Prioriteren en delegeren in NCLEX-stijl: samenvattingspakket

Using the Emergency Severity Index, which level fits a 70-year-old with chest pressure that suggests a heart attack, but normal vital signs?

1. ALevel 4
2. BLevel 2
3. CLevel 1
4. DLevel 5

A patient admitted with a stroke this morning asks for a glass of water. What should the nurse do first?

1. AGive thickened fluids without checking the swallow
2. BCheck that a swallow screen has been done before giving anything by mouth
3. CAsk the family to help the patient drink while sitting upright in a chair at the bedside
4. DGive the water through a straw so it goes down slowly

Why does a nurse wear chemotherapy-tested gloves and a gown when emptying the urinal of a patient who recently had chemotherapy?

1. AChemotherapy makes the urine strongly acidic and corrosive
2. BThe body fluids can contain active drug for a time after treatment
3. CThe patient is on airborne precautions after treatment
4. DThe urine always contains infectious bacteria after chemotherapy

During a disaster, the hospital needs to free beds quickly. Which patient is the best candidate for early discharge?

1. AA patient admitted overnight for observation who is now stable with normal tests
2. BA patient on a ventilator in the intensive care unit who is slowly improving
3. CA patient on an IV heparin infusion that is still being adjusted
4. DA patient with ongoing chest pain awaiting cardiac tests

A patient on carbamazepine becomes confused and has a headache. Which laboratory result would most likely explain this?

1. AA low serum sodium
2. BA low serum magnesium
3. CA high serum potassium
4. DA high serum calcium

Een patiënt met diabetische ketoacidose krijgt een intraveneuze insulineinfusie. Welke laboratoriumwaarde moet bijzonder nauwlettend worden bewaakt?

1. ANatrium, omdat insuline ervoor zorgt dat de nieren zeer grote hoeveelheden uitscheiden
2. BAlbumine, omdat insuline ervoor zorgt dat de lever de aanmaak stopt
3. CKalium, omdat insuline het de cellen in verplaatst en het snel kan dalen
4. DHemoglobine, omdat insuline rode bloedcellen afbreekt

A patient with anaphylaxis is hypotensive but has no breathing difficulty. How should they be positioned?

1. ALying face down
2. BStanding up and walking around
3. CLying flat, with the legs raised
4. DSitting upright with the legs dangling

A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?

1. ATo treat hidden diabetes; HbA1c must be checked daily
2. BTo protect the heart muscle directly; the patient must be kept nil by mouth
3. CTo remove potassium from the body; urine output must be stopped for a time
4. DTo shift potassium into cells; blood glucose must be monitored for hypoglycaemia

Which ECG pattern is typical of acute pericarditis?

1. AST elevation only in leads II, III and aVF with Q waves
2. BA sawtooth baseline with a regular ventricular rate
3. CTall peaked T waves with a wide QRS
4. DWidespread saddle-shaped ST elevation with PR depression

A nurse phones the doctor about a patient with pneumonia whose observations are worsening. Using SBAR, which statement is the clearest "recommendation"?

1. A"His heart rate is 124/min, his BP is 88/50 mmHg and he is confused."
2. B"He is 72 and was admitted yesterday with community-acquired pneumonia."
3. C"I am calling about the patient in bed 6."
4. D"I think he may have sepsis; please review him within 30 minutes."

A patient has had a calcium oxalate kidney stone. Which advice best helps prevent another?

1. ACut all calcium out of the diet
2. BTake extra vitamin C supplements
3. CDrink only a little to avoid diluting the urine
4. DDrink plenty of fluid so the urine stays pale

A patient with renal colic has normal kidney function and no other contraindications. Which drug is usually the first choice for pain?

1. AAn oral antihistamine such as cetirizine
2. BAn NSAID such as diclofenac
3. CA benzodiazepine such as diazepam
4. DOral paracetamol (acetaminophen) alone

Why is the Lund and Browder chart preferred to the rule of nines for children?

1. AIt is faster to use than any other method of estimation
2. BIt is used only for burns of the hands
3. CIt adjusts for body proportions that change with age
4. DIt counts superficial burns as well

Een 74-jarige met chronische nierschade heeft ernstige pijn na een operatie. Welk opioïdprobleem is het belangrijkst?

1. AOpioïden mogen bij ouderen nooit worden gebruikt, ongeacht de pijn
2. BDe nierfunctie heeft geen invloed op hoe opioïden worden verwerkt
3. CMorfine is het veiligste opioïd bij nierfalen, dus de doses kunnen vrij worden verhoogd
4. DMorfinemetabolieten stapelen zich op, dus een lagere dosis of een ander opioïd kan nodig zijn