NCLEX Tarzı Önceliklendirme ve Görev Devri: hızlı tekrar paketi

A patient reports pain of 8/10. Before giving the prescribed as-needed analgesic, what does the nurse do first?

1. ATell the patient to wait until the next scheduled dose is due in two hours
2. BGive the strongest analgesic on the chart straight away
3. CAsk the nursing assistant to reposition the patient
4. DAssess the location, character and onset of the pain and the vital signs

Bir LPN/LVN, stabil bir hastada yeni göğüs ağrısı olduğunu bildiriyor. RN ne yapmalıdır?

1. ALPN/LVN’den bunu halletmesini ve vardiya sonunda bildirmesini istemelidir
2. BHemşire yardımcısından EKG çekmesini istemeli ve sonucu beklemelidir
3. CHastayı bizzat değerlendirmeli ve sonraki adımlara karar vermelidir
4. DLPN/LVN’ye değerlendirme yapmadan gerektiğinde verilecek nitrogliserini vermesini söylemelidir

A patient with a respiratory infection has a raised procalcitonin level. What does this most suggest?

1. AA bacterial rather than a viral infection
2. BDehydration from poor intake
3. CA purely viral illness
4. DAn allergic reaction to a recent medication

A patient sitting in a chair starts to have a generalized seizure. What should the nurse do?

1. AHold the patient firmly in the chair until the seizure stops
2. BPut a padded tongue blade between the teeth to protect the tongue and airway
3. CEase the patient to the floor, protect the head and turn them on their side
4. DLeave to get the provider, then return

A patient on a heparin infusion has an aPTT below the target range on the protocol. What should the nurse do?

1. AStop the infusion and give protamine sulfate as quickly as possible
2. BSwitch the infusion to oral warfarin without a prescription
3. CContinue the same rate and recheck the aPTT in a few days
4. DAdjust the rate as the protocol directs and recheck as scheduled

A patient with diabetes had a glucose of 58 mg/dL (3,2 mmol/L), took 15 g of fast-acting carbohydrate and, 15 minutes later, the glucose is 64 mg/dL (3,6 mmol/L). The patient is alert. What should the nurse do next?

1. AWait until the next meal before giving anything
2. BGive another 15 g of fast carbohydrate and recheck
3. CGive a long-acting insulin dose to stabilize it
4. DGive a protein snack only and recheck tomorrow

Ameliyat sonrası bir hastanın kalp hızı 125/dk, kan basıncı 88/50 mmHg ve pansumanı kanla ıslanmış. Ne oluyor?

1. AKanamaya bağlı hipovolemik şok
2. BYalnızca kaygı
3. Cİdrar yolu enfeksiyonuna bağlı septik şok
4. DNormal ağrı tepkisi

IV vankomisin alan bir hastada hızlı infüzyon sırasında yüz ve boyunda kızarma ve kaşıntılı kırmızı döküntü gelişiyor. En olası neden ve yanıt nedir?

1. ANormal yanıt; infüzyon hızını artırın
2. Bİnfüzyonla ilişkili reaksiyon; infüzyonu durdurun veya yavaşlatın ve order edeni bilgilendirin
3. CGüneş yanığı; krem sürün ve devam edin
4. DKaraciğer yetmezliği; tüm ilaçları kalıcı olarak kesin

A woman with hypertension who takes lisinopril says she is planning a pregnancy. What should the nurse advise?

1. AStop all blood pressure treatment straight away without telling anyone
2. BContinue lisinopril, as it is the safest blood pressure drug in pregnancy
3. CDiscuss switching medicine with the prescriber before trying to conceive
4. DDouble the dose to protect the baby from high blood pressure

A patient taking warfarin for AF falls and hits their head. An hour later they are drowsy and have vomited. What is the priority?

1. AUrgent escalation for CT of the head and anticoagulant reversal
2. BEncourage sleep and check observations at the next routine time
3. CWithhold tonight's warfarin and review tomorrow
4. DGive paracetamol (acetaminophen) and a light meal

An 82-year-old taking apixaban fell three weeks ago. Since then their family has noticed increasing confusion and headaches. Which condition is most likely?

1. ASubarachnoid haemorrhage from an aneurysm
2. BAcute extradural haematoma
3. CChronic subdural haematoma
4. DNormal ageing with mild memory loss

Near the end of a haemodialysis session, a patient has painful leg cramps and a falling blood pressure. What is the most likely cause?

1. ANot enough fluid is being removed
2. BThe dialysate is too cold
3. CFluid is being removed too quickly
4. DAn allergic reaction to the needles

Which intervention most reduces pressure ulcer risk in an immobile patient?

1. AUsing a doughnut-shaped ring cushion
2. BKeeping the head of the bed raised at 90° all day
3. CMassaging red areas firmly at each turn to bring back the circulation
4. DRegular repositioning and a pressure-redistributing mattress

Which new prescription for a patient with cirrhosis should the nurse question?

1. ALactulose to keep the bowels open
2. BSpironolactone for ascites
3. CThiamine supplements
4. DRegular ibuprofen for back pain