NCLEX tipo prioritetų nustatymas ir delegavimas: pasiruošimo paketas

A patient’s peripheral IV site is swollen, pale and cool, and the infusion has slowed. What should the nurse do first?

1. AFlush the cannula hard to clear the blockage
2. BApply a tight bandage over the site to reduce swelling
3. CStop the infusion and remove the cannula
4. DIncrease the infusion rate to overcome the resistance

A patient is going home on a new oral anticoagulant. There is only a short time for teaching. Which topic is most important?

1. ASigns of bleeding and when to seek help
2. BWhich television programs help with relaxation
3. CHow to choose comfortable walking shoes
4. DHow to cook low-fat meals

A nurse pours sterile saline into a bowl on a sterile field. Which technique is correct?

1. AHold the bottle with the label in the palm and pour without touching the bowl
2. BPour from below the level of the field to reduce splashing
3. CRest the lip of the bottle on the edge of the bowl so that the saline does not splash
4. DReach across the field to fill the bowl at the far side

A patient given naloxone for an opioid overdose wakes up. An hour later, the patient is drowsy again with slow breathing. What is the likely reason?

1. ANaloxone itself causes slow breathing and drowsiness once it has been given
2. BThe patient is now allergic to naloxone
3. CThe patient is simply tired after the event
4. DNaloxone wears off sooner than many opioids, so the opioid effect returns

Pacientui po oda leidžiamas enoksaparinas (mažos molekulinės masės heparinas). Kuris teiginys apie stebėjimą teisingas?

1. AaPTT turi būti tikrinamas kas 6 valandas dozei koreguoti
2. BJokių kraujo tyrimų niekada nereikia
3. CĮprastinio aPTT nėra; vietoj to tikrinami trombocitai ir inkstų funkcija
4. DINR naudojamas kiekvienai dozei koreguoti, kaip su varfarinu

A health care worker's hepatitis B tests show: HBsAg negative, anti-HBs positive, anti-HBc positive. What does this mean?

1. ANot immune and never exposed to the virus
2. BPast infection that has resolved, with immunity
3. CCurrent chronic hepatitis B infection
4. DImmunity from vaccination only, never infected

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

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

An older patient has fallen several times since starting a new medicine. Which drug group is most likely to contribute?

1. ALubricating eye drops
2. BBenzodiazepine sleeping tablets
3. CEmollient creams applied to the legs
4. DVitamin D supplements

A patient is starting long-term amiodarone. Which teaching and monitoring are most important?

1. AExpect orange urine and no need for blood tests
2. BProtect skin from sunlight and have thyroid, liver and lung checks
3. CEat extra salt and stop the drug as soon as the pulse is regular
4. DAvoid dairy products and have the INR checked once at the start

During CPR on an adult, a nurse notices a colleague compressing at about 140/min and leaning on the chest between compressions. Which correction is most appropriate?

1. ASpeed up to about 160/min to improve the blood flow
2. BPress more gently, to a depth of about 2 cm
3. CSlow to 100–120/min and allow full chest recoil
4. DStop compressions until a pulse is felt

A patient receives phenytoin through a nasogastric tube along with continuous enteral feed. Which issue should the nurse know about?

1. AThe feed increases phenytoin levels and causes toxicity within hours
2. BPhenytoin must be crushed and mixed into the feed bag
3. CPhenytoin makes the feed curdle, so the two must never be used in one patient
4. DThe feed can reduce phenytoin absorption, so the feed is often paused around the dose

An older patient with a UTI is now confused, with a respiratory rate of 24/min, BP 88/50 mmHg and a pulse of 120/min. What should happen?

1. AStart sepsis care at once, with IV antibiotics and fluids
2. BGive oral antibiotics and recheck in four hours
3. CEncourage oral fluids and wait for the urine culture
4. DTreat the confusion with a sedative

Kiek laiko po daugelio chemoterapinių vaistų dažnai taikomos ypatingos atsargumo priemonės dirbant su kūno skysčiais?

1. ADažniausiai apie 48 valandas
2. BTik infuzijos metu
3. CJų niekada nereikia
4. DVisus metus

A patient with a sacral pressure ulcer keeps sliding down the bed when the head is raised high. Which advice best reduces shear?

1. AUse a dry sheet and drag the patient up the bed
2. BRaise the head of the bed to 90° and pull the patient up the bed by the arms
3. CSit the patient upright without any support for the feet
4. DKeep the head of the bed at or below 30° if possible; use slide sheets