasms that ease with the prescribed antispasmodic medication

A patient has leftover opioid tablets after surgery. Which advice about disposal is best?

1. AKeep them in an unlocked drawer at home in case of future pain
2. BLeave them in the bathroom cabinet indefinitely
3. CReturn them to a pharmacy or an approved take-back site
4. DGive them to a friend or relative who has back pain

During a urinary catheter insertion with sterile technique, the catheter tip touches the patient’s thigh. What should the nurse do?

1. AContinue, because the thigh was cleaned
2. BDiscard the catheter and use a new sterile one
3. CRinse the tip with sterile water and then continue
4. DWipe the tip with an antiseptic and continue

A patient on warfarin started eating large daily portions of kale and spinach. The INR has fallen. What advice is most appropriate?

1. ADouble the warfarin dose without telling the prescriber
2. BNever eat green vegetables again
3. CStop warfarin until the diet is normal
4. DKeep the intake of vitamin K–rich foods steady from day to day

A patient with chronic hyponatremia (sodium 118 mEq/L) is being treated. Why must the sodium be raised slowly?

1. ARapid correction causes hypokalemia, which is the only risk
2. BSlow correction is needed only to reduce hospital costs
3. CRapid correction makes the sodium fall again even further
4. DIt can cause osmotic demyelination, a serious brain injury

Which measure helps prevent delirium in older inpatients?

1. AReorientation, glasses and hearing aids in use, and good sleep and hydration
2. BRestricting fluids to avoid incontinence
3. CKeeping the lights on all night
4. DMoving the patient to a different bed each night to give them a change of scene

An older patient's blood pressure is 142/80 mmHg lying and 116/72 mmHg after standing for three minutes, and they feel dizzy. What does this show?

1. AWhite coat hypertension
2. BPostural hypotension
3. CNormal blood pressure variation
4. DHypertensive emergency

What is the purpose of cardiac resynchronisation therapy (a biventricular pacemaker)?

1. ATo slow the atrial rate in patients with atrial fibrillation
2. BTo make both ventricles contract together and more efficiently
3. CTo deliver a shock whenever the heart rate exceeds 100/min
4. DTo replace a damaged heart valve

Four hours after abdominal surgery, a patient's heart rate has risen from 84 to 122/min and they are restless and pale. BP is still 118/76 mmHg, and the surgical drain is filling with blood. What should the nurse conclude?

1. AThe patient is stable because the blood pressure is normal
2. BEarly haemorrhagic shock is likely, so escalate urgently
3. CThe drain is working well, so no action is needed
4. DThe tachycardia is from pain and needs only analgesia

A man starts finasteride for an enlarged prostate. Which statement is correct?

1. AIt lowers the blood pressure, so dizziness is very common
2. BIt is used only for a few days at a time
3. CIt works within hours by relaxing the bladder muscle
4. DIt takes months to work; pregnant women must not handle broken tablets

A man who takes tamsulosin for BPH is listed for cataract surgery. Which statement is correct?

1. AIt should be swapped for oxybutynin the night before to protect the eye
2. BTamsulosin has no effects outside the urinary tract, so nothing changes
3. CThe eye surgeon must be told, as it can cause floppy iris during surgery
4. DThe dose should be doubled before surgery to prevent urinary retention

Which approach to red cell transfusion in a stable patient with a GI bleed fits current evidence?

1. ANever transfuse, whatever the haemoglobin or the symptoms
2. BTransfuse everyone to keep the haemoglobin above 150 g/L at all times
3. CTransfuse two units routinely before every endoscopy
4. DA restrictive threshold, often around 70 g/L, in most stable patients

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. AGive a diuretic to increase urine flow
2. BRestrict fluids until the urge returns
3. CCatheterise as per protocol or prescription
4. DWait another twelve hours before acting