Prioritas & Delegasi ala NCLEX: paket kilat

Pernyataan mana yang menunjukkan pemahaman yang benar tentang akuntabilitas dalam pendelegasian?

1. A"Begitu saya mendelegasikan suatu tugas, itu bukan lagi urusan saya."
2. B"Asisten keperawatan bertanggung jawab atas apakah tugas itu tepat didelegasikan."
3. C"Saya tetap bertanggung jawab atas keputusan mendelegasikan dan menindaklanjuti hasilnya."
4. D"Jika tugas itu salah, hanya asistennya yang bertanggung jawab."

A patient suddenly has severe pain in one leg. The leg is pale and cold with no pedal pulse. What does this suggest?

1. AChronic venous insufficiency that needs elevation
2. BA deep vein thrombosis that can be treated next week
3. CA muscle cramp that will pass with stretching
4. DAcute arterial occlusion, which is an emergency

Saat memakai sarung tangan steril, bagaimana perawat memakai sarung tangan kedua?

1. AMenarik sarung tangan kedua pada ujung jarinya dengan tangan telanjang
2. BMenggunakan tangan telanjang untuk merapikan sisi luar sarung tangan pertama
3. CMenyelipkan jari bersarung tangan di bawah manset sarung tangan kedua dan menariknya
4. DMemegang sisi dalam sarung tangan kedua dengan tangan bersarung tangan

A nurse teaches a patient going home with an MRSA wound infection. Which statement shows a need for further teaching?

1. A“I will put used dressings in a sealed bag before throwing them out.”
2. B“I can share towels with my family if I wash them every week.”
3. C“I will wash my hands after touching my dressing.”
4. D“I will keep the wound covered with a clean, dry dressing.”

A patient on warfarin has an INR of 7,8 and a nosebleed. Which medication would the nurse expect the provider to prescribe?

1. ANaloxone hydrochloride
2. BAcetylcysteine
3. CVitamin K (phytonadione)
4. DProtamine sulfate

A patient admitted with heavy alcohol use and malnutrition has a glucose of 52 mg/dL (2,9 mmol/L) and low magnesium. Which prescribed treatment should be given before the IV glucose?

1. AIV potassium
2. BIV insulin
3. COral iron
4. DIV thiamine

Why is an urgent brain scan needed before thrombolysis for a suspected stroke?

1. ATo rule out bleeding in the brain
2. BTo check for brain tumours only
3. CTo measure the size of the ventricles
4. DTo confirm the patient's age

Hasil tes darah seorang pasien menunjukkan kalium 6,8 mmol/L dan EKG menunjukkan gelombang T runcing. Pengobatan mana yang paling cepat melindungi jantung?

1. ASuplemen kalium oral
2. BKalsium glukonat IV
3. CHanya diet rendah kalium
4. DTablet furosemid keesokan harinya

A patient is starting doxazosin, an alpha-blocker, for hypertension. Which advice is most important?

1. AStop it suddenly if the heart rate rises after the first few doses
2. BTake the first dose at bedtime, as dizziness and fainting can occur
3. CAvoid all potassium-containing foods
4. DTake it with a large glass of grapefruit juice to improve absorption

Selang drainase dada pasien terlepas dari unit drainase. Apa yang harus dilakukan perawat pertama kali?

1. AMelepas drain dari dada dan menutup lokasi
2. BMenyambungkannya kembali, atau memasukkan ujung selang ke air steril, lalu mengkaji
3. CMembiarkannya terbuka ke udara sampai dokter datang meninjau
4. DMengklem selang selama beberapa jam dan memeriksa pasien kemudian

How does the nurse test the facial nerve (VII)?

1. AAsk the patient to stick out the tongue and move it from side to side
2. BTouch the forehead, cheek and chin with cotton wool
3. CAsk them to raise the eyebrows, shut the eyes tightly and smile
4. DShine a light in each eye and check the pupil response

Seorang pasien dialisis peritoneal menyadari bahwa cairan yang keluar lebih sedikit daripada yang dimasukkan. Ia belum buang air besar selama empat hari, dan efluen jernih. Apa penyebab yang paling mungkin?

1. APenyerapan normal tanpa perlu tindakan
2. BKonstipasi yang menghalangi aliran keluar
3. CDialisat diberikan terlalu dingin
4. DPeritonitis bakteri

Nasihat makanan mana yang mengurangi risiko sumbatan pada ileostomi baru?

1. AMenelan makanan dengan cepat tanpa banyak mengunyah
2. BMinum sangat sedikit cairan agar keluaran tetap kental
3. CMakan banyak kacang dan biji sejak hari pertama
4. DMengunyah dengan baik, dan memasukkan makanan berserat secara perlahan

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. AUse the highest NSAID dose to shorten the course
2. BCombine two different NSAIDs at lower doses
3. CTake the NSAID with a glass of milk instead of food
4. DConsider an alternative; if an NSAID is needed, add a PPI