NCLEX-style Prioritization & Delegation: cram pack

A nurse cannot read part of a medication order. What should the nurse do?

1. ASkip the drug and not tell anyone until the next ward round
2. BGive the usual dose of the drug the nurse thinks was meant
3. CContact the prescriber to clarify the order before giving the drug
4. DAsk another nurse to guess what the order most likely says, then give it

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

1. A2 days after colostomy formation: stoma moist and pink, small amount of output
2. B6 hours after carotid endarterectomy: neck swelling increasing, says it is hard to swallow
3. CAfter prostate surgery with bladder irrigation: light pink urine, no clots
4. D2 days after hip replacement: pain 5/10 on moving, analgesic given 1 hour ago

A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?

1. AGive syrup of ipecac from the medicine cabinet
2. BMake the child vomit, using a finger at the back of the throat
3. CContact the local poison advice service now for specific advice
4. DWait to see whether any symptoms develop over the next day

A unit keeps vials of concentrated potassium chloride in the ward stock cupboard. Why do many safety guidelines advise against this?

1. APotassium chloride must always be given by mouth
2. BPotassium chloride is too expensive to keep as general ward stock
3. CUndiluted concentrate given by mistake can stop the heart
4. DPotassium chloride vials expire within a day of opening

A patient has started parenteral nutrition (PN) through a central line. Which test is monitored most frequently in the first days?

1. ASerum lipase
2. BThyroid hormones
3. CBlood glucose
4. DHemoglobin A1c

A child with sickle cell disease and a recent viral illness is pale and tired. The hemoglobin has fallen sharply, and the reticulocyte count is very low. What is the most likely problem?

1. AAn aplastic crisis, often caused by parvovirus B19
2. BA normal finding in sickle cell disease
3. CIron deficiency from a poor diet over months
4. DA vaso-occlusive pain crisis in the bones

Why must levodopa for Parkinson's disease be given at the exact times prescribed in hospital?

1. ALate doses cause dangerous high potassium
2. BDelays can quickly worsen rigidity, immobility and swallowing
3. CEarly doses cause severe low blood glucose and sweating attacks
4. DThe drug only works if taken at midnight

A patient's blood test shows potassium 6.8 mmol/L and the ECG shows peaked T waves. Which treatment protects the heart most quickly?

1. AIV calcium gluconate
2. BOral potassium supplements
3. CFurosemide tablets the next day
4. DA low-potassium diet only

After varicose vein surgery, which advice is usually given?

1. AStand still for long periods to help the veins heal
2. BAvoid all walking until the bruising has gone
3. CWear the compression stockings as advised and walk regularly
4. DStay in bed for two weeks with the legs hanging down

A patient's chest drain tubing disconnects from the drainage unit. What should the nurse do first?

1. ARemove the drain from the chest and cover the site
2. BClamp the tube for several hours and recheck the patient later
3. CLeave it open to air until the doctor arrives to review it
4. DReconnect it, or put the tube end in sterile water, then assess

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 works within hours by relaxing the bladder muscle
3. CIt takes months to work; pregnant women must not handle broken tablets
4. DIt is used only for a few days at a time

After removal of a cortisol-producing adrenal adenoma, why may the patient need hydrocortisone for months?

1. AThe tumour will grow back quickly without it
2. BThe other adrenal gland has been suppressed
3. CThe operation always removes both adrenal glands
4. DHydrocortisone helps the wound to heal

Which description fits a category (stage) 4 pressure ulcer?

1. AIntact skin with redness that does not blanch
2. BA blister filled with clear fluid over the heel or sacrum
3. CFull-thickness loss with exposed bone, tendon or muscle
4. DA shallow wound into the dermis only

A 76-year-old with a past peptic ulcer needs long-term anti-inflammatory treatment for arthritis. Which plan best reduces GI bleeding risk?

1. AConsider an alternative; if an NSAID is needed, add a PPI
2. BTake the NSAID with a glass of milk instead of food
3. CUse the highest NSAID dose to shorten the course
4. DCombine two different NSAIDs at lower doses