Priorità e delega in stile NCLEX: pacchetto last-minute

Dopo la consegna, quale paziente deve vedere per primo l'infermiere?

1. AUn paziente con polmonite, temperatura 38,2 °C, che ha ricevuto un antipiretico 30 minuti fa
2. BUn paziente con diabete la cui glicemia prima di colazione è 160 mg/dL (8,9 mmol/L)
3. CUn paziente a due giorni da una protesi d'anca con dolore 5/10
4. DUn paziente con asma che usa i muscoli accessori e ha una SpO₂ dell'88%

A nurse sees a colleague put a vial of an opioid into their own pocket instead of returning it. What should the nurse do?

1. ATell the patients to watch the colleague carefully
2. BReport it to the nurse manager according to policy
3. CAsk the colleague to share the vial with them
4. DSay nothing, because it is not their business

Un paziente con sospetta tubercolosi si trova in una stanza a pressione negativa. Quale pratica è corretta?

1. ALasciare entrare i visitatori senza alcuna protezione
2. BTenere la porta aperta così che il personale veda sempre il paziente
3. CTenere la porta chiusa tranne che per entrare o uscire
4. DSpegnere la ventilazione della stanza di notte

A nurse finds an unknown liquid leaking from a container in the utility room, with a strong smell. What should the nurse do first?

1. AMop it up with paper towels
2. BLeave the area, keep others out and alert the trained response team
3. CPour water over it to dilute it
4. DMove closer and smell it carefully to identify what the substance is

A patient is starting dabigatran, a direct oral anticoagulant. Which laboratory test is most important to review before the first dose?

1. ATSH, to rule out an overactive thyroid gland
2. BKidney function (creatinine clearance)
3. CINR, to set the dose of the anticoagulant
4. DLipase, to rule out an inflamed pancreas first

A patient has marked generalized edema. Results show heavy proteinuria, serum albumin 1,8 g/dL (18 g/L) and total cholesterol 340 mg/dL (8,8 mmol/L). Which condition fits best?

1. ALiver cirrhosis only
2. BPrerenal kidney injury
3. CNephrotic syndrome
4. DAcute pyelonephritis

A patient with Guillain–Barré syndrome has weakness spreading upwards from the legs. Which monitoring is most important?

1. ABreathing function, such as forced vital capacity
2. BVisual acuity
3. CBlood glucose, measured once a day before breakfast
4. DWeekly weight

A patient with full mental capacity decides against a treatment that the team thinks is best. What does the Mental Capacity Act 2005 (England and Wales) say?

1. AThe family may make the decision instead if they disagree with the patient's choice
2. BThe team may override any decision that it disagrees with if it is serious
3. CThe patient must be assessed by a psychiatrist before refusing
4. DA person is not treated as lacking capacity just because they make an unwise decision

Which advice is most helpful for a patient with Raynaud's phenomenon?

1. ARub the fingers hard with snow during an attack
2. BTake a decongestant tablet before going outdoors
3. CKeep the whole body warm, wear gloves and stop smoking
4. DSoak the hands in cold water to toughen the vessels

A patient being treated for pulmonary TB repeatedly misses doses and stops when they feel better. Which strategy is most effective?

1. ADoubling the dose on the days the patient remembers to take it
2. BDirectly observed therapy with support for barriers to adherence
3. CStopping treatment, as it is clearly not working for this patient
4. DSwitching to a single drug to make it easier

A patient who has had type 1 diabetes for 30 years says they no longer feel the warning signs of a hypo. What is this called?

1. AInsulin resistance
2. BThe dawn phenomenon
3. CHypoglycaemia unawareness
4. DDiabetic ketoacidosis

Un paziente in nutrizione enterale continua notturna riceve insulina calibrata sull'alimentazione. Alle 02:00 il sondino si ostruisce e l'alimentazione si interrompe. Qual è il rischio principale e che cosa deve fare l'infermiere?

1. AIpoglicemia; controllare spesso la glicemia e seguire il piano per la copertura glucidica
2. BNessun rischio; l'insulina verrà semplicemente immagazzinata fino alla ripresa dell'alimentazione
3. CIperglicemia; somministrare subito una dose extra di insulina
4. DChetoacidosi; sospendere tutta l'insulina fino al mattino

Qual è lo scopo dell'intervallo di blocco (lockout) su una pompa PCA?

1. AFa attendere al paziente un giorno tra una dose elevata e l'altra
2. BBlocca la pompa in modo che la siringa non possa essere cambiata
3. CImpedisce al paziente di ricevere qualsiasi dose di notte
4. DImpedisce una nuova dose prima che l'ultima abbia agito

On the ward after surgery, a patient has a red, blistered area of skin under where the diathermy plate was. What should the nurse do?

1. AApply a hot water bottle to improve the circulation
2. BTreat it as a possible burn, report it and complete an incident form
3. CIgnore it because skin changes after surgery are normal and expected to fade
4. DWash it with alcohol and leave it uncovered