Priorytetyzacja i delegowanie w stylu NCLEX: zestaw na powtórkę

Podczas triażu START na miejscu masowego zdarzenia poszkodowany potrafi dojść do wyznaczonego miejsca, gdy się go o to poprosi. Do jakiej kategorii zostaje zakwalifikowany?

1. ACzarnej (oczekujący)
2. BŻółtej (odroczona)
3. CZielonej (drobne obrażenia)
4. DCzerwonej (natychmiastowa pomoc)

A patient was knocked out briefly in a fall, then woke and talked normally. Two hours later the patient becomes drowsy and one pupil is larger. What is the most likely cause?

1. ANormal tiredness after a fall
2. BA mild concussion that is settling
3. CLow blood sugar from missing a meal
4. DAn epidural hematoma

Sputum specimens are ordered to look for acid-fast bacilli (TB). How are they usually collected?

1. AThree deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
2. BOne specimen of sputum collected straight after the evening meal, when coughing is easiest
3. CThree specimens collected after an antiseptic mouthwash
4. DOne saliva sample collected at any convenient time of day

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

1. AHelping the patient bathe while wearing a gown and gloves
2. BAssessing the wound for new signs of infection during the bath
3. CTeaching the family how to follow the precautions
4. DDeciding when the precautions can be stopped

A healthy patient has a mildly raised CK after running a marathon yesterday, without dark urine or symptoms. What is the most likely explanation?

1. AStrenuous exercise raised CK from skeletal muscle
2. BThe patient has developed acute pancreatitis
3. CAn acute myocardial infarction has occurred
4. DThe patient has developed acute hepatitis

Pacjent z niewydolnością serca przyjmuje lizynopryl, spironolakton i suplement potasu. Dziś potas wynosi 6,0 mEq/L. Jakie jest najbardziej prawdopodobne wyjaśnienie?

1. AJednocześnie przyjmuje się kilka leków zwiększających potas
2. BSpironolakton powoduje utratę potasu
3. CSuplementy potasu nie wpływają na jego stężenie w surowicy
4. DLizynopryl obniża potas

Why should a urinary catheter drainage bag be kept below the level of the bladder?

1. ATo make the bag easier for the nurse to empty
2. BTo prevent urine flowing back into the bladder
3. CTo keep the urine warm
4. DTo stop the catheter from falling out

Why might a patient with diabetes who takes a beta-blocker not notice hypoglycaemia early?

1. ABeta-blockers stop the liver from responding to insulin
2. BBeta-blockers can mask warning signs such as tremor and a fast heart rate
3. CBeta-blockers raise blood glucose, so true hypoglycaemia cannot happen at all
4. DBeta-blockers make the patient sleep through the night

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

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

A patient with a confirmed pulmonary embolism has BP 78/50 mmHg despite fluids, and the right ventricle is dilated on echocardiography. Which treatment is most likely?

1. ASystemic thrombolysis
2. BAn inhaled bronchodilator
3. CCompression stockings and bed rest
4. DOral apixaban only, started next week

After a kidney biopsy, which observation is most important?

1. ASigns of bleeding, such as haematuria and a rising pulse
2. BThe patient's appetite at the next meal
3. CThe colour of the patient's skin on the face
4. DThe temperature every four hours only

Pacjent dochodzący do siebie po ostrej martwicy cewek nerkowych wchodzi w fazę wielomoczu i oddaje ponad 4 L moczu na dobę. Jaki jest główny problem pielęgniarski?

1. AHipoglikemia spowodowana nadmiarem insuliny
2. BOdwodnienie z niskim stężeniem potasu i sodu
3. CPrzeciążenie płynami z wysokim stężeniem potasu
4. DZaleganie moczu w rozdętym pęcherzu

Which statement about giving medicines through a feeding tube is correct?

1. AMedicines can be added to the bag of feed
2. BModified-release tablets should not be crushed
3. CAll tablets can be crushed together and given at once
4. DTubes do not need flushing between medicines

A patient with a PICC line develops swelling and aching of the same arm and prominent veins on the chest. What should the nurse suspect?

1. ANormal swelling after line insertion
2. BA catheter-related deep vein thrombosis
3. CLymphoedema from a previous operation
4. DAn allergy to the dressing