NCLEX-style Prioritization & Delegation: cram pack

A stable adult with normal vital signs has a cut on the hand that needs sutures and nothing else. Which ESI level fits?

1. ALevel 4
2. BLevel 3
3. CLevel 5
4. DLevel 2

After report, which patient should the nurse assess first?

1. ADay 2 after gallbladder surgery: pain 6/10, next analgesic due in 30 minutes
2. BCOPD on 2 L/min oxygen: SpO₂ 90%, respiratory rate 22/min, at usual baseline
3. C1 hour after femoral cardiac catheterization: new back pain, pulse 118/min, BP 92/58 mmHg
4. DType 2 diabetes: glucose 210 mg/dL (11.7 mmol/L) before lunch, no symptoms

A child has swallowed a button battery. Why is this urgent?

1. AThe only risk is poisoning from heavy metals years later
2. BIt can burn through the lining of the esophagus within hours
3. CIt always passes through the gut without harm
4. DIt is only harmful if several batteries are swallowed

Two look-alike vials of different drugs are stored next to each other, and a nurse almost picks the wrong one. Which response best reflects a just culture?

1. AReport it and fix the system, for example by separating the vials
2. BTell the nurse to be more careful and do nothing else
3. CDiscipline the nurse who nearly picked the wrong vial
4. DKeep the incident quiet to protect the unit’s reputation

A patient with acute pancreatitis has muscle twitching and numbness around the mouth. Which laboratory value should the nurse check?

1. ASerum amylase
2. BSerum chloride
3. CSerum sodium
4. DSerum calcium

At the start of a shift, the nurse reviews four new results. Which patient needs attention first?

1. AHemoglobin 11.0 g/dL (110 g/L) in a patient with rheumatoid arthritis
2. BSodium 119 mEq/L in a patient with new confusion and vomiting
3. CGlucose 180 mg/dL (10 mmol/L) after a meal in a patient with diabetes
4. DPotassium 5.2 mEq/L in a patient with stable chronic kidney disease

A patient on insulin reports nightmares, night sweats and morning headaches. What should be suspected?

1. ARaised intracranial pressure
2. BHyperthyroidism
3. CA urinary tract infection
4. DNight-time hypoglycaemia

In triage, which patient should be seen first?

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

A patient who had a leg amputation says they feel burning pain in the missing foot. What is the best response?

1. ATell the patient the pain must be imaginary as the foot has gone
2. BAdvise that it will be ignored until it stops
3. CExplain that burning pain in the missing foot shows wound infection
4. DExplain that phantom limb pain is real and arrange treatment

During tracheal suctioning, a patient's heart rate drops from 88/min to 48/min. What should the nurse do?

1. AStop suctioning, give oxygen and monitor the patient
2. BGive a dose of atropine without a prescription
3. CIncrease the suction pressure to finish faster
4. DContinue suctioning until the airway is completely clear

After a kidney biopsy, which observation is most important?

1. ASigns of bleeding, such as haematuria and a rising pulse
2. BThe temperature every four hours only
3. CThe patient's appetite at the next meal
4. DThe colour of the patient's skin on the face

Two days after an ileal conduit was formed, the stoma is dark purple and dry. What should the nurse do?

1. AChange the bag and check again next week
2. BApply a warm compress to improve the colour of the stoma
3. CReport it urgently, because the stoma may be ischaemic
4. DRecord it as normal for a new stoma

Which signs suggest severe acute pancreatitis with bleeding into the tissues?

1. ASwelling of the lips, tongue and face
2. BBruising around the umbilicus or flanks
3. CA purple rash on the palms and soles
4. DYellow discolouration of the fingernails

A patient has negative pressure wound therapy. The pump alarms and the dressing has lost its seal. What is the most appropriate action?

1. ARestore the seal; if that fails in time, change to a moist dressing
2. BLeave the foam in the wound without suction for several days until review
3. CPack the wound with dry gauze over the foam and tape it tightly
4. DTurn the suction up to its maximum setting to pull the seal back