Prioritas & Delegasi ala NCLEX: paket kilat

Before accessing a central venous catheter, what should the nurse do to prevent infection?

1. AScrub the hub with an antiseptic such as chlorhexidine and let it dry
2. BBlow on the hub to remove any dust before connecting the syringe or line
3. CRinse the hub with tap water and dry it
4. DTouch the hub to check it is clean

An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?

1. AAn infection, such as a urinary tract infection, presenting atypically
2. BA sudden worsening of long-standing dementia that needs no tests
3. CNormal aging that needs no assessment
4. DBoredom from not having enough activities

Which practice is safe when transferring a patient from a bed to a stretcher?

1. ALeave the stretcher wheels unlocked so it can move with the patient
2. BLower the stretcher side rails during transport
3. CLock the wheels of both the bed and the stretcher before moving the patient
4. DHave the patient slide across without help or a slide sheet

Minutes after the first IV dose of an antibiotic starts, the patient develops wheezing, hives and low blood pressure. What should the nurse do first?

1. ASlow the infusion rate
2. BStop the infusion
3. CGive an oral antihistamine
4. DRecord the new allergy in the chart

A patient has taken a proton pump inhibitor (such as omeprazole) for many years and now has muscle cramps and tremor. Which electrolyte is most likely to be low?

1. AChloride
2. BPhosphate
3. CSodium
4. DMagnesium

A patient's total calcium is 7,6 mg/dL and the albumin is 2,0 g/dL. Using the common correction (add 0,8 mg/dL for each 1 g/dL that albumin is below 4,0), what is the corrected calcium?

1. A9,2 mg/dL, within the normal range
2. B7,6 mg/dL, below the normal range
3. C6,0 mg/dL, well below the normal range
4. D11,6 mg/dL, above the normal range

Which group of symptoms suggests hypothyroidism?

1. ATiredness, weight gain and feeling cold
2. BFever, neck stiffness and photophobia
3. CWeight loss, heat intolerance and tremor
4. DExcessive thirst and passing large volumes of urine

Dalam triase, pasien mana yang harus ditangani lebih dulu?

1. APasien yang meminta resep ulang
2. BPasien dengan sakit tenggorokan sejak dua hari
3. CPasien dengan pergelangan kaki terkilir dan bengkak ringan
4. DPasien dengan napas berbunyi dan bibir bengkak setelah makan kacang tanah

A patient in cardiac rehabilitation asks how hard to exercise. Which simple guide is commonly taught?

1. AExercise so they are a little breathless but can still talk
2. BExercise only until the heart rate rises even slightly
3. CExercise until chest pain starts, then stop
4. DExercise until they are too breathless to speak at all

A patient with severe asthma develops a stable narrow-complex tachycardia, and IV adenosine is prescribed. What should the nurse do?

1. AGive it as a slow infusion over an hour to reduce side effects
2. BGive it as prescribed, as adenosine is safe in every patient
3. CQuestion the prescription, as adenosine can cause bronchospasm
4. DGive it orally instead of intravenously

Which approach helps most when talking to a patient with expressive aphasia?

1. AAsk questions that can be answered with yes, no or a gesture
2. BAvoid talking to them until their speech has recovered
3. CFinish their sentences quickly to save them effort
4. DSpeak louder, because the patient cannot hear well

An adult stares blankly for about a minute, smacks their lips and fumbles with their clothes. Afterwards they are confused for ten minutes and remember nothing. Which seizure type fits best?

1. AFocal impaired awareness seizure
2. BAbsence seizure
3. CAtonic (drop) seizure with a fall
4. DMyoclonic seizure

Pola elektrolit mana yang khas untuk sindrom lisis tumor?

1. AKalium dan fosfat rendah dengan kalsium tinggi
2. BKalium, fosfat, dan asam urat tinggi; kalsium rendah
3. CKalium rendah, fosfat rendah, dan asam urat rendah
4. DNatrium dan kalsium tinggi dengan kadar asam urat rendah

A nurse has a needlestick injury after taking blood from a patient with hepatitis B. What should the nurse do first?

1. AScrub the area hard with a nail brush and alcohol
2. BFinish the shift and report it the next day
3. CSuck the wound to remove as much of the blood as possible
4. DWash the site with soap and running water, without scrubbing