Prioriteren en delegeren in NCLEX-stijl: samenvattingspakket

A patient wants to leave the hospital against medical advice. What should the nurse do?

1. ALet the patient leave without telling anyone
2. BInform the provider, explain the risks and document the discussion
3. CLock the door so the patient cannot leave the unit
4. DHide the patient’s clothes and belongings until the provider arrives

Two call lights go on at the same time. One patient has pain of 7/10 after surgery. The other is a confused patient at high risk of falls who is climbing out of bed alone. Who does the nurse go to first?

1. AThe confused patient climbing out of bed
2. BThe patient whose call light went on first
3. CWhichever patient’s room is closer to the station
4. DThe patient in pain after surgery

Which measure reduces errors caused by interruptions during medication preparation?

1. AAnswering phone calls and pages while counting tablets, to save time
2. BA quiet “no interruption” zone or signal while preparing medications
3. CPreparing medications for all patients at once
4. DPreparing medications at the busiest place on the ward

A patient on oxygen needs an MRI scan. Which plan is safe?

1. AUse only MRI-safe equipment, and never take a standard steel oxygen cylinder into the scanner room
2. BRemove the oxygen for the scan without telling anyone
3. CLeave the steel cylinder on the patient’s bed during the scan
4. DTake the usual steel cylinder into the room if it is tightly strapped to the trolley frame

How should a patient collect a clean-catch midstream urine sample?

1. AFill the cup completely, then add tap water if there is not enough
2. BClean the area, start voiding into the toilet, then catch the middle part
3. CCollect the very first urine of the stream directly in the sterile cup
4. DCollect urine from the toilet bowl after voiding into the toilet

A patient's results: sodium 140 mEq/L, chloride 100 mEq/L, bicarbonate 12 mEq/L. What is the anion gap, and what does it suggest?

1. A40 mEq/L, a high anion gap
2. B28 mEq/L, a high anion gap
3. C52 mEq/L, a very high anion gap
4. D12 mEq/L, a normal anion gap

Which factor is most likely to slow wound healing?

1. AA diet rich in protein
2. BSmoking
3. CAdequate fluid intake
4. DGood blood glucose control

A patient with known cirrhosis suddenly vomits large amounts of bright red blood and becomes tachycardic. What is the most likely cause?

1. AA Mallory-Weiss tear from a small amount of vomiting
2. BSwallowed blood from a nosebleed
3. CBleeding from ruptured oesophageal varices
4. DA lower GI bleed from diverticular disease

A patient stops ramipril because of a troublesome dry cough. Which drug class is a common alternative?

1. AAn angiotensin II receptor blocker such as losartan
2. BA nitrate such as isosorbide mononitrate
3. CA loop diuretic such as furosemide
4. DA non-selective beta-blocker such as propranolol

A patient who has had a total laryngectomy becomes breathless and needs oxygen. How should it be given?

1. AVia a non-rebreather mask over the mouth only
2. BVia a mask or humidified device over the neck stoma
3. CVia a standard face mask over the nose and mouth
4. DVia nasal cannula at 2 L/min

A patient with migraine takes painkillers or triptans on most days and now has a headache almost every day. What is the likely problem?

1. AAn allergy to the painkillers
2. BA brain tumour, which is almost certain
3. CMedication overuse headache
4. DNormal progress of migraine

Which task for a patient with a urinary catheter can the nurse delegate to a healthcare assistant (nursing assistant)?

1. ADeciding whether the catheter can be removed
2. BAssessing a patient whose irrigation is not draining
3. CEmptying the drainage bag and recording the volume
4. DTeaching self-catheterisation for the first time

Which lung problem is a known toxicity of bleomycin?

1. APulmonary fibrosis
2. BLung cancer within weeks
3. CPneumothorax from coughing
4. DAsthma from pollen

A patient on warfarin has a major upper GI bleed with an INR of 5. Which treatment should the nurse anticipate to reverse the warfarin?

1. AProthrombin complex concentrate with IV vitamin K
2. BOral aspirin to balance the clotting system quickly
3. CMore warfarin to stabilise the INR
4. DProtamine sulfate on its own