NCLEX-style Prioritization & Delegation: cram pack

During labor, the nurse sees the umbilical cord in the vagina after the membranes rupture. What is the first action?

1. AWait for the next contraction before acting
2. BRelieve pressure on the cord by lifting the presenting part with a gloved hand
3. CPush the cord back into the uterus
4. DAsk the patient to walk around the room to bring the baby lower and speed up labor

Which patient needs airborne precautions rather than droplet precautions?

1. AA child with pertussis (whooping cough)
2. BA teenager with mumps
3. CA child with chickenpox (varicella)
4. DAn adult with influenza

An infusion pump’s drug library warns that the programmed dose is above the safe limit. What should the nurse do?

1. AOverride the alert, because pump alerts are often wrong
2. BSwitch off the drug library for this infusion
3. CContinue the infusion and recheck the pump at the end of the shift
4. DRecheck the order, the calculation and the pump settings first

While preparing a chemotherapy infusion, the drug splashes onto a nurse’s forearm. What should the nurse do first?

1. AFinish hanging the infusion and then wash the skin
2. BCover the area with a dressing and report later
3. CRemove contaminated PPE and wash the skin with soap and water at once
4. DWipe the skin with an alcohol swab and continue preparing the infusion

A trauma patient receives 2 L of IV crystalloid. The hemoglobin falls from 13.0 to 11.4 g/dL (130 to 114 g/L), and the vital signs are now stable. Which explanation is most likely?

1. AA sudden failure of the bone marrow
2. BIncreased red cell production
3. CDilution of the blood by the IV fluid
4. DA laboratory error in the first sample

A patient on digoxin has a calcium of 12.1 mg/dL (3.0 mmol/L) and new nausea and a slow pulse. Why is the calcium result important?

1. AHigh calcium makes the kidneys clear digoxin faster
2. BHigh calcium increases the risk of digoxin toxicity
3. CHigh calcium blocks digoxin, so the drug stops working
4. DHigh calcium only matters if the potassium is also high

A patient with liver cirrhosis becomes confused and drowsy, with a flapping tremor of the hands. Which complication is likely?

1. AStroke
2. BAlcohol intoxication only
3. CHypoglycaemia caused by insulin
4. DHepatic encephalopathy

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

1. ALift the bottle above the patient to empty it
2. BKeep the drainage bottle below the level of the chest
3. CClamp the tube routinely during every transfer or bed move
4. DRemove the water from the bottle to prevent spills

Why are patients with mitral stenosis at high risk of atrial fibrillation?

1. AThe left atrium enlarges as it pushes blood through the narrow valve
2. BThe narrow valve presses on the sinus node and slows it down directly
3. CThe coronary arteries become blocked by the valve
4. DThe right ventricle shrinks and stops contracting properly over time

Which instruction from the registered nurse to a healthcare assistant (unlicensed assistive personnel) caring for a patient with COPD is most appropriate?

1. A"Listen to his chest after lunch and let me know what you can hear."
2. B"Turn his oxygen up to whatever he needs if he looks short of breath."
3. C"Teach him how to use his new inhaler this afternoon after his rest."
4. D"Tell me straight away if his SpO₂ is under 88% or he is more breathless."

Which picture fits anterior cord syndrome?

1. AArms much weaker than legs after a neck injury
2. BNormal movement but complete loss of position sense
3. CWeakness on one side and loss of pain sensation on the other side
4. DLoss of movement and pain sense, with position sense kept

A kidney transplant recipient has had vomiting and diarrhoea for two days. Why should the transplant team be contacted?

1. AVomiting proves that rejection has already happened
2. BThe kidney will start to produce far too much urine
3. CThe patient may not be absorbing their immunosuppressants
4. DThe tablets will make the vomiting stop

Why are carbohydrate drinks often given before surgery in enhanced recovery programmes?

1. ATo raise the blood pressure during the anaesthetic
2. BTo make the bowels open before the operation
3. CTo reduce insulin resistance and improve recovery
4. DTo replace the need for any IV fluids afterwards

On day 3 after laparoscopic cholecystectomy, a patient has abdominal pain, fever and mild jaundice, and green fluid is draining from the drain. What is most likely?

1. AA bile leak
2. BNormal post-operative drainage
3. CA wound haematoma
4. DUrinary retention