NCLEX tipo prioritetų nustatymas ir delegavimas: pasiruošimo paketas

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. BMeet both of them privately to hear each side
3. CReport them to human resources at once
4. DChange both of their assignments without any discussion

A patient suddenly has severe pain in one leg. The leg is pale and cold with no pedal pulse. What does this suggest?

1. AA muscle cramp that will pass with stretching
2. BChronic venous insufficiency that needs elevation
3. CAcute arterial occlusion, which is an emergency
4. DA deep vein thrombosis that can be treated next week

A patient has fallen, and the nurse completes an incident report. Which statement about this report is correct?

1. AIt is only needed when the patient is injured
2. BIt replaces the need to document the fall in the patient’s record
3. CA copy of it is placed in the patient’s chart so all staff know about the fall
4. DIt is written factually and does not replace documenting the fall in the patient’s record

Slaugytojas atvyksta į gaisro koridoriuje vietą, ir gaisras plinta. Netoliese palatose guli pacientai. Ką slaugytojas turėtų daryti paskelbęs pavojų?

1. ABandyti vienam užgesinti plintantį gaisrą gesintuvu
2. BUždaryti duris ir perkelti pavojuje esančius pacientus horizontaliai už priešgaisrinių durų
3. CNuvežti pacientus į pirmą aukštą artimiausiu liftu
4. DAtidaryti visas duris ir langus, kad išeitų dūmai

Why is a baseline platelet count taken before starting heparin therapy?

1. ABecause heparin increases the platelet count to dangerous levels
2. BBecause heparin is given at a dose based on the platelet count
3. CSo a later fall from heparin-induced thrombocytopenia is detected
4. DSo that the INR can be calculated from the platelet count later

A patient's results: sodium 140 mEq/L, chloride 100 mEq/L, bicarbonate 12 mEq/L. What is the anion gap, and what does it suggest?

1. A12 mEq/L, a normal anion gap
2. B28 mEq/L, a high anion gap
3. C40 mEq/L, a high anion gap
4. D52 mEq/L, a very high anion gap

PSO analgetikų kopėčios rekomenduoja:

1. AVėžio skausmui naudoti tik nemedikamentinius metodus
2. BDidėjant skausmui pereiti nuo neopioidinių prie silpnų, o vėliau stiprių opioidų
3. CSkirti analgetikų tik tada, kai skausmas tampa stiprus
4. DVisiems pacientams pradėti nuo stiprių opioidų

Pacientas su tracheostoma staiga negali kvėpuoti, vamzdelis atrodo užsikimšęs. Koks pirmas veiksmas?

1. ALaukti gydytojo prieš ką nors darant
2. BDuoti deguonies tik per burną
3. CIštraukti vidinę kaniulę ir patikrinti, ar ji neužsikimšusi
4. DIšleisti manžetę ir palikti pacientą

After an above-knee amputation, which measure helps prevent a hip flexion contracture?

1. AKeeping the hip bent to reduce stump swelling
2. BLying prone for periods and avoiding pillows under the stump
3. CSitting in a chair for most of the day with the hips bent
4. DKeeping a pillow under the stump at all times, day and night

During drainage of a large pleural effusion, a patient starts coughing and feels tight in the chest. What should the nurse do?

1. AAsk the patient to cough harder to help the flow
2. BStop or clamp the drainage and inform the doctor
3. CLie the patient flat until the drainage is complete
4. DSpeed up the drainage to finish quickly

A routine blood test shows a potassium of 6,4 mmol/L. The lab reports that the sample was haemolysed. The patient feels well. What should the nurse do?

1. AInform the doctor and arrange an urgent repeat sample
2. BIgnore it, because haemolysis always gives a normal result
3. CStart dialysis as soon as possible
4. DGive oral potassium supplements straight away

Which statement correctly distinguishes spinal shock from neurogenic shock?

1. ANeurogenic shock is caused by blood loss; spinal shock is caused by infection
2. BSpinal shock is lost reflexes; neurogenic shock is low BP and slow pulse
3. CThey are two names for exactly the same condition
4. DSpinal shock is low blood pressure; neurogenic shock is the loss of reflexes

Why do patients usually have a dental review before radiotherapy to the head and neck?

1. AIt causes dry mouth and raises the risk of decay and jaw damage
2. BRadiotherapy can only be given once all the teeth have been removed
3. CTeeth block the radiation beam completely
4. DThe dentist gives the radiotherapy

On day 5 after bowel resection, a patient has a fever, tachycardia and worsening abdominal pain, and the drain contains brown, faeculent fluid. What is most likely?

1. AA urinary tract infection
2. BA normal day 5 recovery
3. CAn anastomotic leak
4. DPostoperative constipation