Priorità e delega in stile NCLEX: pacchetto last-minute

An older adult asks for something to help them sleep. Which drug is most likely to cause confusion and falls in this age group?

1. AAcetaminophen (paracetamol)
2. BMelatonin
3. CDiphenhydramine
4. DA warm milky drink

A patient taking an MAO inhibitor antidepressant is taught about diet. Which statement shows a need for further teaching?

1. A“I can still eat aged cheese and cured salami.”
2. B“I will check with the pharmacist before cold remedies.”
3. C“I will avoid tap beer and red wine.”
4. D“A sudden severe headache is a warning sign.”

How are neuromuscular blocking drugs, such as vecuronium, safely stored?

1. AMixed in the same bin as other high-use drugs
2. BIn the general stock cupboard with the other IV drugs and no special labels
3. CNext to common IV antibiotics so they are easy to find
4. DSeparate from other drugs, with a warning that they cause paralysis

A patient with suspected sepsis has orders for blood cultures and an IV antibiotic. What is the correct order of actions?

1. AWait for the culture results before starting the antibiotic
2. BDraw the blood cultures first, then give the antibiotic without delay
3. CGive the antibiotic first so that treatment starts, and take the cultures the next day
4. DGive the antibiotic and take the cultures an hour later

A patient has weight loss, tremor and heat intolerance. Which thyroid test pattern fits Graves disease?

1. ANormal TSH with a low free T₄
2. BHigh TSH with a low free T₄
3. CLow TSH with a high free T₄
4. DHigh TSH with a normal free T₄

A patient with kidney stones and fatigue has a calcium of 11,6 mg/dL (2,9 mmol/L), a high parathyroid hormone (PTH) and a low phosphate. Which condition is most likely?

1. AVitamin D deficiency
2. BCancer-related hypercalcemia
3. CPrimary hyperparathyroidism
4. DHypoparathyroidism

Why are people with diabetes advised to have regular eye screening?

1. ATo detect diabetic retinopathy early, before sight is lost
2. BTo measure their blood glucose through the eye
3. CTo prevent conjunctivitis
4. DTo check whether they need reading glasses for close work

A patient is recognised by the team as being in the last days of life. Which approach is correct?

1. AStop all medicines, including pain relief and anti-sickness drugs
2. BContinue all routine blood tests and observations four-hourly
3. CAvoid talking with the family about what is happening
4. DReview and stop treatments that no longer help, and focus on comfort

Why is a beta-blocker started at a low dose and increased slowly in heart failure?

1. AIt is safe only at the highest possible dose from the very start
2. BIt must be stopped as soon as symptoms improve
3. CIt works only if the dose is never changed after the first day
4. DIt can briefly worsen symptoms before long-term benefit appears

A patient declines enoxaparin for VTE prevention because it is made from pork, which conflicts with their beliefs. What is the best response?

1. AGive the injection anyway without explaining what the medicine is made from
2. BRespect the decision, inform the prescriber and discuss non-animal options
3. CTell the patient that refusal means they cannot have surgery
4. DDocument the refusal in the notes and take no further action at all

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

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

Un paziente con DKA sta migliorando: glicemia 9 mmol/L, chetoni 0,4 mmol/L, pH 7,36. Sta mangiando e bevendo. Come va sospesa l'insulina EV?

1. ASomministrare insulina sottocutanea con un pasto, poi interrompere l'EV dopo una sovrapposizione
2. BInterrompere subito l'insulina EV e iniziare l'insulina sottocutanea domani
3. CSomministrare insulina sottocutanea solo se la glicemia sale sopra 20 mmol/L
4. DSospendere tutta l'insulina, perché la chetoacidosi si è risolta del tutto

Which lifestyle change most improves the course of Crohn's disease?

1. AStopping smoking
2. BAvoiding all exercise
3. CDrinking more coffee
4. DEating more red meat

A patient with active cancer on chemotherapy develops new swelling and pain in one calf. Why must this be reported promptly?

1. ACalf swelling is a normal effect of chemotherapy
2. BThe swelling shows the cancer has gone
3. CCancer and its treatment greatly increase clot risk
4. DIt is only a muscle strain from walking