Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

The day after a total thyroidectomy, a patient reports tingling around the mouth and in the fingers. What should the nurse do first?

1. ACheck for signs of low calcium and inform the provider
2. BGive the patient’s routine oral iron supplement early
3. CEncourage deep breaths into a paper bag until it passes
4. DReassure the patient that this is normal after neck surgery

A patient with a severe asthma attack had a PaCO₂ of 32 mmHg (4.3 kPa) on arrival. An hour later it is 46 mmHg (6.1 kPa), and the patient seems tired. What does this suggest?

1. AA laboratory error that should be ignored
2. BRespiratory muscle fatigue with possible impending respiratory failure
3. CThe patient is hyperventilating even more than before and needs calming
4. DThe asthma is improving, because the PaCO₂ is now near normal

A newly hired nurse had BCG vaccine as a child. Which TB screening test is usually preferred?

1. AAn interferon-gamma release assay (IGRA) blood test
2. BA chest x-ray every month for the first year
3. CNo screening, because BCG prevents all TB
4. DA tuberculin skin test, which is read 24 hours after it is placed

A patient on oxygen needs an MRI scan. Which plan is safe?

1. ATake the usual steel cylinder into the room if it is tightly strapped to the trolley frame
2. BLeave the steel cylinder on the patient’s bed during the scan
3. CRemove the oxygen for the scan without telling anyone
4. DUse only MRI-safe equipment, and never take a standard steel oxygen cylinder into the scanner room

A patient on hemodialysis has an arteriovenous (AV) fistula in the left arm. Where should the nurse draw routine blood samples?

1. AFrom the right arm
2. BFrom the left wrist
3. CFrom the fistula
4. DFrom the left hand

Mengapakah kreatinin yang normal boleh mengelirukan pada warga emas yang lemah dengan jisim otot yang rendah?

1. AParas kreatinin tidak bergantung pada jisim otot sama sekali
2. BWarga emas sentiasa mempunyai kreatinin lebih tinggi daripada orang muda
3. CKreatinin yang normal sentiasa membuktikan fungsi buah pinggang yang normal
4. DOtot yang kurang menghasilkan kreatinin yang kurang, menyembunyikan fungsi buah pinggang yang berkurang

Seorang pesakit mengalami sakit abdomen berkolik, abdomen bengkak, muntah dan tidak melepaskan najis atau angin selama dua hari. Apakah masalah yang mungkin?

1. AHalangan usus
2. BSindrom usus mudah rangsang
3. CApendisitis tanpa komplikasi
4. DGastroenteritis

A patient with new fast atrial fibrillation has chest pain, a blood pressure of 75/40 mmHg and is confused. What does this indicate?

1. AA stable rhythm that can safely be reviewed at the next routine ward round
2. BA normal response to atrial fibrillation needing no action
3. CAnxiety about the new diagnosis that will settle with reassurance and rest alone
4. DHaemodynamic instability needing urgent treatment, possibly electrical cardioversion

Why does a large, rapidly forming pericardial effusion lower the blood pressure?

1. AIt causes the aortic valve to leak backwards into the ventricle
2. BIt compresses the heart and stops the ventricles filling
3. CIt dilates the arteries throughout the body
4. DIt makes the heart muscle contract too strongly and too fast

A 70-year-old man has a small abdominal aortic aneurysm found on screening and is placed under surveillance. Which advice is most important?

1. AAvoid all exercise and lifting for the rest of his life to protect the aorta
2. BStop smoking, control BP and seek help at once for sudden back pain
3. CStop all blood pressure medicines to avoid low pressure
4. DHave the aneurysm repaired immediately, whatever its size or growth rate

Several hours after a carotid endarterectomy, which finding needs the most urgent action?

1. AA blood pressure slightly above the baseline
2. BAn expanding neck swelling with noisy breathing
3. CA small amount of dried blood on the dressing
4. DMild pain at the incision site

Seorang pesakit hipotiroidisme yang tidak mengambil ubat selama berminggu-minggu dimasukkan ke wad dalam keadaan hipotermia dan mengantuk, dengan nadi 46/min, natrium rendah dan PaCO₂ meningkat. Keadaan manakah yang paling mungkin?

1. ARibut tiroid
2. BKoma miksedema
3. CStrok haba
4. DKrisis adrenal

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

A patient with recurrent diverticulitis reports passing air and faecal matter in the urine. What is the most likely cause?

1. ABowel preparation that was taken too quickly
2. BA kidney stone blocking the ureter
3. CA fistula between the colon and the bladder
4. DA simple lower urinary tract infection