Soalan latihan gaya NCLEX-PN (LPN/LVN): pek ulang kaji kilat

What makes "Risk for falls" a risk nursing diagnosis rather than an actual one?

1. AThe doctor has confirmed the diagnosis with tests and a scan
2. BThe patient has already fallen several times
3. CThe problem can never be prevented
4. DThe fall has not happened yet, but risk factors are present

A healthcare assistant (nursing assistant) has recorded a blood pressure of 82/50 mmHg during routine observations but did not report it. What should the registered nurse do first?

1. ATalk to the healthcare assistant about reporting
2. BComplete an incident report
3. CRepeat the observations at the next routine time
4. DAssess the patient straight away

Many intensive care units bathe patients daily with chlorhexidine. What is the main purpose?

1. ATo treat existing wound infections without the need for antibiotics
2. BTo moisturize dry skin in older patients
3. CTo reduce skin bacteria and bloodstream infections linked to central lines
4. DTo lower the patient’s body temperature

An 84-year-old resident with an indwelling catheter suddenly becomes confused but has no fever. What should the nurse consider?

1. AThe confusion is part of normal aging at this age and needs no further action
2. BAn infection may present as confusion in older adults, so assess further and report
3. CA sedative is needed to keep the resident calm
4. DInfection can be ruled out because there is no fever

A patient has a blood pressure of 210/120 mmHg. Which finding would make this a hypertensive emergency?

1. ANew chest pain or confusion suggesting organ damage
2. BForgetting to take the blood pressure tablet this morning
3. CA history of high blood pressure for ten years
4. DMild anxiety about the high reading on the monitor

Pesakit manakah yang merupakan pilihan terbaik untuk dipindahkan keluar daripada rawatan rapi untuk memberi ruang kepada kemasukan baharu?

1. ADiekstubasi 2 hari lalu, stabil dengan oksigen hidung 2 L/min, tiada infusi vasoaktif
2. BDengan infusi norepinefrin yang dosnya dinaikkan pagi ini
3. CDimasukkan semalaman dengan pendarahan GI dan masih menerima darah
4. DDiintubasi 1 jam lalu untuk kegagalan pernafasan, masih disedasi

A patient's low potassium does not improve despite potassium replacement. Which other electrolyte should be checked?

1. ASodium
2. BChloride
3. CMagnesium
4. DPhosphate

A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?

1. ATo shift potassium into cells; blood glucose must be monitored for hypoglycaemia
2. BTo remove potassium from the body; urine output must be stopped for a time
3. CTo protect the heart muscle directly; the patient must be kept nil by mouth
4. DTo treat hidden diabetes; HbA1c must be checked daily

A patient had a total gastrectomy. Which long-term therapy is needed to prevent anemia?

1. AMonthly transfusions of red blood cells
2. BWeekly doses of oral vitamin K tablets
3. CLifelong vitamin B₁₂ replacement
4. DLifelong oral folic acid tablets only

A patient with thalassemia major has received regular red cell transfusions for years. The ferritin is now very high. What does this most likely show, and what treatment is used?

1. ALiver failure, treated with a liver transplant at once
2. BIron overload, treated with iron chelation therapy
3. CIron deficiency, treated with IV iron supplements
4. DAcute infection, treated with broad-spectrum antibiotics

Which adverse effect of doxorubicin requires monitoring of heart function?

1. ACumulative heart muscle damage leading to heart failure
2. BPericarditis caused by infection
3. CRapid rise in cholesterol
4. DSevere hypertension during the infusion itself

A 19-year-old woman is starting isotretinoin for severe acne. Which requirement is most important?

1. ATaking the drug only at weekends
2. BReliable contraception and pregnancy tests, as it is highly teratogenic
3. CWeekly hearing tests and monthly eye examinations during treatment
4. DA high-vitamin A diet to boost the effect

A woman with hypertension who takes lisinopril says she is planning a pregnancy. What should the nurse advise?

1. ADouble the dose to protect the baby from high blood pressure
2. BContinue lisinopril, as it is the safest blood pressure drug in pregnancy
3. CStop all blood pressure treatment straight away without telling anyone
4. DDiscuss switching medicine with the prescriber before trying to conceive

A frightened young woman is breathing fast and has tingling fingers. Her blood gas shows pH 7.50 and a low PaCO₂. SpO₂ is 99% on air. What does this show?

1. AMetabolic alkalosis from vomiting
2. BRespiratory acidosis from hypoventilation
3. CRespiratory alkalosis from hyperventilation
4. DMetabolic acidosis from kidney failure

A patient with untreated hyperthyroidism is losing weight. Which diet is most appropriate until the condition is controlled?

1. AA high-calorie diet with enough protein
2. BA low-calorie diet to protect the heart
3. CA strict low-protein diet
4. DA diet very high in caffeine for energy

Selepas tiroidektomi total, seorang pesakit menjadi cemas dengan stridor dan bengkak tegang di leher. Apakah yang patut dilakukan oleh jururawat dahulu?

1. AMemberikan analgesia dan menilai semula bengkak dalam sejam
2. BMeletakkan paket ais pada leher dan membaringkan pesakit mendatar
3. CMemanggil bantuan kecemasan: hematoma mungkin menekan saluran udara
4. DMeminta pesakit bercakap sebanyak mungkin untuk menguji suara

Which group of findings suggests obstruction of the bile duct?

