Priorytetyzacja i delegowanie w stylu NCLEX: zestaw na powtórkę

On day 3 after hip surgery, a patient suddenly becomes short of breath with sharp chest pain and an SpO₂ of 88%. What should the nurse do first?

1. AGive the next dose of oral analgesia and reassess the patient in an hour
2. BEncourage the patient to walk to improve the circulation
3. CMassage the patient’s calves to ease any muscle cramp
4. DRaise the head of the bed, give oxygen and call for urgent help

During JumpSTART triage, a child who cannot walk is breathing 50 times a minute. Which category is the child given?

1. AYellow (delayed)
2. BRed (immediate)
3. CGreen (minor)
4. DBlack (expectant)

Which measure reduces errors caused by interruptions during medication preparation?

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

A nurse finds a patient lying on the floor next to the bed. What should the nurse do first?

1. ATelephone the family to tell them about the fall
2. BComplete an incident report while the details are fresh
3. CLift the patient back into bed with a colleague
4. DAssess the patient for injury before moving them

A patient had a total gastrectomy. Which long-term therapy is needed to prevent anemia?

1. AWeekly doses of oral vitamin K tablets
2. BLifelong vitamin B₁₂ replacement
3. CLifelong oral folic acid tablets only
4. DMonthly transfusions of red blood cells

Potas pacjenta od miesięcy wynosi 3,4–3,6 mEq/L, a dzisiejszy pojedynczy wynik to 5,4 mEq/L. Pacjent czuje się dobrze, a EKG jest prawidłowe. Jaki jest najlepszy następny krok?

1. AOdstawić wszystkie regularnie przyjmowane leki pacjenta
2. BZignorować wynik, ponieważ pacjent czuje się dobrze
3. CNatychmiast włączyć lek wiążący potas bez dalszych sprawdzeń
4. DSprawdzić sposób pobrania próbki, ocenić pacjenta i powtórzyć badanie

Which side effects are common after high doses of salbutamol (albuterol)?

1. AConstipation and urinary retention
2. BTremor and a fast heart rate
3. CBradycardia and drowsiness
4. DHair loss and weight gain

Diureza pacjenta od 12 godzin jest bardzo mała, a kreatynina gwałtownie wzrosła. Który lek z karty zleceń najpewniej wymaga przeglądu?

1. AKrem natłuszczający
2. BSuplement witaminowy
3. CParacetamol w zwykłych dawkach
4. DNiesteroidowy lek przeciwzapalny, np. ibuprofen

A patient is starting doxazosin, an alpha-blocker, for hypertension. Which advice is most important?

1. ATake the first dose at bedtime, as dizziness and fainting can occur
2. BStop it suddenly if the heart rate rises after the first few doses
3. CAvoid all potassium-containing foods
4. DTake it with a large glass of grapefruit juice to improve absorption

Pacjent przyjmujący bisoprolol i diltiazem ma zawroty głowy, częstość serca 38/min i ciśnienie 82/50 mmHg. Jaka jest najodpowiedniejsza pierwsza reakcja?

1. APrzeprowadzić pacjenta po oddziale, aby przyspieszyć czynność serca
2. BZapisać obserwacje i ponownie sprawdzić je za cztery godziny
3. CWezwać pilną pomoc, ocenić według schematu ABCDE i podłączyć monitor serca
4. DPodać następne dawki obu leków wcześniej, aby utrzymać stałą częstość serca

A patient is due a rapid-acting insulin dose before lunch, but the meal trays are delayed. What should the nurse do?

1. AWait to give the insulin until the meal arrives
2. BGive the insulin now and the meal when it comes
3. COmit the dose entirely for the rest of the day
4. DGive the insulin with a glass of water instead

At bedtime, a patient was given their rapid-acting insulin by mistake instead of their long-acting insulin. What should the nurse do?

1. ATell the prescriber and check glucose often overnight
2. BGive the long-acting dose as well and check glucose at breakfast
3. CGive glucagon now, before the glucose has fallen
4. DSay nothing, because the patient is asleep and seems fine

Które zaburzenie elektrolitowe może wystąpić w ciężkim ostrym zapaleniu trzustki?

1. AHiperkaliemia
2. BHipokalcemia
3. CHiperkalcemia
4. DHipernatremia

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. AProtamine sulfate on its own
2. BProthrombin complex concentrate with IV vitamin K
3. CMore warfarin to stabilise the INR
4. DOral aspirin to balance the clotting system quickly