Priorytetyzacja i delegowanie w stylu NCLEX: zestaw na powtórkę

Five days after starting heparin, a patient’s platelet count has fallen by more than half. What should the nurse suspect?

1. AVitamin K deficiency
2. BHeparin-induced thrombocytopenia
3. CAn expected effect that needs no action
4. DIron deficiency anemia

Pacjent miał 45 minut temu nagłą trudność z mówieniem. Które działanie ma najwyższy priorytet?

1. ANatychmiast podać kwas acetylosalicylowy doustnie, aby ograniczyć skrzeplinę
2. BPodać wodę, aby pacjent mógł przyjąć zwykłe poranne leki
3. CUruchomić zespół udarowy w celu pilnego obrazowania, odnotowując czas ostatniego znanego dobrego stanu
4. DPoczekać, aż neurolog oceni pacjenta podczas porannego obchodu

Which technique is used for suctioning a tracheostomy in hospital?

1. AClean technique, with the catheter rinsed in tap water
2. BClean technique, reusing the catheter during the shift
3. CSterile technique, with a sterile catheter and sterile glove
4. DNo gloves at all, because the airway already contains bacteria

A nurse has raised a safety concern about an order with the prescriber, who dismissed it without addressing it. What should the nurse do next?

1. ADiscuss the concern with the patient and let them decide
2. BState the concern clearly a second time and, if still unresolved, use the chain of command
3. CRefuse to care for the patient for the rest of the shift until the prescriber apologizes
4. DCarry out the order as written, because the prescriber has heard the concern

Pacjent ma sód 124 mEq/L, ból głowy i nowe splątanie. Które działanie pielęgniarskie jest najwłaściwsze?

1. AZachęcić pacjenta do picia dużej ilości zwykłej wody
2. BWprowadzić środki ostrożności przeciwdrgawkowe i monitorować stan neurologiczny
3. CUtrzymywać pacjenta w pozycji płaskiej i ograniczyć kontrole neurologiczne do jednej na zmianę
4. DPodać wcześniej następną dawkę zleconego diuretyku tiazydowego

A patient with severe hypertriglyceridemia has a measured sodium of 128 mEq/L, but a measured serum osmolality is normal, and the patient has no symptoms. What is the most likely explanation?

1. ATrue hyponatremia from SIADH that needs fluid restriction
2. BPseudohyponatremia, an artifact caused by very high lipids
3. CHyponatremia caused by drinking far too much water
4. DHyponatremia caused by severe hyperglycemia in diabetes

What should a patient be told before using sublingual glyceryl trinitrate (GTN, nitroglycerin) spray for angina?

1. AUse it only after the pain has lasted over an hour, with the patient lying flat
2. BTake it with a large glass of milk to protect the stomach lining
3. CSwallow the spray rather than leaving it under the tongue
4. DSit down before using it, as it can cause dizziness and low blood pressure

A patient has a blood pressure of 220/130 mmHg with headache, confusion and visual disturbance. Why is the blood pressure lowered in a controlled way rather than as fast as possible?

1. AA sudden drop can reduce blood flow to the brain, heart and kidneys
2. BBlood pressure cannot be lowered with drugs
3. CRapid lowering causes hyperglycaemia
4. DRapid lowering always causes the hypertension to come back much worse

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

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

A patient with severe sepsis becomes increasingly breathless over 24 hours. SpO₂ stays low despite high-flow oxygen, and the chest X-ray shows bilateral infiltrates. The heart function is normal. Which condition is most likely?

1. AAn acute asthma attack
2. BSpontaneous pneumothorax
3. CAcute left ventricular failure after an MI
4. DAcute respiratory distress syndrome

A patient who has had type 1 diabetes for 30 years says they no longer feel the warning signs of a hypo. What is this called?

1. AHypoglycaemia unawareness
2. BInsulin resistance
3. CDiabetic ketoacidosis
4. DThe dawn phenomenon

Which patient on a stroke unit is most at risk of falling?

1. AA patient with a left-hemisphere stroke who has expressive aphasia and waits for help
2. BA patient with a TIA whose symptoms resolved completely yesterday
3. CA patient with mild dysarthria who walks steadily with a frame
4. DA patient with a right-hemisphere stroke who is impulsive and denies having weakness

Which liver function test pattern suggests bile duct obstruction?

1. AVery high ALT with a normal bilirubin only
2. BNormal bilirubin with a low ALP and low GGT
3. CA low albumin with all other results normal
4. DHigh bilirubin with a markedly raised ALP and GGT

Podczas resuscytacji oparzeniowej dorosły o masie 80 kg ma diurezę 15 mL/h przez 2 godziny. Co to wskazuje?

1. ANiedostateczną resuscytację; szybkość płynów zwykle trzeba zwiększyć
2. BPrzeciążenie płynami; wszystkie płyny dożylne należy teraz zatrzymać
3. CPrawidłową diurezę u pacjenta z oparzeniami
4. DZatkany cewnik, który należy po prostu usunąć