NCLEX Tarzı Önceliklendirme ve Görev Devri: hızlı tekrar paketi

A patient on a nasal cannula at 6 L/min still has a low SpO₂. What should the nurse do?

1. ARecheck the SpO₂ at the next routine set of observations in four hours
2. BRemove the oxygen to see if the SpO₂ changes
3. CReport it, because a different oxygen device is likely to be needed
4. DTurn the nasal cannula up to 15 L/min

Four stable patients need routine morning care. To reduce the spread of infection, which patient should the nurse visit first?

1. AA patient with C. difficile diarrhea
2. BA patient with influenza on droplet precautions
3. CA patient with an MRSA wound infection
4. DA patient with neutropenia after chemotherapy

Which household item is a strangulation risk for young children?

1. AA large wooden building block
2. BSoft cotton socks
3. CA plastic picture book
4. DLooped cords on window blinds

The fire alarm sounds, but the nurse does not know where the fire is. What should the nurse do?

1. AClose the doors to patient rooms, stay on the unit and wait for instructions
2. BEvacuate all patients down the stairs at once, starting with those in bed
3. CLeave the unit and the building to find out where the fire is
4. DOpen all doors so patients can be seen easily

On the first day after major surgery, a patient's white cell count is 12,5 × 10³/µL, with no fever or wound signs. What is the best interpretation?

1. AA laboratory error, since surgery lowers white cells
2. BA common stress response to surgery that is monitored
3. CA sign of leukemia that needs bone marrow testing
4. DDefinite wound infection that needs antibiotics now

A patient on hemodialysis receives epoetin, but the hemoglobin has not risen in 2 months. Which results should be checked first?

1. ATroponin and creatine kinase
2. BAmylase and lipase levels
3. CFerritin and transferrin saturation
4. DTSH and the free T₃ level

A nurse finds a patient lying on the floor beside the bed. What should be done first?

1. APhone the patient's family
2. BComplete the incident report form
3. CLift the patient straight back into bed so they are comfortable
4. DCheck the patient for injuries before moving them

Heparin infüzyonu alan bir hastada başladıktan beş gün sonra trombosit sayısı aniden düşüyor. Ne düşünülmelidir?

1. AHeparine bağlı trombositopeni
2. BYetersiz alıma bağlı K vitamini eksikliği
3. CHeparine normal yanıt
4. DDemir eksikliği anemisi

After coronary artery bypass surgery through a median sternotomy, which instruction is usually given for the first several weeks?

1. AAvoid heavy lifting and pushing up with the arms
2. BAvoid walking until the stitches are removed
3. CSleep only on the stomach to protect the wound
4. DLift the arms above the head often to stretch the chest

On day 2 after a surgical tracheostomy, the tube falls out. The patient is breathing but distressed. What should the nurse do first?

1. ACover the stoma completely with a sealed dressing and wait for help
2. BForce the tube back through the stoma immediately with firm pressure
3. CLeave the patient alone while fetching a new tube
4. DCall for expert help and give oxygen to both the face and the stoma

A patient with type 1 diabetes has gastroenteritis and cannot eat. Which sick-day advice is correct?

1. ACheck glucose once a day only and rest in bed until better
2. BKeep taking basal insulin and check glucose and ketones more often
3. CStop all insulin until normal eating restarts
4. DAvoid drinking fluids to reduce the vomiting

A patient with motor neurone disease reports morning headaches, poor sleep and sleepiness during the day. What do these symptoms suggest?

1. ALow mood, which should be treated with an antidepressant first
2. BNormal tiredness that needs no specific action
3. CWeak breathing at night, so a review for ventilation support
4. DA side effect of riluzole, which should be stopped straight away by the nurse

Aspirate from a nasogastric tube has a pH of 7. What should the nurse do?

1. AStart the feed slowly and watch the patient closely for coughing
2. BGive the medicines but not the feed
3. CDo not use it; re-test later or arrange an X-ray as per policy
4. DFlush with 50 mL of air and start the feed

On the day after a Hartmann's procedure, the end colostomy is dark purple to black. What should the nurse do?

1. ARecord it as normal postoperative bruising and recheck it next week
2. BReport it urgently, as the stoma may be necrotic
3. CRub the stoma to improve its colour
4. DCut a smaller hole in the pouch