Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

A nurse teaches a patient to use an incentive spirometer. Which statement shows a need for further teaching?

1. A“I will blow into it as hard and fast as I can.”
2. B“I will breathe in slowly and deeply through the mouthpiece.”
3. C“I will try to hold my breath for a few seconds at the top.”
4. D“I will use it several times every hour while awake.”

A patient with suspected sepsis has four prescribed orders. Which should usually be done first?

1. ATake blood cultures
2. BArrange a chest X-ray for later today
3. CRepeat the lactate in six hours
4. DGive the IV antibiotic

Sisa pembalut manakah yang patut dilupuskan sebagai sisa klinikal (bahaya biologi)?

1. ATuala kertas bersih yang digunakan untuk mengeringkan tangan
2. BBungkus kertas luar bagi bungkusan pembalut steril
3. CPembalut yang direndam dengan cecair daripada luka yang dijangkiti
4. DPembalut yang tidak digunakan dan masih bertutup tetapi telah melepasi tarikh luput

Tindakan manakah yang paling baik mencegah kesilapan laluan yang salah dengan infusi epidural?

1. AMelekatkan semua talian bersama dengan pita supaya kemas
2. BMenggunakan port IV yang kosong jika port epidural tersumbat
3. CMenggunakan jenis pam dan tiub yang sama untuk semua infusi pesakit
4. DMelabel talian epidural dan mengekalkannya pada pam khusus tersendiri

A patient has burning on urination and frequency. The dipstick is positive for nitrites and leukocyte esterase, and a urine culture is ordered. When should the sample be taken?

1. AAfter the symptoms have fully settled
2. BAfter 3 days of antibiotic treatment
3. CAt any time, as antibiotics do not matter
4. DBefore the first dose of antibiotic

Seorang pesakit penyakit buah pinggang kronik mempunyai fosfat 7.2 mg/dL (2.3 mmol/L). Pengajaran diet manakah yang paling sesuai?

1. AAmbil suplemen kalsium dengan perut kosong dan bukan pengikat
2. BTingkatkan susu dan keju untuk melindungi tulang daripada kehilangan kalsium
3. CMinum lebih banyak minuman ringan jenis kola untuk kekal terhidrat
4. DHadkan makanan kaya fosfat, seperti makanan diproses dan kola

A pressure ulcer shows full-thickness tissue loss with exposed bone. Which category (stage) is this?

1. ACategory 2
2. BCategory 4
3. CCategory 3
4. DCategory 1

A patient with an epidural catheter develops new back pain and increasing leg weakness when the block should be wearing off. What should be suspected?

1. AMild hypokalaemia
2. BThe normal expected effect of the local anaesthetic
3. CAn epidural haematoma or abscess compressing the spinal cord
4. DMuscle strain from lying in the same position in bed for many hours

A patient uses a glyceryl trinitrate (nitroglycerin) patch for angina. Why is it usually removed for several hours each day?

1. AThe patch works only during the night
2. BThe skin needs a break to absorb a larger dose
3. CIt lowers the risk of a high potassium level
4. DA nitrate-free interval prevents tolerance

Shortly after a thoracentesis, a patient becomes breathless with sharp chest pain and reduced breath sounds on the same side. What complication is most likely?

1. AInfection at the puncture site
2. BPulmonary embolism from the leg
3. CPneumothorax
4. DRe-accumulation of the effusion

An 85-year-old care home resident becomes newly confused and is falling more often. A UTI is one possibility. Why?

1. AA UTI cannot occur in people over 80
2. BConfusion is the only symptom of a UTI at any age
3. CUrinary infections always cause a high fever in older adults
4. DOlder adults often show infection as confusion

A patient with an acute stroke has a glucose of 15 mmol/L (270 mg/dL). They do not have known diabetes. What is appropriate?

1. AReport it and monitor glucose, as it can worsen outcome
2. BIgnore it, because stress always raises glucose
3. CGive glucose gel to stabilise the level
4. DStop all IV fluids to lower the glucose

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

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

A nurse teaches a carer about overnight tube feeding at home. Which statement shows a need for further teaching?

1. A"I'll stop the feed and call if he coughs or struggles to breathe."
2. B"I'll let him lie flat so he sleeps better while the feed runs."
3. C"I'll check the external length mark on the tube every day."
4. D"I'll flush the tube with water before and after his medicines."