Prioriteren en delegeren in NCLEX-stijl: samenvattingspakket

An anxious patient is breathing very fast and has tingling fingers. The blood gas shows pH 7,51 and PaCO₂ 29 mmHg (3,9 kPa). What should the nurse do first?

1. AStay with the patient and coach slow, calm breathing
2. BEncourage the patient to breathe even faster
3. CGive IV sodium bicarbonate as soon as it can be found
4. DGive oxygen at the highest flow and leave the room

A patient has a new spinal cord injury at C4. Which assessment is the priority?

1. ABreathing effort and ability to cough
2. BAbility to feed themselves
3. CBowel sounds in all four abdominal quadrants
4. DSkin over the sacrum and heels

Which PPE does a nurse wear when giving an IV chemotherapy drug?

1. AA reusable cloth gown and one pair of gloves
2. BA surgical mask and no gloves
3. CTwo pairs of chemotherapy-tested gloves and a disposable impermeable gown
4. DOne pair of standard latex gloves, changed after the infusion is started

A patient on an anticoagulant falls and hits their head but says they feel fine. What should the nurse do?

1. AWait until the next day to see if a headache develops
2. BGive the next anticoagulant dose early to prevent clots from forming after the fall
3. CNotify the provider and start neurological observations, because a brain bleed may develop
4. DHelp the patient back to bed and do nothing more if they feel fine

A patient with diabetes is found unconscious with a blood glucose of 38 mg/dL (2,1 mmol/L). Which treatment is appropriate?

1. AGlucose tablets placed between the patient's teeth
2. BGlucagon by injection, or IV dextrose as prescribed
3. CA dose of rapid-acting insulin to stabilize the glucose
4. DOrange juice poured slowly into the patient's mouth

Een patiënt komt binnen 30 minuten na het braken van een grote hoeveelheid bloed. De hartfrequentie is 125/min, maar het eerste hemoglobine is 13,0 g/dL (130 g/L). Waarom is het hemoglobine misleidend?

1. AEr gaat volbloed verloren, dus de waarde daalt pas uren later
2. BDe test is in noodsituaties nooit nauwkeurig
3. CDe waarde bewijst dat er geen significante bloeding is
4. DHemoglobine stijgt tijdens een bloeding, waardoor het verlies verborgen blijft

Welke tekenen wijzen in de eerste minuten op een transfusiereactie?

1. ALichte honger
2. BBetere kleur en meer energie
3. CLangzame, gestage stijging van het hemoglobine in de loop van de volgende dag
4. DKoorts, koude rillingen, rugpijn en lage bloeddruk

A patient is taught to self-inject low-molecular-weight heparin. Which statement shows a need for further teaching?

1. A"I will report any unusual bleeding or bruising."
2. B"I will rub the area firmly after the injection."
3. C"I will inject into the fatty tissue of my abdomen."
4. D"I will change the injection site each time."

A patient is starting long-term amiodarone. Which teaching and monitoring are most important?

1. AProtect skin from sunlight and have thyroid, liver and lung checks
2. BAvoid dairy products and have the INR checked once at the start
3. CExpect orange urine and no need for blood tests
4. DEat extra salt and stop the drug as soon as the pulse is regular

An 84-year-old with heart failure becomes breathless with new crackles and a rising blood pressure during a blood transfusion. What should the nurse suspect?

1. AAn acute haemolytic reaction from wrong blood
2. BA mild febrile reaction
3. CNormal effects of the transfusion
4. DTransfusion-associated circulatory overload

Welke bloeddrukgrens wordt gewoonlijk gebruikt vóór intraveneuze trombolyse bij een beroerte?

1. ABoven ongeveer 200/120 mmHg
2. BEr is geen bloeddrukgrens
3. COnder ongeveer 90/60 mmHg
4. DOnder ongeveer 185/110 mmHg

A patient with type 1 diabetes is vomiting at home. Their glucose is 12 mmol/L (216 mg/dL), and blood ketones are 3,5 mmol/L. What advice is correct?

1. ASeek urgent hospital assessment for possible DKA
2. BDrink less fluid to stop the vomiting
3. CWait until the glucose is above 20 mmol/L (360 mg/dL)
4. DStop insulin until the vomiting has settled

Why is a pregnancy test often done before surgery in women who could be pregnant?

1. AAnaesthesia, drugs and some tests may harm a fetus
2. BIt is needed to calculate the anaesthetic drug dose
3. CPregnant women cannot sign consent forms
4. DPregnancy always makes surgery impossible

A surgical patient's MUST score is 3 and the wound is healing slowly. What is the most appropriate action?

1. ARepeat the score in three months' time
2. BRefer to the dietitian, start a nutrition plan and monitor intake
3. CEncourage fasting to reduce wound exudate and the size of the dressing
4. DRestrict protein to help the kidneys