Prioritas & Delegasi ala NCLEX: paket kilat

A malnourished patient admitted with alcohol use disorder needs IV glucose. Which vitamin is given before or with it?

1. AVitamin C (ascorbic acid)
2. BVitamin D (calciferol)
3. CThiamine (vitamin B₁)
4. DVitamin K (phytonadione)

A nurse has a needlestick injury from a used needle. What should the nurse do first?

1. ASqueeze the wound hard and suck it
2. BFinish the shift and report it tomorrow
3. CWash the area with soap and water
4. DScrub the area with bleach

Before inserting a peripheral IV, the nurse cleans the skin with chlorhexidine-alcohol. What should the nurse do next?

1. ABlow on the site so it dries faster
2. BFeel for the vein again with an ungloved finger
3. CWipe it off with a dry gauze straight away
4. DLet it dry fully and do not touch the site again

Seorang pasien bingung terus menarik selang nasogastrik. Pendekatan mana yang harus dicoba pertama kali?

1. ATindakan yang kurang membatasi, seperti reorientasi dan penjaga
2. BLangsung memasang restrain pergelangan tangan untuk melindungi selang
3. CMelepas selang tanpa berkonsultasi dengan tim
4. DSedatif agar pasien tidur tenang sepanjang malam

A patient with acute pancreatitis has muscle twitching and numbness around the mouth. Which laboratory value should the nurse check?

1. ASerum calcium
2. BSerum chloride
3. CSerum amylase
4. DSerum sodium

The nurse prepares a patient for a 2-hour oral glucose tolerance test tomorrow morning. Which statement shows a need for further teaching?

1. A"I can have a light breakfast before the test"
2. B"I'll fast overnight but can drink plain water"
3. C"I'll stay seated during the test if I can"
4. D"I'll avoid smoking until the test is over"

A patient taking a statin reports unexplained muscle pain and weakness. What should the nurse do?

1. AReport it, as statins can cause muscle damage
2. BAdvise more vigorous exercise to work through it
3. CReassure them that this is a sign the drug is working
4. DTell them to double the dose

A patient taking regular ibuprofen suddenly develops severe upper abdominal pain, a rigid abdomen and becomes tachycardic. What is most likely?

1. AA perforated peptic ulcer
2. BIrritable bowel syndrome
3. CIndigestion that will settle with antacids
4. DConstipation

A patient who had a leg amputation says they feel burning pain in the missing foot. What is the best response?

1. ATell the patient the pain must be imaginary as the foot has gone
2. BExplain that burning pain in the missing foot shows wound infection
3. CAdvise that it will be ignored until it stops
4. DExplain that phantom limb pain is real and arrange treatment

A patient with end-stage COPD has severe breathlessness at rest despite optimal treatment and wants comfort-focused care. Which measure is recognised to help?

1. AHigh-flow oxygen at 15 L/min whatever the oxygen saturation is
2. BA low-dose opioid with a hand-held fan and calm positioning
3. CStopping all medicines, including inhalers
4. DEncouraging long walks to build fitness

Why are patients with an acute spinal cord injury at high risk of deep vein thrombosis?

1. AThey usually take oestrogen as part of their treatment
2. BParalysed leg muscles no longer pump blood back to the heart
3. CSpinal injuries always damage the large veins of the legs
4. DThe injury makes the blood too thin to clot properly in the veins

A patient with a known ureteric stone develops a fever of 39 °C (102,2 °F) and rigors. Scanning shows a blocked, swollen kidney. What is needed?

1. AStrong pain relief alone, then discharge
2. BA fluid restriction to reduce the swelling
3. CUrgent drainage of the kidney plus IV antibiotics
4. DOral antibiotics and waiting for the stone to pass

Why are patients with diabetes often placed early on the operating list?

1. ABecause they need to go home before midday
2. BBecause their surgery always takes longer than others
3. CBecause their wounds heal faster in the morning
4. DTo shorten fasting and reduce swings in blood glucose

Using the adult rule of nines, what is the total burn area of the whole right arm plus the whole front of the trunk (both with partial-thickness burns)?

1. A27%
2. B36%
3. C18%
4. D45%