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

Tanda amaran awal manakah yang sering muncul dahulu apabila keadaan pesakit bertambah teruk?

1. AKadar pernafasan yang meningkat
2. BKadar jantung lebih rendah
3. CSelera makan bertambah baik
4. DSuhu badan yang menurun

A patient with new swallowing difficulty is prescribed a modified-release tablet. What should the nurse do?

1. AContact the prescriber or pharmacist for a suitable alternative
2. BCut the tablet into quarters and give the pieces one at a time with water
3. COmit the medicine without telling anyone
4. DCrush the tablet and mix it with yoghurt

A small spill of blood is found on the floor. How should it be cleaned?

1. AWipe it up quickly with a dry cloth using bare hands, then wash the hands well
2. BCover it with a clean sheet and keep working
3. CWear gloves, absorb the blood, then clean the area with an approved disinfectant
4. DLeave it until housekeeping arrives the next morning

A patient on chemotherapy develops shingles over several areas on both sides of the body. Which precautions are needed?

1. AContact precautions only, with gloves for dressing changes
2. BStandard precautions only, with the lesions covered
3. CDroplet precautions until the pain settles
4. DAirborne and contact precautions until all lesions are crusted

A nurse teaches a patient who uses crutches. Which statement shows a need for further teaching?

1. A“I will lean on the crutch pads under my arms to rest.”
2. B“I will take my weight on my hands, not on my armpits.”
3. C“I will keep the crutch tips in good condition.”
4. D“I will remove loose rugs from the floor at home.”

An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?

1. AStarting physiotherapy to prevent contractures straight away
2. BApplying antibiotic cream to all the burns before anything else
3. CLarge-volume IV fluids with close monitoring of urine output
4. DGiving a high-protein meal to support healing

What is the most common cause of hypernatraemia in frail older inpatients?

1. AToo much exercise
2. BTaking too many vitamins
3. CEating too much salt in one meal
4. DNot drinking enough water

Pesakit yang menerima pemakanan tiub enteral selepas tempoh kebuluran yang lama mengalami fosfat rendah, kalium rendah dan aritmia. Apakah yang paling mungkin?

1. AHipertiroidisme
2. BSindrom lambakan (dumping)
3. CSindrom pemakanan semula (refeeding)
4. DKetoasidosis diabetes

Which technique is recommended for a capillary blood glucose test on an adult's finger?

1. APrick the side of the fingertip
2. BUse the same finger every time
3. CPrick the center of the fingertip
4. DSqueeze the finger very hard

Seorang pesakit yang mengambil apiksaban bertanya mengapa mereka tidak memerlukan ujian INR berkala seperti jiran mereka yang mengambil warfarin. Apakah penjelasan yang terbaik?

1. AApiksaban dipantau dengan aPTT setiap hari sebaliknya
2. BApiksaban sebenarnya tidak mencairkan darah
3. CKesannya boleh diramal, maka ujian pembekuan rutin tidak diperlukan
4. DINR diperiksa secara rahsia bersama ujian darah rutin yang lain

Which approach is usually recommended to prevent constipation in a patient on regular opioids?

1. ABulk-forming fibre alone, with fluid intake restricted
2. BNo laxative until the patient has not opened the bowels for a week
3. CAn antidiarrhoeal drug at night to slow the gut
4. DA stimulant laxative such as senna, often with a stool softener

Metotreksat untuk artritis reumatoid diambil seminggu sekali. Pesakit tersalah mengambil dos yang sama setiap hari. Apakah bahaya utama?

1. AHipertensi teruk akibat pengekalan cecair
2. BPenindasan sumsum tulang dan mukositis akibat ketoksikan metotreksat
3. CHipoglisemia kerana metotreksat merangsang pembebasan insulin dengan kuat
4. DArtritis menjadi lebih teruk kerana toleransi ubat

A patient stops ramipril because of a troublesome dry cough. Which drug class is a common alternative?

1. AA non-selective beta-blocker such as propranolol
2. BA loop diuretic such as furosemide
3. CA nitrate such as isosorbide mononitrate
4. DAn angiotensin II receptor blocker such as losartan

A patient with a confirmed type A aortic dissection is hypertensive and tachycardic while awaiting surgery. Which drug class is usually given first to lower the heart rate and blood pressure?

1. AOral aspirin
2. BAn intravenous fluid bolus
3. CAn intravenous thrombolytic
4. DAn intravenous beta-blocker

A patient on ciclosporin or tacrolimus asks about grapefruit juice. Which advice is correct?

1. ADrink it daily to protect the kidney
2. BAvoid it, because it can raise the drug levels
3. CIt has no effect on these drugs
4. DDrink it with each dose to improve the absorption

A patient's glucose is 6.2 mmol/L (112 mg/dL) at 03:00 and 12 mmol/L (216 mg/dL) before breakfast. No hypoglycaemia occurred overnight. What is the most likely explanation?

1. AThe Somogyi effect from a night-time hypo
2. BThe meter is faulty and should be replaced
3. CThe dawn phenomenon from early-morning hormones
4. DA large snack eaten in the night by mistake

Which technique is correct when giving a prefilled low molecular weight heparin injection?

1. AExpel the air bubble first and inject into the deltoid muscle
2. BInject into a vein in the back of the hand
3. CRub the site firmly afterwards to help absorption
4. DLeave the air bubble in and inject into a skin fold

On day 3 after admission, a patient with alcohol dependence becomes confused, with hallucinations, sweating, tremor, fever and tachycardia. What is the most likely cause?

