Приоритизация и делегирование в стиле NCLEX: шпаргалка-пакет

A young adult has just started an SSRI antidepressant for major depression. What should the nurse monitor most closely in the first weeks?

1. ARising blood glucose levels
2. BHair growth and skin color
3. CThoughts of suicide or self-harm
4. DWeight loss from too much appetite

An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?

1. ALarge-volume IV fluids with close monitoring of urine output
2. BApplying antibiotic cream to all the burns before anything else
3. CGiving a high-protein meal to support healing
4. DStarting physiotherapy to prevent contractures straight away

A patient with poorly controlled seizures asks about activities at home. Which advice is most important?

1. ANever swim or bathe alone
2. BSleep sitting up in a chair
3. CAvoid all forms of exercise
4. DAvoid drinking water before bed

A hospital will introduce new infusion pumps and wants to find out how the process could fail before any harm occurs. Which method fits best?

1. AAn incident report for each new pump
2. BRoot cause analysis (RCA) of the new pumps
3. CA morbidity and mortality meeting
4. DFailure mode and effects analysis (FMEA)

When is a peak level for an IV aminoglycoside such as gentamicin usually drawn?

1. AJust before the next dose is started
2. BExactly 24 hours after the first dose
3. CAbout 30 minutes after the infusion ends
4. DAt any time convenient for the patient

A patient with diabetes and chronic kidney disease had a CT scan with IV contrast. Two days later, the creatinine has risen from 1,4 to 2,0 mg/dL (124 to 177 µmol/L). Which action is most appropriate?

1. AReport it, monitor urine output and hold metformin until reviewed
2. BGive extra metformin, because the glucose rises after contrast
3. CRestrict all fluids to protect the kidneys from more contrast
4. DIgnore it, because contrast never affects kidney function

Why does a patient with a suspected TIA need urgent specialist assessment?

1. AA TIA always turns into a brain tumour unless it is treated
2. BThe symptoms will come back permanently within an hour
3. CThe risk of a full stroke is highest in the days after a TIA
4. DThe patient needs urgent surgery on the brain

An acutely ill patient without COPD is on 15 L/min oxygen, and their SpO₂ is now 100% and stable. What should be done?

1. AStop the oxygen and the saturation monitoring because the patient is now well
2. BReduce the oxygen to keep the SpO₂ within the prescribed target range
3. CIncrease the oxygen further to build up a reserve
4. DKeep the oxygen at 15 L/min for at least a week to be on the safe side

A patient with diabetes is starting a beta-blocker. What should the nurse teach about hypoglycaemia?

1. AInsulin should be stopped while taking a beta-blocker
2. BSome warning signs, such as a fast heartbeat, may be masked
3. CHypoglycaemia will always cause a very slow and weak pulse
4. DThe beta-blocker will prevent all episodes of hypoglycaemia

A patient with heart failure wakes extremely breathless, coughing pink frothy sputum. BP is 168/96 mmHg and SpO₂ 86%. Help has been called. What is the best initial nursing action?

1. AEncourage the patient to walk to ease the breathing
2. BSit the patient upright with the legs down and give oxygen
3. CGive a large IV fluid bolus to support the circulation
4. DLie the patient flat with the legs raised on pillows

A patient with a new ileal conduit has threads of mucus in their urine. What should the nurse explain?

1. AThis is a sign that the stoma is dying
2. BThis is normal, because the conduit is made from bowel
3. CThe kidneys have stopped working properly after surgery
4. DThis proves a serious kidney infection

Which statement correctly distinguishes spinal shock from neurogenic shock?

1. ANeurogenic shock is caused by blood loss; spinal shock is caused by infection
2. BThey are two names for exactly the same condition
3. CSpinal shock is low blood pressure; neurogenic shock is the loss of reflexes
4. DSpinal shock is lost reflexes; neurogenic shock is low BP and slow pulse

Which advice may help reduce the risk of a parastomal hernia after stoma surgery?

1. ADo intensive sit-ups from the first week
2. BAvoid heavy lifting early on and use support garments as advised
3. CKeep the stoma bag as full as possible
4. DStrain hard on the toilet each day to strengthen the abdominal muscles

Пациента, длительно принимающего опиоид по поводу хронической боли, госпитализируют для операции. Какое утверждение верно?

1. AПосле завершения операции им следует давать только парацетамол
2. BИм нужны меньшие послеоперационные дозы опиоидов, чем пациентам, ранее не получавшим опиоиды
3. CВсе опиоиды следует отменить при поступлении, чтобы предотвратить зависимость
4. DОбычный опиоид продолжают плюс дополнительное обезболивание из-за толерантности