Priorità e delega in stile NCLEX: pacchetto last-minute

Which patient with diabetes should the nurse see first?

1. ANeeds foot care teaching before discharge tomorrow
2. BGlucose 210 mg/dL (11,7 mmol/L) after a large lunch, feels well
3. CHbA1c result of 8,2%, asking about diet
4. DGlucose 48 mg/dL (2,7 mmol/L), sweating and confused

A patient in labor is receiving oxytocin, and the fetal monitor shows repeated late decelerations. What should the nurse do first?

1. AIncrease the oxytocin rate
2. BPlace the patient flat on her back
3. CEncourage the patient to start pushing
4. DStop the oxytocin infusion

When is a prophylactic antibiotic usually given to prevent a surgical site infection?

1. AWithin about 60 minutes before the incision
2. BOnly if a fever develops after surgery
3. CThe day after surgery, once the wound is closed
4. DOne week before surgery

Why can a patient with severe neutropenia have a serious infection but little redness, swelling or pus?

1. ANeutropenia makes infections stay limited to the skin
2. BChemotherapy kills the bacteria before they can multiply
3. CAntibiotics given with chemotherapy hide all signs of infection
4. DThere are too few neutrophils to produce the usual inflammatory signs

Dopo un intervento all'ipofisi, un paziente emette circa 400 mL di urina chiara all'ora con un peso specifico di 1,002, e il sodio è salito a 149 mEq/L. Quale condizione è più probabile?

1. ASIADH
2. BDiabete insipido
3. CIperglicemia con chetoacidosi
4. DDanno renale acuto con oliguria

A patient without symptoms has a finger-stick glucose of 340 mg/dL (18,9 mmol/L). The previous values were normal, and the patient has just peeled an orange. What should the nurse do first?

1. AGive a correction dose of insulin for a glucose of 340 mg/dL
2. BAsk the laboratory to measure HbA1c from the same drop of blood
3. CReport the result as a new diagnosis of diabetes mellitus
4. DHave the patient wash and dry their hands, then repeat the test

Why is blood pressure monitored closely in a patient with an epidural infusion?

1. AEpidurals always cause severe hypertension that needs regular treatment
2. BThe epidural pump uses the blood pressure to set the rate
3. CThe local anaesthetic can block sympathetic nerves and cause hypotension
4. DBlood pressure readings show whether the catheter is infected

A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?

1. AStopping all regular medicines until the day the patient is discharged
2. BMedicines reconciliation against reliable sources, such as primary care records
3. CDoubling the doses to make up for any missed while at home
4. DPrescribing only the medicines that the patient can remember taking

How should a patient breathe in when using a dry powder inhaler?

1. AThrough the nose with the mouthpiece in the mouth
2. BQuickly and deeply, after breathing out away from the device
3. CSlowly and gently over about ten seconds
4. DSeveral times, breathing out into the device between breaths

A one-way speaking valve is fitted to a patient's tracheostomy tube while the cuff is still inflated. What is the danger?

1. AThe valve will humidify the air too much
2. BThere is no danger, as the valve works with any cuff
3. CThe patient will speak too loudly
4. DThe patient cannot breathe out and may suffocate

Which lifestyle advice best helps a patient with epilepsy reduce their seizures?

1. AKeep regular sleep and take every dose on time
2. BSkip a dose on days without any warning signs
3. CAvoid all physical exercise and stay indoors
4. DDrink coffee in the evening to stay alert

The night after hip surgery, an 84-year-old becomes suddenly confused and tries to pull out their IV line. What is the most appropriate first step?

1. AAsk for a strong sedative so that the patient can sleep
2. BLook for causes such as low oxygen, pain, retention or infection
3. CApply wrist restraints to protect the IV line
4. DTell the family that this is the start of dementia

Which patient is at highest risk of refeeding syndrome?

1. AA patient with a normal BMI eating three meals a day
2. BAn underweight patient who has eaten very little for 10 days
3. CA patient who missed one lunch because of a scan
4. DA healthy adult after an overnight fast for minor surgery

Which group of signs suggests that a patient is entering the last days of life?

1. AClearer thinking and increased movement
2. BRising appetite, more energy and normal skin colour and warmth
3. CHigh blood pressure and very fast weight gain
4. DReduced intake, mottled skin and changes in breathing