NCLEX-style Prioritization & Delegation: cram pack

A charge nurse needs to free a bed. Which patient is most appropriate for discharge or transfer to a lower level of care?

1. ADay 1 after bowel surgery with a new temperature of 38.5 °C
2. BDay 3 after uncomplicated appendectomy, eating, on oral analgesia
3. CPneumonia, with an oxygen need that rose overnight from 2 to 4 L/min
4. DAdmitted two hours ago with chest pain; troponin result still pending

On a cardiac unit, which patient should the nurse see first?

1. AA patient with heart failure who has gained 0.3 kg since yesterday
2. BA patient taking digoxin with a pulse of 48/min, nausea and a potassium of 3.0 mEq/L
3. CA patient with atrial fibrillation whose heart rate is 88/min and irregular, as before
4. DA patient who has been asked to fast before a scan tomorrow

A confused patient keeps pulling at an IV line. Which is a less restrictive option to consider before wrist restraints?

1. ATying both arms to the bed frame
2. BGiving a sedative every few hours
3. CUsing a vest restraint in the chair so that the patient’s hands stay down
4. DCovering the site with a sleeve or using hand mitts with supervision

A nurse has given a medication to the wrong patient. The patient seems well. What is the first priority?

1. ASay nothing to the patient, in order to avoid worrying them
2. BWait until the end of the shift to tell anyone
3. CAssess the patient and monitor for effects of the drug
4. DComplete the incident report before anything else

A patient's eGFR has fallen to 24 mL/min/1.73 m². Which prescribed drug should the nurse question before giving it?

1. AAcetaminophen (paracetamol)
2. BLevothyroxine
3. CInsulin glargine
4. DMetformin

A patient with a serum albumin of 1.9 g/dL (19 g/L) has signs of phenytoin toxicity, although the total phenytoin level is in the usual range. What is the most likely explanation?

1. ALow albumin makes the total level falsely high in all cases
2. BLow albumin stops phenytoin from crossing into the brain
3. CLow albumin makes the liver clear phenytoin much faster
4. DLow albumin raises the free (active) fraction of phenytoin

Which ECG change is typical of hypokalaemia?

1. ATall, peaked T waves
2. BA very short PR interval with a delta wave
3. CFlattened T waves and prominent U waves
4. DST elevation in leads II, III and aVF

A patient with diabetes is found confused with slurred speech and weakness on one side. What should the nurse check first?

1. ACapillary blood glucose
2. BUrine output for the last day
3. CSerum cholesterol
4. DBody mass index

Which laboratory test is used to adjust an unfractionated heparin infusion?

1. AaPTT (or anti-Xa level)
2. BSerum fibrinogen level
3. CD-dimer level
4. DINR (international normalised ratio)

A patient with rheumatoid arthritis is due to start an anti-TNF biologic drug. Which screening is essential beforehand?

1. AA sweat chloride test
2. BAn exercise ECG test on a treadmill
3. CScreening for latent tuberculosis
4. DA peak flow diary for a month

A patient has acute glomerulonephritis with oedema and high blood pressure. Which nursing care is most appropriate?

1. AGive large amounts of IV fluid
2. BCheck the weight once a week
3. CEncourage a high-salt diet to balance the fluids
4. DMonitor BP, fluid balance and daily weight

At 03:00 a patient's glucose is 3.6 mmol/L, but before breakfast it is high. They take a long-acting insulin in the evening. What should the nurse do?

1. AIgnore the night reading and act on the morning value only
2. BTreat the low and report the pattern so the evening dose is reviewed
3. CStop all insulin permanently and monitor glucose four-hourly
4. DGive extra insulin at 03:00 because the morning value will be high

Which risk is particularly linked with tramadol?

1. ASerotonin syndrome with some antidepressants, and seizures
2. BHigh blood pressure that needs emergency treatment in most patients
3. CSevere stomach ulcers in all patients
4. DRapid liver failure at normal doses

On day 2 after upper abdominal surgery, a patient has a temperature of 37.8 °C, SpO₂ 93% on air and reduced breath sounds at both bases. They have not used their incentive spirometer because of pain. What is the most appropriate nursing plan?

1. AStop all analgesia so that the patient can cough more strongly
2. BBetter pain control, sitting up, deep breathing, mobilising and reporting
3. CGive oxygen at 15 L/min and leave the patient to rest quietly
4. DKeep the patient in bed and restrict movement until the fever settles