Priorità e delega in stile NCLEX: pacchetto last-minute

Two nursing assistants argue loudly at the station about their assignments. What is the charge nurse’s best first step?

1. AIgnore it and hope they sort it out
2. BChange both of their assignments without any discussion
3. CMeet both of them privately to hear each side
4. DReport them to human resources at once

A patient in hypovolemic shock is receiving IV fluids. Which finding best shows that the treatment is working?

1. ANew crackles at both lung bases
2. BCooler, paler skin on the arms and legs
3. CUrine output at least 0,5 mL/kg/h and clearer thinking
4. DA heart rate that keeps rising after each bag of fluid

Which patient has the highest risk of a burn from a heating pad?

1. AA patient with diabetic peripheral neuropathy
2. BA healthy young adult with a strained muscle
3. CA patient with a sprained wrist who is fully alert
4. DA patient recovering from a cold

The laboratory reports that a blood sample labeled with one patient’s name has a blood group different from that patient’s previous result. What is the most likely problem and response?

1. AA normal change in the patient’s blood group over the years since the last test
2. BA laboratory machine fault, so no action is needed
3. CA wrong-patient sample, so the test is repeated and the event reported
4. DThe previous result was wrong, so it is deleted

Un paziente in terapia con fenitoina ha un livello di 28 mcg/mL (intervallo abituale circa 10–20 mcg/mL). Quali reperti si aspetterebbe l'infermiere?

1. AOnde T alte e appuntite
2. BFame e aumento di peso
3. CSolo comportamento iperattivo e insonnia
4. DNistagmo, andatura instabile e linguaggio impastato

A patient's creatinine was 0,9 mg/dL (80 µmol/L) on admission and is 1,3 mg/dL (115 µmol/L) 36 hours later. Using the common KDIGO criteria, what does this show?

1. AChronic kidney disease, because creatinine has risen above baseline
2. BA laboratory error, because creatinine cannot change within 2 days
3. CNo kidney injury, because the creatinine is still within the normal range
4. DAcute kidney injury, because it rose by at least 0,3 mg/dL within 48 hours

Che cosa misura l'HbA1c?

1. ALa glicemia al momento del prelievo
2. BLa glicemia media negli ultimi due-tre mesi circa
3. CI livelli di insulina dopo un pasto
4. DLa quantità di chetoni nelle urine

Un paziente con sospetta meningite ha febbre, rigidità nucale ed eruzione cutanea non sbiancabile. Qual è la priorità?

1. ASomministrare paracetamolo per la febbre e rivalutare il paziente domani
2. BAttendere il risultato della puntura lombare prima di iniziare qualsiasi trattamento
3. CValutazione urgente e antibiotici immediati, senza attendere gli esami
4. DAbbassare le luci, incoraggiare il riposo e ricontrollare i parametri dopo quattro ore

How does digoxin help a patient with atrial fibrillation and heart failure?

1. AIt slows AV node conduction and increases contractility
2. BIt lowers potassium to stabilise the heart
3. CIt speeds conduction through the AV node to the ventricles
4. DIt dissolves clots that have formed in the left atrium

An older patient with three rib fractures is breathing shallowly and refuses to cough because of pain. What is the priority intervention?

1. AKeep the patient flat and still in bed until the pain settles
2. BWithhold analgesia to avoid depressing breathing
3. CEffective analgesia so they can breathe deeply and cough
4. DStrap the chest tightly with bandages to stop the ribs moving

An 85-year-old care home resident becomes newly confused and is falling more often. A UTI is one possibility. Why?

1. AUrinary infections always cause a high fever in older adults
2. BOlder adults often show infection as confusion
3. CConfusion is the only symptom of a UTI at any age
4. DA UTI cannot occur in people over 80

During a TURP, a patient becomes confused and nauseated, with a slow pulse and a raised BP. The sodium is 121 mmol/L. What is most likely?

1. ATURP syndrome from absorbed irrigation fluid
2. BAn allergic reaction to the catheter
3. CHypoglycaemia from fasting for many hours before surgery
4. DA normal reaction to the spinal anaesthetic

In the UK National Early Warning Score (NEWS2), what does an aggregate score of 5 or more usually trigger?

1. ARoutine observations once every 12 hours, with no other change in care
2. BDischarge planning for the next day
3. CNo change unless the patient complains
4. DAn urgent review by a clinician skilled in acute illness

After two days of large volumes of IV 5% glucose, a postoperative patient becomes confused with a headache. Sodium is 124 mmol/L. What is the likely cause?

1. ANormal confusion after any anaesthetic
2. BHyponatraemia from hypotonic fluids
3. CHypernatraemia from too much salt
4. DHypoglycaemia from the glucose