Приоритизация и делегирование в стиле NCLEX: шпаргалка-пакет

A drowsy patient has an arterial blood gas with pH 7,30, PaCO₂ 58 mmHg (7,7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?

1. ALoss of bicarbonate from the bowel through severe diarrhea
2. BToo much bicarbonate from antacids
3. CHyperventilation caused by anxiety
4. DPoor ventilation causing carbon dioxide to build up

О каком пациенте медсестре следует в первую очередь сообщить бригаде быстрого реагирования?

1. AПациент с инфекцией мочевых путей, у которого новая спутанность, частота дыхания 26/мин и систолическое давление 94 mmHg
2. BПациент после операции на колене с болью 6/10 и нормальными жизненными показателями
3. CПациент с целлюлитом с температурой 38,1 °C при остальных нормальных жизненных показателях
4. DПациент с известной гипертензией, у которого давление 152/94 mmHg и который чувствует себя хорошо

A patient on contact precautions must be taken to another department for a test. What is correct?

1. APut the patient in a separate elevator with the doors open
2. BCancel the test until the precautions are no longer needed, however urgent it is
3. CCover wounds, give the patient a clean gown and tell the receiving department
4. DHave the patient wear an N95 respirator during transport

A small-bore feeding tube has just been inserted blindly at the bedside. Which method is the most reliable way to confirm its position before the first feeding?

1. ABy listening over the stomach while injecting air
2. BBy putting the end in water to look for bubbles
3. CBy checking that the patient can still talk
4. DBy an x-ray reviewed by a competent clinician

A patient who is breathless during a transfusion has hypotension, fever and bilateral lung infiltrates, with no signs of fluid overload. Which complication is most likely?

1. ATransfusion-associated circulatory overload
2. BA mild febrile nonhemolytic reaction
3. CA simple allergic reaction with hives
4. DTransfusion-related acute lung injury (TRALI)

Пациент с сердечной недостаточностью принимает лизиноприл, спиронолактон и добавку калия. Сегодня калий 6,0 mEq/L. Какое объяснение наиболее вероятно?

1. AЛизиноприл снижает калий
2. BОдновременно принимается несколько препаратов, повышающих калий
3. CСпиронолактон вызывает потерю калия
4. DДобавки калия не влияют на уровень в сыворотке

When should discharge planning usually begin?

1. AAfter the patient has been home for a week
2. BOn or soon after admission
3. COnly after the patient asks to go home
4. DOn the morning of discharge

An arterial blood gas shows a low PaO₂ with a low or normal PaCO₂. How is this classified?

1. AType 2 respiratory failure
2. BMetabolic acidosis
3. CType 1 respiratory failure
4. DNormal blood gas

A patient on ramipril is to start sacubitril/valsartan for heart failure. What is the key safety point?

1. AThe ACE inhibitor dose should be doubled during the change
2. BSacubitril/valsartan is safe to start on the same morning
3. CThe ACE inhibitor must be stopped first, with a gap before starting
4. DBoth drugs should be taken together each day for the best effect

A woman starting rifampicin (rifampin) for tuberculosis uses a combined oral contraceptive pill. What advice is correct?

1. AStop all contraception during TB treatment, as pregnancy cannot occur
2. BContinue the pill as usual, because there is no interaction with TB drugs
3. CTake two pills a day to make up for the drug
4. DUse another reliable method, as rifampicin reduces the pill's effect

Через пятнадцать минут после лечения таблетками глюкозы глюкоза пациента выросла с 3,2 до 5,1 mmol/L. Следующий приём пищи через два часа. Что делать дальше?

1. AДать ещё одну дозу таблеток глюкозы, чтобы поднять уровень выше
2. BНикаких дальнейших действий не нужно до следующего приёма пищи
3. CСразу ввести обычную дозу инсулина быстрого действия
4. DДать закуску с более долго действующими углеводами, например бутерброд

A nurse teaches the family of a patient on insulin how to manage a severe hypo. Which statement shows a need for further teaching?

1. A"If she is unconscious, I will pour juice into her mouth."
2. B"I will put her on her side and call an ambulance straight away."
3. C"When she can swallow, I will give her a snack."
4. D"I will give the glucagon as I was shown."

Why is the time a surgical limb tourniquet is inflated carefully recorded?

1. AThe surgeon is paid per minute of use
2. BThe tourniquet slowly loses all its air after one minute
3. CLong inflation can cause nerve and muscle damage
4. DIt shows how long the anaesthetic gas was used

A patient with a sacral pressure ulcer keeps sliding down the bed when the head is raised high. Which advice best reduces shear?

1. AKeep the head of the bed at or below 30° if possible; use slide sheets
2. BSit the patient upright without any support for the feet
3. CRaise the head of the bed to 90° and pull the patient up the bed by the arms
4. DUse a dry sheet and drag the patient up the bed