Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

A patient receiving chemotherapy has a temperature of 38.3 °C and a very low neutrophil count. What should the nurse do?

1. ARecheck the temperature in four hours before telling anyone
2. BGive a cool shower and offer extra fluids, then wait and see what happens
3. CDocument the reading and mention it at the next handover
4. DReport it at once, because cultures and antibiotics are needed quickly

A patient has a potassium of 7.0 mEq/L with peaked T waves. Several drugs are prescribed. Which one is usually given first to protect the heart?

1. AIV furosemide
2. BIV calcium gluconate
3. COral potassium binder
4. DOral sodium bicarbonate

When is it appropriate to use the override function on an automated dispensing cabinet to take a drug before pharmacist review?

1. AWhenever the pharmacist is slow to review new orders and the patient is waiting
2. BWhenever the nurse is sure of the dose
3. CAt the start of each shift to save time later
4. DOnly in an urgent situation where delay would harm the patient, per policy

Seorang jururawat mengambil vial heparin yang mengandungi 10 000 unit/mL; wad lazimnya menyimpan vial 1000 unit/mL. Mengapakah penjagaan tambahan diperlukan?

1. AMenggunakan vial yang lebih pekat secara tersilap akan menyebabkan dos berlebihan sepuluh kali ganda
2. BKedua-dua kekuatan vial boleh ditukar ganti dengan bebas
3. CKepekatan heparin tidak memberi kesan kepada keselamatan
4. DVial pekat lebih selamat, kerana isi padu yang disedut lebih sedikit

Makmal menelefon wad dengan keputusan kritikal kalium 6.9 mEq/L. Apakah yang patut dilakukan oleh jururawat?

1. ABaca semula nilai itu, nilai pesakit dan maklumkan pembekal
2. BRekodkan nilai itu dan serahkan kepada syif seterusnya
3. CMinta makmal mengulang ujian sebelum memberitahu sesiapa
4. DTunggu laporan bertulis tiba sebelum mengambil sebarang tindakan

The nurse teaches a patient with thrombocytopenia (platelets 25 × 10³/µL) about home safety. Which statement shows a need for further teaching?

1. A"I'll use a soft-bristled toothbrush"
2. B"I'll use an electric razor to shave"
3. C"I'll blow my nose gently, not forcefully"
4. D"I'll take aspirin if I get a headache"

A patient on peritoneal dialysis notices the drained fluid has become cloudy and has abdominal pain. What is likely?

1. AConstipation
2. BA urinary tract infection
3. CPeritonitis
4. DNormal dialysis fluid

A patient with a small leg wound has severe pain out of proportion to the skin changes, rapidly spreading redness and signs of sepsis. What should be suspected?

1. ANecrotising fasciitis
2. BA superficial bruise
3. CAn allergic reaction to the dressing
4. DSimple cellulitis that will settle with oral antibiotics

Why must inspired air be humidified for a patient with a tracheostomy?

1. AThe nose and upper airway, which warm and moisten air, are bypassed
2. BDry air is needed to stop secretions forming in the trachea
3. CHumidification prevents the cuff from deflating
4. DHumidified air contains more oxygen than dry air at the same flow

A nurse receives handover on four patients. Which patient should be seen first?

1. AA patient with asthma who wants a reliever inhaler before a walk
2. BA patient on day 1 after surgery who is newly restless, RR 30/min, SpO₂ 88% on 4 L/min
3. CA patient with COPD on 1 L/min whose SpO₂ has been 89% and stable throughout the night
4. DA patient with pneumonia on IV antibiotics who now has a temperature of 38.2 °C

Which group of drugs is a well-known cause of SIADH and hyponatraemia, especially in older people?

1. AProton pump inhibitors
2. BSSRI antidepressants
3. CBulk-forming laxatives
4. DPenicillin antibiotics

A 74-year-old falls forward and hits their chin. Their arms are much weaker than their legs, and they have burning pain in the hands. Which injury is most likely?

1. AA complete lumbar cord injury
2. BCauda equina syndrome
3. CCentral cord syndrome
4. DBrown-Séquard syndrome

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

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

Which history should most alert the nurse to a possible latex allergy before surgery?

1. AHay fever every spring since childhood
2. BItching with bananas, avocado and kiwi, and many operations
3. CFeeling sick after eating shellfish once
4. DA rash after taking amoxicillin as a child, with a family history of asthma