Prioritas & Delegasi ala NCLEX: paket kilat

A patient with asthma has two inhalers: a corticosteroid and salbutamol (albuterol). Which statement shows a need for further teaching?

1. A“I will carry my salbutamol inhaler with me.”
2. B“I will use my steroid inhaler every day, even when I feel well.”
3. C“I will use my steroid inhaler when I have a sudden attack.”
4. D“I will rinse my mouth after using the steroid inhaler.”

A patient’s serum potassium is 6,1 mEq/L. Which of the patient’s medications should the nurse question first?

1. AHydrochlorothiazide
2. BSpironolactone
3. CFurosemide
4. DOmeprazole

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

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

A nurse teaches the daughter of a patient with moderate Alzheimer’s disease about home safety. Which statement shows a need for further teaching?

1. A“I let Mom cook alone on the gas stove because she enjoys it.”
2. B“We put locks high up on the outside doors.”
3. C“I keep her medicines locked away and give each dose to her myself.”
4. D“She wears an ID bracelet in case she gets lost.”

In the third trimester of pregnancy, a woman's alkaline phosphatase (ALP) is about twice the usual adult range, and the other liver tests are normal. What is the best interpretation?

1. AA sign of acute viral hepatitis
2. BA sign of blocked bile ducts
3. CA sign of new bone cancer
4. DA normal rise from placental ALP

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

Seorang pasien gagal jantung memiliki sputum merah muda berbusa dan ronki di seluruh kedua paru. Apa yang terjadi?

1. ASerangan asma
2. BEdema paru akut
3. CPerdarahan saluran cerna atas
4. DPneumotoraks

Temuan mana yang paling kuat menunjukkan emboli paru pada pasien pascaoperasi?

1. ANadi lambat dengan tekanan darah tinggi
2. BAwitan bertahap batuk dengan dahak kuning dan demam ringan selama seminggu
3. CMengi yang membaik dengan salbutamol
4. DSesak napas mendadak dan nyeri dada pleuritik disertai takikardia

Which emergency equipment should be kept at the bedside of a patient with a tracheostomy?

1. AA urinary catheter set, a blood glucose meter and a thermometer
2. BA nasogastric tube and a feeding pump
3. CSpare tubes (same size and one smaller), suction and oxygen
4. DOnly a spare oxygen mask, since the tube rarely causes problems

A patient with lung cancer develops swelling of the face and arms, distended neck and chest veins and breathlessness that is worse when bending forward. What is the most likely cause?

1. ARight-sided heart failure
2. BSuperior vena cava obstruction
3. CAn allergic reaction to chemotherapy
4. DA deep vein thrombosis in the leg

Seorang pasien SIADH memiliki natrium 126 mmol/L dan gejala ringan. Pengobatan mana yang biasanya lini pertama?

1. AInfus glukosa 5% IV
2. BPembatasan cairan
3. CDesmopresin
4. DTambahan air oral

A patient with an external ventricular drain sat up in bed without help. The drain stayed at its old height, and the drainage bag filled quickly. The patient now has a headache. What is the concern?

1. AAn infected drain, so the dressing should be removed
2. BUnderdrainage, so the drain should be lowered further
3. CNo concern, because more drainage always lowers the ICP safely
4. DOverdrainage of CSF, so act per protocol and inform the team

Which statement about moist wound healing is correct?

1. AA moist, not wet, wound bed helps cells move and heal faster
2. BA wet wound bed always prevents infection
3. CWounds heal fastest when left to dry out and form a scab
4. DWounds should be soaked in water for hours every day

A patient on immunotherapy for melanoma has six watery stools a day and abdominal cramps. What should the nurse do?

1. AReassure that diarrhoea is normal and harmless
2. BGive loperamide and review next week
3. CAdvise eating more fibre and fruit to firm up the stools
4. DEscalate urgently, as immune-related colitis is likely