Priorità e delega in stile NCLEX: pacchetto last-minute

A nurse takes a telephone order from a provider. What must the nurse do?

1. AAsk the ward clerk to take the order on the nurse’s behalf instead
2. BRemember the order and write it in the chart at the end of the shift
3. CCarry out the order first and ask the provider to confirm it later
4. DWrite the order down and read it back to the provider to confirm it

During surgery under general anesthesia, a patient develops rising end-tidal carbon dioxide, muscle rigidity and a rapidly increasing temperature. Which drug should the nurse anticipate?

1. AFlumazenil
2. BDantrolene
3. CNaloxone
4. DAtropine

A cup of water is spilled over an infusion pump plugged into the wall. What should the nurse do?

1. AWipe it dry quickly with a towel and keep using it for the infusion
2. BSwitch it off and unplug it safely, then have it checked before reuse
3. CLeave it running and place a towel over it until it dries
4. DTurn the pump upside down to drain it while running

Quale abbinamento tra microrganismo e relative precauzioni basate sulla modalità di trasmissione è corretto?

1. AC. difficile – via aerea
2. BInfluenza – solo via aerea
3. CParotite – droplet
4. DMorbillo – solo contatto

A patient receiving chemotherapy has an ANC of 300/µL and a new temperature of 38,3 °C (100,9 °F). What should the nurse do first?

1. AReport it at once so cultures and antibiotics start quickly
2. BEncourage oral fluids and record the fever in the chart
3. CRemove extra blankets and offer a tepid sponge bath
4. DGive acetaminophen (paracetamol) and recheck the temperature in 4 hours

Un paziente con chetoacidosi diabetica riceve un'infusione endovenosa di insulina. Quale valore di laboratorio deve essere monitorato con particolare attenzione?

1. AIl potassio, perché l'insulina lo sposta nelle cellule e può calare rapidamente
2. BIl sodio, perché l'insulina fa eliminare ai reni quantità molto grandi di sodio
3. CL'emoglobina, perché l'insulina distrugge i globuli rossi
4. DL'albumina, perché l'insulina fa smettere al fegato di produrla

Quali segni suggeriscono una reazione trasfusionale nei primi minuti?

1. AUn aumento lento e costante dell'emoglobina nel corso del giorno successivo
2. BColorito migliore e più energia
3. CLieve fame
4. DFebbre, brividi, mal di schiena e pressione bassa

A patient on metformin with reduced kidney function is due a CT scan with IV contrast. Why might metformin be withheld?

1. AMetformin makes the images blurry
2. BMetformin causes severe bleeding during scans
3. CThere is a risk of lactic acidosis if kidney function worsens
4. DMetformin reacts with the contrast to cause severe hyperglycaemia

Where is the V1 electrode placed for a 12-lead ECG?

1. AThe fourth intercostal space just right of the sternum
2. BThe fifth intercostal space in the mid-axillary line
3. COver the left nipple
4. DJust below the left collarbone

A patient with severe aortic stenosis is prescribed glyceryl trinitrate (nitroglycerin) for chest pain. Why should the nurse use particular caution?

1. AVasodilators can cause a severe fall in BP with a fixed outflow obstruction
2. BGTN makes the narrowed aortic valve tighten further within a few minutes
3. CGTN raises the blood pressure dangerously in aortic stenosis
4. DThere is no reason for caution, because GTN acts only on the coronary arteries

Una crisi dura da cinque minuti e continua. Qual è di solito il trattamento farmacologico di prima linea?

1. AUna dose di carico EV di fenitoina prima di qualsiasi altra cosa
2. BGlucosio EV al 50% in ogni paziente, poi rivalutare
3. CUna benzodiazepina come lorazepam EV o midazolam buccale
4. DAdrenalina IM nella parte esterna della coscia

A patient with long-standing diabetes suddenly has many new floaters and painless loss of vision in one eye. What is most likely, and what is needed?

1. AA migraine aura, needing pain relief
2. BNormal ageing of the lens, needing new glasses
3. CA bleed into the eye from retinopathy, needing urgent review
4. DDry eyes, needing lubricating drops

Perché le ustioni superficiali (solo arrossamento, come una scottatura solare) non si contano nel calcolo dell'area ustionata per la rianimazione con liquidi?

1. ALa barriera cutanea è intatta, perciò si perde poco liquido
2. BGuariscono sempre completamente entro un giorno
3. CCausano più perdita di liquidi di qualsiasi altra profondità
4. DSono sempre troppo piccole per essere misurate con precisione su una tabella

An older patient on regular opioids has small amounts of liquid stool leaking all day, but has not had a formed bowel movement for 6 days. What is the most likely cause?

1. AA flare of ulcerative colitis
2. BNormal stool pattern on opioids
3. CAcute infective gastroenteritis
4. DFaecal impaction with overflow