Pemberian Keutamaan & Delegasi Gaya NCLEX: pek ulang kaji kilat

Two hours after birth, the nurse finds the uterus firm but above the umbilicus and pushed to the right. What should the nurse do first?

1. AAsk the patient to lie still for another hour
2. BHelp the patient empty her bladder
3. CMassage the uterus firmly for ten minutes
4. DGive a dose of oxytocin straight away

A patient admitted with suspected appendicitis says the pain suddenly got better, but now the abdomen is rigid and the heart rate is rising. What does this suggest?

1. AThe appendicitis is getting better without surgery
2. BThe appendix may have ruptured, causing peritonitis
3. CThe pain has moved to a different, harmless place
4. DThe patient’s analgesic has finally started to work

A child has swallowed a button battery. Why is this urgent?

1. AIt can burn through the lining of the esophagus within hours
2. BIt always passes through the gut without harm
3. CIt is only harmful if several batteries are swallowed
4. DThe only risk is poisoning from heavy metals years later

A patient is admitted with suspected pneumonic plague after a possible bioterrorism release. Which precautions are used?

1. AAirborne precautions
2. BContact precautions only
3. CDroplet precautions
4. DStandard precautions only

A urine culture is ordered for a patient with an indwelling urinary catheter. How should the nurse collect the sample?

1. ADisconnect the catheter from the tubing and let it drain
2. BAspirate from the sampling port with a sterile syringe
3. CPour urine from the drainage bag into a sterile cup
4. DRemove the catheter and culture the catheter tip

A patient with SIADH is on fluid restriction. Which task can the RN delegate to unlicensed assistive personnel (UAP), such as a nursing or healthcare assistant?

1. AMeasuring and recording intake and output
2. BTeaching the reasons for fluid restriction
3. CDeciding when to recheck the sodium level
4. DAssessing the patient for new confusion

Why are older adults at higher risk of dehydration?

1. ATheir kidneys hold on to too much water
2. BTheir body water content increases with age
3. CThey always drink large amounts of tea
4. DTheir sense of thirst is often reduced

Pesakit asma teruk menjadi senyap, dengan "dada senyap", keletihan dan kadar pernafasan yang menurun. Apakah yang ditunjukkan oleh ini?

1. AKebimbangan sahaja
2. BPemulihan normal selepas nebuliser
3. CPertambahbaikan serangan apabila bronkospasme reda dan saluran udara mengendur
4. DAsma yang mengancam nyawa dengan henti pernafasan yang akan berlaku

A patient with an implantable cardioverter-defibrillator asks what to do if it fires. Which teaching is correct?

1. ADrive straight to hospital alone after any shock so the device can be checked by the team
2. BRemove the device battery at home if it fires more than once
3. CIgnore any shock at all, because the device is designed to fire every day and needs no follow-up
4. DOne shock and well: contact the device clinic; repeated shocks or unwell: call emergency services

Seorang pesakit asma mempunyai sejarah mengi selepas mengambil aspirin. Ibuprofen dipreskripsikan untuk kesakitan pasca-operasi. Apakah yang patut dilakukan oleh jururawat?

1. AMemberikannya hanya jika skor kesakitan melebihi 8/10
2. BMemberikannya, kerana ibuprofen tidak berkaitan dengan aspirin
3. CMenahannya dan meminta alternatif
4. DMemberikannya bersama inhaler pelega pada masa yang sama

What does a positive pronator drift test show?

1. ASubtle weakness in one arm
2. BLoss of hearing on one side
3. CWeakness of the eye muscles
4. DA normal response in older adults

A patient on carbamazepine is admitted confused, with a sodium of 121 mmol/L. Which explanation is most likely?

1. ACarbamazepine causes salt loss through severe diarrhoea
2. BCarbamazepine can cause hyponatraemia through an SIADH-like effect
3. CConfusion is a normal, expected effect of carbamazepine and is unrelated to sodium
4. DThe low sodium proves the patient has stopped taking the drug

How should a patient with facial burns usually be positioned?

1. ALying face down on the pillow to protect the airway
2. BLying flat with the head lower than the feet
3. CIn any position that keeps the face covered
4. DWith the head of the bed raised to reduce swelling

Four hours after surgery, a catheterised patient's urine output has been 10 mL/h for two hours. Vital signs are stable. What should the nurse check first?

1. AThe time the patient last ate
2. BWhether the patient wants a cup of tea
3. CThat the catheter and tubing are not kinked or blocked
4. DYesterday's chest X-ray and blood gas results