1. AJaundice, dark urine, pale stools and itching
2. BPale urine, dark stools and a flapping tremor
3. CRed urine, black stools and a high blood glucose
4. DNormal skin colour with diarrhoea and fever

Semasa infusi vinkristin IV melalui kanula periferi, pesakit melaporkan rasa terbakar, dan tapak bengkak. Apakah yang patut dilakukan oleh jururawat dahulu?

1. AMenghentikan infusi, membiarkan kanula untuk menyedut, mengikut dasar
2. BMeneruskan infusi dengan lebih perlahan dan meletakkan paket ais pada tapak
3. CMembilas kanula dengan salin untuk menolak baki ubat ke dalam vena
4. DMengeluarkan kanula serta-merta dan mengurut kawasan itu untuk menyebarkan ubat

A woman with pre-eclampsia is on magnesium sulfate. Which task can be delegated to a healthcare assistant (unlicensed assistive personnel)?

1. AAssessing her deep tendon reflexes
2. BAdjusting the magnesium infusion rate
3. CEvaluating her for signs of toxicity
4. DMeasuring and recording urine output

The triage nurse receives four phone calls from pregnant women. Who should be told to come in immediately?

1. AAt 25 weeks with mild backache after standing
2. BAt 36 weeks with constant pain and a hard uterus
3. CAt 30 weeks with heartburn after large meals
4. DAt 12 weeks with mild nausea in the mornings

Manakah kontraindikasi sebenar bagi dos lanjut vaksin yang sama?

1. AKemerahan dan rasa sakit pada tapak suntikan selepas dos sebelum ini
2. BAnafilaksis selepas dos sebelum ini bagi vaksin itu
3. CDemam gred rendah selepas dos sebelum ini
4. DSejarah keluarga alahan

An infant on digoxin has vomited twice. The apical pulse is below the limit set by the prescriber. What should the nurse do?

1. AWithhold the dose and inform the prescriber
2. BGive the dose with milk to stop the vomiting
3. CGive half the dose to be on the safe side
4. DGive the dose and recheck the pulse in an hour

Which finding in a patient with anorexia nervosa is most concerning?

1. AA resting heart rate of 38/min
2. BFeeling cold in a warm room
3. CDry skin and brittle hair
4. DConstipation for the past few days

A nurse realises she has given a patient another patient's olanzapine dose. What should she do first?

1. AAssess the patient, including his vital signs and level of sedation
2. BFill in an incident report before checking the patient
3. CSay nothing, because one dose will not cause harm
4. DGive the patient his own prescribed medicine as well, to stay on schedule

Latihan (nilai rekaan, bukan panduan klinikal). Suhu seorang pesakit ialah 36.5 °C. Tukarkan kepada darjah Fahrenheit T dengan °F = °C × 9/5 + 32. Bundarkan kepada satu tempat perpuluhan.

Latihan (nilai rekaan, bukan panduan klinikal). Satu preskripsi berbunyi 1 tsp ampaian oral setiap 12 jam selama 7 hari. Dengan menggunakan 1 tsp = 5 mL, berapa mL V yang diperlukan untuk seluruh kursus rawatan?

Seorang pesakit berberat 60 kg. Dos yang dipreskripsikan ialah 5 mg/kg sehari, diberi dalam 4 dos yang sama. Berapakah miligram D yang diberi bagi setiap dos?

Preskripsi ialah 950 unit ubat yang datang sebagai 1000 unit/mL. Sedut dos itu dalam picagari 1 mL: berapakah isi padu V yang anda berikan?

Infuskan 500 mL selama 6 jam dengan set pemberian 15 gtt/mL. Cari kadar titisan R dalam titis seminit. Bundarkan kepada nombor bulat yang terdekat.

Satu infusi 50 mg dalam 250 mL berjalan pada 3 mL/j. Berapa mikrogram seminit D yang diterima pesakit?

Latihan (nilai rekaan, bukan panduan klinikal). Rekod menunjukkan pengambilan dan pengeluaran seorang pesakit untuk satu syif 8 jam. Infusi IV berjalan pada kadar yang ditunjukkan sepanjang syif. Cari imbangan cecair B = pengambilan − pengeluaran dalam mL (jawapan negatif bermaksud kehilangan bersih). Kira ketulan ais sebagai separuh isi padunya.

Latihan (nilai rekaan, bukan panduan klinikal). Satu beg 500 mL berjalan dengan pam pada 120 mL/j. Pada 19:30, 50 mL telah diinfuskan. Berapa jam t sehingga beg kosong? Bundarkan kepada satu tempat perpuluhan.

Latihan (nilai rekaan, bukan panduan klinikal). Satu carta latihan merekodkan GCS 11, dengan E3 dan V3. Apakah skor motor M yang direkodkan, dan respons yang manakah yang dihuraikannya? Berikan nombornya.

Latihan (nilai rekaan, bukan panduan klinikal). Pasukan menyasarkan tekanan arteri purata sekurang-kurangnya 70 mmHg. Tekanan sistolik pesakit ialah 94 mmHg. Dengan menggunakan MAP = (SBP + 2·DBP)/3, apakah tekanan diastolik terendah DBP yang masih memberikan MAP 70 mmHg?