Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

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

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

Dapatan pesakit manakah yang tidak dijangka dan memerlukan tindakan selepas reseksi transuretra prostat dengan pengairan pundi kencing berterusan?

1. APerasaan perlu membuang air kecil walaupun terdapat kateter
2. BKejang pundi kencing ringan yang reda dengan ubat antispasmodik yang ditetapkan
3. CAir kencing merah jambu muda yang menjadi lebih jernih sepanjang hari
4. DAir kencing merah terang dengan ketulan dan aliran keluar dari kateter yang berkurang

Pernyataan manakah tentang penggunaan sekatan fizikal yang betul?

1. ASekatan boleh digunakan setiap kali unit kekurangan kakitangan kejururawatan
2. BArahan sekatan berterusan mengikut keperluan ialah amalan yang baik
3. CAlternatif didahulukan, dan arahan yang terhad masa diperlukan
4. DSekatan disemak sekali pada akhir setiap syif

Several patients arrive with suspected inhalational anthrax after a deliberate release. Which precautions are needed for their care?

1. AStandard precautions, because it is not spread from person to person
2. BAirborne precautions in negative-pressure rooms, because spores are inhaled
3. CDroplet precautions with surgical masks
4. DContact precautions with gowns and gloves

A patient takes valproate (valproic acid) for epilepsy. Which tests are monitored regularly?

1. AThyroid function and serum calcium
2. BTroponin and B-type natriuretic peptide
3. CLiver function tests and platelet count
4. DSerum lithium and urine specific gravity

A patient receiving parenteral nutrition with lipid emulsion has a triglyceride level of 620 mg/dL (7.0 mmol/L). Why is this result important?

1. AIt shows the nutrition is fully effective
2. BIt raises the risk of acute pancreatitis
3. CIt means the patient needs more lipid
4. DIt is a normal fasting value for adults

Which features suggest pyelonephritis rather than simple cystitis?

1. AFrequency without any pain
2. BCloudy urine with no other symptoms
3. CMild burning on passing urine only
4. DFever, rigors and loin pain

A patient has a full-thickness burn all the way round the forearm. Which complication must be watched for closely?

1. AExcessive bleeding from the burn surface needing an urgent blood transfusion
2. BHypoglycaemia caused by the body using glucose to heal the burn
3. CLoss of circulation to the hand as swelling builds under tight burned skin
4. DDelayed hair growth on the arm

Why is a non-selective beta-blocker such as propranolol usually avoided in a patient with asthma?

1. AIt makes inhaled corticosteroids work too strongly
2. BIt can cause bronchospasm by blocking beta-2 receptors
3. CIt raises the heart rate sharply during an acute asthma attack
4. DIt thickens airway mucus by drying the airways

A patient with a valid, documented do-not-attempt-CPR decision (DNACPR in the UK, DNR or DNAR in the US) is found in cardiac arrest. What should the nurse do?

1. AStart CPR but use only chest compressions
2. BCall the arrest team and let them decide whether to resuscitate
3. CStart full CPR because the patient's family is not present
4. DNot start CPR, call for support, and provide dignity and comfort

Why is an ACE inhibitor often given to a patient with diabetes and albumin in the urine?

1. AIt protects the kidneys and reduces albumin loss
2. BIt raises potassium to protect the heart
3. CIt lowers the blood glucose to normal
4. DIt stops the kidneys from passing so much urine at night

A patient with myasthenia gravis is admitted with pneumonia. Which newly prescribed antibiotic should the nurse question?

1. AAmoxicillin
2. BGentamicin
3. CCeftriaxone
4. DBenzylpenicillin

Which finding suggests a deep tissue pressure injury?

1. AIntact skin that is purple or maroon over a bony area
2. BA small scratch on the skin with a little fresh red blood
3. CDry, flaky skin on both shins
4. DPale pink skin that blanches quickly when pressed

A patient has sharp, tearing pain on passing stool, "like passing glass", with a streak of fresh blood. Which condition is most likely?

1. AUpper GI bleeding
2. BCrohn's disease of the ileum
3. CColorectal cancer
4. DAnal fissure