Prioritas & Delegasi ala NCLEX: paket kilat

Before giving a scheduled dose of metoprolol, which assessment is most important?

1. ABlood glucose and weight
2. BTemperature and the latest pain score
3. CApical pulse and blood pressure
4. DBowel sounds and urine color

A medical-unit nurse is floated to intensive care and given a patient on a ventilator, which the nurse has never managed. What is the best response?

1. AAccept the full assignment without comment to avoid conflict
2. BTell the charge nurse about the gap, accept tasks within competence and ask for support
3. CRefuse to work and go home, because the assignment is unsafe
4. DLeave the intensive care unit and go back to the medical unit without telling anyone

A visitor with a cold wants to see a patient who has severe neutropenia. What should the nurse advise?

1. APostpone the visit until the visitor is well
2. BVisit only if the cold started more than a day ago
3. CVisit as usual after washing the hands
4. DVisit but avoid touching the patient’s bed

During flu season, a nurse wakes up with fever, cough and muscle aches. What is the best action?

1. ATake an antipyretic so the fever does not show at work
2. BGo to work but avoid caring for patients who have weak immune systems
3. CGo to work but wear a surgical mask for the whole shift
4. DStay home and inform the employer according to the illness policy

Laboratorium menelepon bangsal dengan hasil kalium kritis 6,9 mEq/L. Apa yang harus dilakukan perawat?

1. AMeminta laboratorium mengulang tes sebelum memberi tahu siapa pun
2. BMenunggu laporan tertulis tiba sebelum mengambil tindakan apa pun
3. CMembacakan kembali nilai, mengkaji pasien, dan memberi tahu penyedia layanan
4. DMencatat nilai dan menyerahterimakannya kepada giliran jaga berikutnya

The nurse teaches a patient with chronic kidney disease about a potassium-restricted diet. Which statement shows a need for further teaching?

1. A"I'll check food labels and ask my dietitian about portion sizes"
2. B"Dried apricots and raisins will be a good snack for me now"
3. C"I'll limit bananas, oranges and potatoes in my meals"
4. D"I can leach potatoes by soaking them before cooking them"

Which measure helps reduce the risk of surgical site infection?

1. AChanging the wound dressing every hour
2. BRemoving hair, if needed, with clippers rather than a razor
3. CLeaving the patient cool during surgery to slow bacterial growth
4. DShaving the area with a razor the night before surgery

A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?

1. AAnaphylaxis
2. BVasovagal syncope
3. CA stroke
4. DA hypoglycaemic coma

Which skin changes around the ankles are typical of chronic venous insufficiency?

1. AA sharply defined red patch with fever
2. BA cold, white foot with no pulse
3. CBrown staining, swelling and dry, itchy skin
4. DPale, shiny, hairless skin with weak pulses

A patient who injects drugs has a fever, a new heart murmur and splinter haemorrhages. Before antibiotics are started, what is most important?

1. ATake a single blood culture from the cannula
2. BArrange an exercise ECG test
3. CTake several sets of blood cultures from separate sites
4. DWait for an echocardiogram before taking any samples

What does a positive pronator drift test show?

1. AWeakness of the eye muscles
2. BLoss of hearing on one side
3. CA normal response in older adults
4. DSubtle weakness in one arm

A patient with diabetic neuropathy has a hot, red, swollen foot that is barely painful. The skin is intact, and there is no fever. What should the nurse suspect?

1. AA sprained ankle that will settle with walking
2. BAn acute Charcot foot, needing urgent offloading
3. CNormal swelling from standing too long
4. DGout, which only needs pain relief

Golongan obat mana yang umum digunakan untuk mengurangi asam setelah penanganan endoskopik ulkus peptikum yang berdarah?

1. APenghambat pompa proton
2. BDiuretik loop
3. CAntihistamin H1 seperti setirizin
4. DPenyekat beta

During radiotherapy to the chest, a patient develops pain on swallowing and is eating less. What is the most likely cause and nursing focus?

1. AA stomach ulcer; give an antacid after meals only
2. BNormal ageing; no action needed
3. CA heart attack; give aspirin and arrange an ECG
4. DRadiation oesophagitis; analgesia, soft food and nutrition support