Priorytetyzacja i delegowanie w stylu NCLEX: zestaw na powtórkę

Którego pacjenta powinna zobaczyć pielęgniarka w pierwszej kolejności?

1. APacjenta z przewlekłą chorobą nerek, który jutro ma dializę
2. BPacjenta z nową niewyraźną mową i opadnięciem kącika ust, które zaczęły się 30 minut temu
3. CPacjenta z cukrzycą typu 2, który pyta o dietę
4. DPacjenta z wieloletnim reumatoidalnym zapaleniem stawów i zwykłą poranną sztywnością stawów

On a cardiac step-down unit, which patient should the nurse assess first?

1. AHeart failure, weight up 0,5 kg since yesterday, no breathlessness at rest
2. BSix hours after a coronary stent, new chest pain with ST elevation on the monitor
3. CDay 2 after a pacemaker insertion, asking when the wound dressing will be changed
4. DAtrial fibrillation on warfarin with an INR of 2,6 this morning

A patient has orthostatic hypotension. Which teaching helps to prevent falls?

1. AStand up straight after a hot shower to increase blood flow
2. BSit on the edge of the bed for a short time before standing up slowly
3. CAvoid drinking fluids in the morning to reduce trips to the toilet
4. DGet out of bed quickly so the dizziness passes sooner

A patient’s white cell differential shows a raised eosinophil count. Which cause is most consistent with this finding?

1. AAn acute bacterial infection
2. BAn allergic reaction or a parasitic infection
3. CBone marrow suppression from chemotherapy
4. DA viral infection such as a cold

A patient with type 1 diabetes has the flu, is eating little and has a glucose of 290 mg/dL (16,1 mmol/L). Which advice is correct?

1. AWait 3 days before checking the glucose again
2. BDrink only water and avoid all carbohydrate foods
3. CStop all insulin until you are eating normally again
4. DKeep taking insulin and check blood or urine ketones

A patient has a continuous heparin infusion for a pulmonary embolism. A new nurse plans to adjust the infusion using today's INR of 1,1. What should the experienced nurse explain?

1. AThe INR is the correct test, and 1,1 means heparin is therapeutic
2. BHeparin needs no laboratory monitoring once the infusion is started
3. CHeparin is adjusted using the aPTT or anti-Xa level, not the INR
4. DThe INR of 1,1 means the heparin rate must be doubled at once

Which measure helps reduce the risk of surgical site infection?

1. ARemoving hair, if needed, with clippers rather than a razor
2. BLeaving the patient cool during surgery to slow bacterial growth
3. CChanging the wound dressing every hour
4. DShaving the area with a razor the night before surgery

An older patient found on the floor after lying there for many hours has dark brown urine and a very high creatine kinase. What is the main risk?

1. AA stroke
2. BAcute kidney injury from rhabdomyolysis
3. CHypoglycaemia
4. DA urinary tract infection from lying in urine

Why are patients with mitral stenosis at high risk of atrial fibrillation?

1. AThe right ventricle shrinks and stops contracting properly over time
2. BThe coronary arteries become blocked by the valve
3. CThe left atrium enlarges as it pushes blood through the narrow valve
4. DThe narrow valve presses on the sinus node and slows it down directly

After an anaphylactic reaction to a bee sting that responded to adrenaline (epinephrine), a patient asks to go home immediately. Which advice is most appropriate?

1. AGo home straight away, because anaphylaxis never recurs once adrenaline has worked
2. BStay in hospital for at least two weeks on daily intravenous antihistamines
3. CStay for observation, then go home with an adrenaline auto-injector and teaching
4. DGo home and take antihistamines only if the throat swells

For which patient with migraine would the nurse question an order for sumatriptan?

1. AA patient who also has asthma
2. BA patient with an allergy to penicillin
3. CA patient with a history of angina
4. DA patient with well-controlled hypothyroidism

A nurse teaches a patient with Hashimoto's thyroiditis about levothyroxine. Which statement shows a need for further teaching?

1. A"I will report palpitations or chest pain."
2. B"I can stop the tablets once I feel back to normal."
3. C"I will take the tablets at the same time each day."
4. D"I will have regular blood tests to check my dose."

What are anticipatory ("just in case") medicines at the end of life usually prescribed for?

1. AWeight gain and appetite stimulation
2. BInfection prevention and vaccination
3. CHigh blood pressure, high cholesterol and diabetes
4. DPain, nausea, agitation and respiratory secretions

74-letni pacjent z przewlekłą chorobą nerek ma silny ból po operacji. Jaka kwestia dotycząca opioidów jest najważniejsza?

1. AMorfina jest najbezpieczniejszym opioidem w niewydolności nerek, więc dawki można swobodnie zwiększać
2. BOpioidów nigdy nie wolno stosować u osób starszych, niezależnie od bólu
3. CMetabolity morfiny kumulują się, więc może być potrzebna niższa dawka lub inny opioid
4. DCzynność nerek nie wpływa na sposób, w jaki organizm radzi sobie z opioidami