Prioriteren en delegeren in NCLEX-stijl: samenvattingspakket

Straight after birth, what is the first priority for a healthy-looking newborn?

1. AWeigh and measure the baby on the scale
2. BDry and warm the baby while checking that it is breathing
3. CGive the first bath to remove the blood and vernix
4. DGive the vitamin K injection before anything else is done

A patient at 36 weeks of pregnancy has sudden severe abdominal pain, a hard, board-like uterus and dark vaginal bleeding. What should the nurse suspect?

1. AA urinary tract infection
2. BNormal labor contractions starting
3. CPlacenta previa, which is usually painless
4. DPlacental abruption, which is an emergency

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

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

A nurse has worked three long shifts in a row and feels exhausted. The manager asks the nurse to stay for another shift. What is the most appropriate response?

1. AAgree and drink extra coffee to stay alert
2. BAgree without telling anyone about the fatigue
3. CExplain that fatigue would make care unsafe and decline the extra shift
4. DAgree, but skip the independent medication checks to save energy on the shift

A patient with iron-deficiency anemia started oral iron. Which result is usually the earliest sign that treatment is working?

1. AA fall in the mean cell volume (MCV)
2. BA rise in the reticulocyte count
3. CA rise in the platelet count
4. DA fall in the white cell count

Which cerebrospinal fluid (CSF) pattern most strongly suggests bacterial meningitis?

1. ACloudy fluid, low glucose, high protein, many neutrophils
2. BClear fluid, normal glucose, mildly raised protein, lymphocytes
3. CClear fluid, normal glucose, normal protein, no white cells
4. DClear fluid, high glucose, low protein, many red cells

A patient with sickle cell disease is admitted with a painful crisis. What is a key early nursing priority?

1. AGiving prompt, effective analgesia
2. BApplying cold packs to the painful areas
3. CRestricting oral fluids
4. DDelaying pain relief until a diagnosis is confirmed

During CPR for asystole, when should adrenaline (epinephrine) be given according to standard adult guidelines?

1. AOnly once the patient has a pulse again
2. BAs soon as IV or IO access is obtained, then every 3–5 minutes
3. COnly after three shocks have been delivered by the defibrillator
4. DNever, because asystole is not treated with drugs

How is the jugular venous pressure usually assessed?

1. APatient sitting upright with the arms raised above the head
2. BPatient lying completely flat with the head turned to the right
3. CPatient reclined at 45° with the head turned slightly to the left
4. DPatient standing with the neck flexed forward

A patient's blood gas shows pH 7,26, PaCO₂ 9,0 kPa (68 mmHg) and bicarbonate 25 mmol/L. What does this show?

1. AMetabolic alkalosis
2. BAcute respiratory acidosis
3. CRespiratory alkalosis
4. DMetabolic acidosis with compensation

Why are patients with an acute spinal cord injury at high risk of deep vein thrombosis?

1. AParalysed leg muscles no longer pump blood back to the heart
2. BThe injury makes the blood too thin to clot properly in the veins
3. CThey usually take oestrogen as part of their treatment
4. DSpinal injuries always damage the large veins of the legs

A patient with stable epilepsy on phenytoin started a new medicine last week. They now have nystagmus, an unsteady gait and slurred speech. What should the nurse do?

1. ASuspect a new stroke and give aspirin straight away before any scan
2. BGive the next phenytoin dose early to prevent a seizure
3. CEncourage the patient to walk more to improve their balance
4. DSuspect phenytoin toxicity, hold the next dose and ask for a drug level

How are skin staples usually removed from a healed incision?

1. AAlternate staples first, then the rest if the wound holds
2. BOnly the staples at each end, leaving the others for good
3. CAll staples at once by pulling each one straight up from the skin
4. DThe staples are left in permanently under the skin

A nurse teaches a patient with GORD. Which statement shows a need for further teaching?

1. A"I'll try to lose some weight over the next months."
2. B"Peppermint tea after dinner will settle my reflux."
3. C"I'll stop smoking because it makes reflux worse."
4. D"I'll keep a diary of foods that trigger my symptoms."