Приоритизация и делегирование в стиле NCLEX: шпаргалка-пакет

A patient speaks little English, and the nurse needs to explain a new procedure. What is the best way to communicate?

1. AAsk the patient’s 10-year-old child to translate
2. BUse hand gestures and hope the patient understands
3. CUse a professional medical interpreter
4. DSpeak loudly and slowly in English

A visitor on the ward becomes threatening and shows a knife. What is the nurse’s priority?

1. AArgue with the visitor to persuade them to leave
2. BTry to take the knife away from the visitor straight away before anyone is hurt
3. CMove away to safety, keep others away and call security or the police
4. DIgnore the visitor and carry on with patient care

Which room lighting is safest at night for a patient at high risk of falls?

1. ABright overhead lights left on all night in the room
2. BOnly the light from the television screen
3. CComplete darkness so the patient sleeps more deeply
4. DA low night light that lights the path to the bathroom

Several patients arrive with suspected inhalational anthrax after a deliberate release. Which precautions are needed for their care?

1. AContact precautions with gowns and gloves
2. BStandard precautions, because it is not spread from person to person
3. CDroplet precautions with surgical masks
4. DAirborne precautions in negative-pressure rooms, because spores are inhaled

A patient had a total thyroidectomy yesterday. Which laboratory value is most important to monitor in the first days after surgery?

1. ASerum sodium
2. BSerum calcium
3. CSerum glucose
4. DSerum potassium

A patient with heavy alcohol use and a poor diet has a hemoglobin of 10,1 g/dL (101 g/L), an MCV of 110 fL and a low red cell folate. Which explanation fits best?

1. AIron deficiency from slow, chronic bleeding in the gut
2. BThalassemia trait inherited from one of the parents
3. CFolate deficiency, made worse by a direct alcohol effect
4. DAnemia caused by long-standing chronic kidney disease

When is a rapid-acting insulin such as insulin aspart usually given?

1. ATwo hours after finishing a meal
2. BOnly at bedtime
3. CJust before or with a meal
4. DOnce a week

A nurse phones a doctor about a deteriorating patient using SBAR. Which statement belongs in the "R" section?

1. A"I am calling about Mr Smith, who is breathless."
2. B"His blood pressure is 85/50 and he is confused."
3. C"Please review him within the next 15 minutes."
4. D"He was admitted three days ago with pneumonia."

Согласно современным рекомендациям, когда следует давать кислород пациенту с острым коронарным синдромом?

1. AТолько после получения результата тропонина
2. BВсегда 15 L/min независимо от сатурации
3. CТолько когда SpO₂ ниже целевого диапазона
4. DНикогда, потому что кислород вредит сердечной мышце

During a thrombolytic infusion for an MI, the patient develops a sudden severe headache, vomiting and new confusion. What should the nurse do first?

1. ASlow the infusion and give an antiemetic
2. BGive a second dose to finish the treatment
3. CStop the infusion and call for urgent medical help
4. DContinue the infusion, as headache is a common side effect

Какое утверждение о базальном инсулине длительного действия, например гларгине, верно?

1. AУ него резкий пик действия примерно через 30 минут после инъекции
2. BПри диабете 1 типа его продолжают, даже когда пациент не ест
3. CЕго смешивают с инсулином быстрого действия в одном шприце
4. DЕго вводят только после обильной еды, чтобы покрыть углеводы

A patient with a new arm fistula says their hand on that side is cold, pale and painful, especially during dialysis. What is the concern?

1. AFluid overload in the arm
2. BAn allergic reaction to the dressing on the arm
3. CNormal healing that needs no action
4. DSteal syndrome, which needs urgent review

For which stoma can colostomy irrigation be considered?

1. AA new ileostomy in the first week
2. BAn ileal conduit draining urine
3. CAn established descending or sigmoid colostomy
4. DAny stoma that has liquid or very loose output

Four patients are on a gastroenterology ward. Which should the nurse see first?

1. AA patient with GORD who wants an antacid
2. BA patient with cirrhosis who is newly confused and drowsy
3. CA patient with an ileostomy waiting to change the pouch
4. DA patient with stable ulcerative colitis asking about diet