1. ANormal anxiety about being in hospital
2. BAn allergic reaction to hospital food
3. CHepatitis A caught on the ward
4. DDelirium tremens from alcohol withdrawal

Parents ask why their baby is having a pulse oximetry check on the right hand and a foot. What is the reason?

1. ATo check the baby's blood glucose
2. BTo screen for hearing loss
3. CTo measure the baby's blood pressure
4. DTo screen for critical congenital heart disease

Selepas urutan fundus, uterus masih lembik dan pendarahan banyak. Apakah tindakan seterusnya yang menjadi keutamaan?

1. ATawarkan cecair oral dan periksa semula dalam sejam
2. BTerus mengurut fundus dengan kuat bersendirian selama 30 minit sebelum memanggil pasukan
3. CMinta bantuan dan beri uterotonik yang ditetapkan, seperti oksitosin, mengikut protokol
4. DDudukkan wanita itu dalam kedudukan Fowler tinggi

A child with a known peanut allergy is starting school. What is the most important step?

1. AKeeping the auto-injector at home, so that it cannot be lost or misused by other children
2. BAsking the child to tell the teachers if she feels unwell
3. CA written allergy action plan, with in-date auto-injectors and trained staff
4. DAllowing the child to eat only foods brought by classmates

A 15-year-old in traction for a femur fracture is withdrawn and irritable. Which intervention best fits his developmental stage?

1. AMove him to a room with toddlers so the ward is less lonely
2. BAsk his parents to stay with him at all times and make decisions for him
3. CSet a strict timetable for him that staff decide without his input
4. DArrange contact with friends and let him control parts of his daily routine

A patient taking valproate is starting lamotrigine. Why must lamotrigine be increased especially slowly?

1. AValproate raises lamotrigine levels, which increases the risk of a serious rash
2. BLamotrigine will lower the valproate level until it has no effect
3. CValproate makes lamotrigine work faster, so the dose must be increased quickly
4. DThe two drugs together cause severe hair growth

A patient with dementia repeatedly walks towards the ward exit, saying he must go to work. What is the most appropriate action?

1. ALock him in his room so that he cannot leave
2. BTell him firmly that he has been retired for 20 years
3. CWalk with him, acknowledge his concern and gently redirect him to an activity
4. DUse a physical restraint in a chair for the rest of the day so that he stays safe and cannot reach the exit

Latihan (nilai rekaan, bukan panduan klinikal). Satu pengiraan dos untuk suntikan kecil memberikan 0.42751 mL. Peraturan dalam latihan ini ialah isi padu di bawah 1 mL dibundarkan kepada perseratus mL yang terdekat. Apakah nilai x yang anda rekodkan?

Latihan (nilai rekaan, bukan panduan klinikal). Semasa satu syif, seorang pesakit mengambil 1 cawan daripada teh, 4 tbsp daripada suplemen cecair, 2 tsp daripada sirap batuk. Dengan menggunakan setara yang diberikan, cari jumlah pengambilan oral V dalam mL.

Seorang kanak-kanak seberat 25 kg dipreskripsikan 3 mg/kg ubat. Larutan stok mengandungi 25 mg/mL. Sedut dos itu: berapakah isi padu V yang anda berikan?

Preskripsi ialah 4600 unit ubat yang datang sebagai 10000 unit/mL. Sedut dos itu dalam picagari 1 mL: berapakah isi padu V yang anda berikan?

Infuskan 250 mL selama 4 jam dengan set pemberian 10 gtt/mL. Cari kadar titisan R dalam titis seminit. Bundarkan kepada nombor bulat yang terdekat.

Satu titisan berjalan pada 32 gtt/min melalui set 60 gtt/mL. Terdapat 300 mL lagi dalam beg. Berapa jam t sehingga ia kosong? Bundarkan kepada satu tempat perpuluhan.

Latihan (nilai rekaan, bukan panduan klinikal). Rekod menunjukkan pengambilan dan pengeluaran seorang pesakit untuk satu syif 12 jam. Pesakit berberat 67 kg. Cari pengeluaran air kencing purata U dalam mL/kg/j. Bundarkan kepada dua tempat perpuluhan.

Latihan (nilai rekaan, bukan panduan klinikal). Satu infusi 1000 mL bermula pada 06:00 dengan 100 mL/j. Selepas 3 jam kadar ditukar kepada 80 mL/j dan tidak ditukar lagi. Berapa jam t selepas permulaan beg akan kosong? Bundarkan kepada satu tempat perpuluhan.

Latihan (nilai rekaan, bukan panduan klinikal). Seorang pesakit latihan dinilai dengan skala jatuh Morse: sejarah jatuh dalam 3 bulan yang lalu: ya; diagnosis sekunder: ya; alat bantu berjalan: tongkat ketiak, tongkat atau alat bantu berjalan; terapi IV atau kunci salina: tidak; cara berjalan: normal, rehat di katil atau kerusi roda; status mental: melebih-lebihkan atau melupakan had. Cari jumlah Morse MFS.

Latihan (nilai rekaan, bukan panduan klinikal). Seorang pesakit latihan dinilai dengan skala Braden: persepsi deria: sangat terhad; kelembapan: sentiasa lembap; aktiviti: terlantar di katil; mobiliti: tidak bergerak sepenuhnya; pemakanan: sangat lemah; geseran dan ricih: potensi masalah. Gunakan jalur 19–23 tiada risiko, 15–18 ringan, 13–14 sederhana, 10–12 tinggi dan 9 atau kurang sangat tinggi. Klik tahap risikonya.

1. 1tiada risiko
2. 2risiko ringan
3. 3risiko sederhana
4. 4risiko tinggi
5. 5risiko sangat tinggi