Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

Seorang jururawat meminta pembantu jururawat "menilai kesakitan pesakit dan memutuskan sama ada pesakit memerlukan lebih banyak ubat". Hak pendelegasian manakah yang dilanggar?

1. AKeadaan yang betul
2. BPenyeliaan dan penilaian yang betul
3. CTugas yang betul
4. DOrang yang betul

A child with sickle cell disease in a pain crisis develops chest pain, fever and an SpO₂ of 89%. What does this most likely mean?

1. AAn ordinary pain crisis that will improve with rest
2. BAcute chest syndrome, which needs urgent escalation and oxygen
3. CA minor chest infection that can safely wait until the morning round
4. DAnxiety that will settle with reassurance

When should the transparent dressing over a peripheral IV site be changed?

1. AWhen it is damp, loose or visibly soiled
2. BOnly when the IV catheter is removed, whatever its state
3. CEvery hour, so the site can be cleaned again
4. DOnly when the patient asks for a new dressing

A nurse has a needlestick from a patient known to have hepatitis C. Which statement about management is correct?

1. ANo follow-up is needed because hepatitis C does not spread by needles
2. BHepatitis C immune globulin is given within 24 hours, followed by a booster dose
3. CThere is no preventive drug, so baseline and follow-up testing are done to detect infection early
4. DThe hepatitis C vaccine series is started at once, with a booster dose six months later

A patient takes high-dose biotin supplements for hair and nails. Why should the nurse report this before blood tests?

1. ABiotin lowers the hemoglobin by destroying the red cells
2. BBiotin causes a true rise in blood glucose in all patients
3. CBiotin makes the blood clot in the tube before testing
4. DBiotin can distort some immunoassays, such as troponin or TSH

A patient with severe hypertriglyceridemia has a measured sodium of 128 mEq/L, but a measured serum osmolality is normal, and the patient has no symptoms. What is the most likely explanation?

1. AHyponatremia caused by drinking far too much water
2. BHyponatremia caused by severe hyperglycemia in diabetes
3. CTrue hyponatremia from SIADH that needs fluid restriction
4. DPseudohyponatremia, an artifact caused by very high lipids

Tangga analgesik WHO mengesyorkan:

1. AMemberi analgesia hanya apabila sakit menjadi teruk
2. BMemulakan semua pesakit dengan opioid kuat
3. CBergerak daripada bukan opioid kepada opioid lemah kemudian opioid kuat apabila sakit bertambah
4. DMenggunakan kaedah bukan ubat sahaja untuk sakit kanser

Why is hypokalaemia particularly dangerous in a patient taking digoxin?

1. ADigoxin raises potassium to dangerous levels when it is already low
2. BLow potassium stops digoxin from being absorbed
3. CLow potassium increases the risk of digoxin toxicity
4. DLow potassium makes digoxin work too slowly

What is the purpose of cardiac resynchronisation therapy (a biventricular pacemaker)?

1. ATo deliver a shock whenever the heart rate exceeds 100/min
2. BTo slow the atrial rate in patients with atrial fibrillation
3. CTo make both ventricles contract together and more efficiently
4. DTo replace a damaged heart valve

Minutes after an IV antibiotic is started, a patient has wheeze, swollen lips, a rash and BP 78/44 mmHg. The infusion has been stopped and help called. What is the next priority?

1. AGive an oral antihistamine tablet and observe for an hour
2. BRestart the infusion at a slower rate
3. CGive intramuscular adrenaline (epinephrine)
4. DGive a nebulised salbutamol dose only

Which long-term risk should a kidney transplant recipient be taught to reduce with sun protection?

1. ASkin cancer
2. BKidney stones
3. CHair loss
4. DGout

Penjagaan kejururawatan manakah yang penting bagi pesakit yang menerima manitol untuk tekanan intrakranial yang meningkat?

1. AMenghentikan carta imbangan cecair semasa rawatan
2. BMemberikan ubat secara oral bersama makanan untuk mengurangkan loya
3. CPemantauan rapi pengeluaran air kencing, natrium dan osmolaliti
4. DMengapit kateter untuk mengekalkan cecair dalam badan

Mengapakah pesakit sirosis berisiko lebih tinggi untuk pendarahan?

1. ATekanan darah arteri yang tinggi dalam sirosis menyebabkan saluran pecah
2. BHati yang berparut membebaskan bahan antikoagulan seperti heparin ke dalam darah
3. CFaktor pembekuan yang lebih sedikit, platelet rendah dan varises akibat hipertensi portal
4. DSirosis meningkatkan kiraan platelet, yang menjadikan platelet lebih lemah

Seorang pesakit yang menggunakan PCA opioid menerima oksigen melalui pelitup muka. SpO₂ ialah 97% dan kadar pernafasan 11/min, tetapi kini sukar dikejutkan. Apakah kesimpulan jururawat?

1. APesakit hanya tidur dengan nyenyak, kerana kesakitan terkawal
2. BPesakit selamat, kerana ketepuan oksigen normal
3. CKetoksikan opioid mungkin; oksigen mungkin menyembunyikan hipoventilasi
4. DDos PCA patut dinaikkan untuk memastikan pesakit selesa