Ưu tiên và ủy quyền kiểu NCLEX: gói ôn nước rút

Which patient should the RN see first after receiving a report from the night nurse?

1. ADay 3 after bowel surgery, wants a shower and hair wash before breakfast
2. BDay 4 after bowel surgery, waiting for discharge teaching
3. CDay 1 after bowel surgery, new chest pain and heart rate 110/min
4. DDay 2 after bowel surgery, asking to start a soft diet

A patient has full-thickness burns all the way around the chest and is finding it harder to breathe, although the airway is clear. What does this suggest?

1. AThe tight burned skin is restricting chest movement, so an escharotomy may be needed
2. BThe patient is anxious and only needs reassurance
3. CThe burns are healing and the skin is tightening normally
4. DThe patient has had too little IV fluid and needs a fast bolus to improve the breathing

A patient in bed has a generalized tonic-clonic seizure. What should the nurse do?

1. ATurn the patient on their side and protect them from injury without restraining
2. BGive sips of water to keep the airway moist
3. CHold the arms and legs firmly to stop the movements
4. DPut a padded tongue blade between the teeth to protect the tongue from biting

Hành động nào phòng ngừa tốt nhất sai sót nhầm đường dùng với truyền ngoài màng cứng?

1. ADán băng keo gom tất cả các dây lại cho gọn
2. BDùng cùng loại bơm và dây cho mọi đường truyền của bệnh nhân
3. CDùng cổng tĩnh mạch còn trống nếu cổng ngoài màng cứng bị tắc
4. DDán nhãn dây ngoài màng cứng và dùng bơm riêng dành cho nó

Which change in clotting tests is normal in late pregnancy?

1. AFibrinogen and D-dimer rise
2. BaPTT doubles from baseline
3. CPlatelets rise above 600 × 10³/µL
4. DINR rises to about 3,0

A patient has a sodium of 150 mEq/L, a glucose of 180 mg/dL and a BUN of 28 mg/dL. Using the formula 2 × Na + glucose/18 + BUN/2,8, what is the calculated serum osmolality?

1. AAbout 358 mOsm/kg, which is high
2. BAbout 300 mOsm/kg, which is normal
3. CAbout 320 mOsm/kg, which is high
4. DAbout 285 mOsm/kg, which is normal

Trước khi cho thuốc chẹn beta, theo dõi nào quan trọng nhất cần kiểm tra?

1. AChỉ nhiệt độ
2. BĐi ngoài
3. CChỉ đường huyết
4. DNhịp tim và huyết áp

A patient is taught to self-inject low-molecular-weight heparin. Which statement shows a need for further teaching?

1. A"I will rub the area firmly after the injection."
2. B"I will change the injection site each time."
3. C"I will report any unusual bleeding or bruising."
4. D"I will inject into the fatty tissue of my abdomen."

Đặc điểm nào mô tả đúng nhất loét động mạch ở chân?

1. AỔ loét không đau dưới ụ gan bàn chân với chai dày xung quanh
2. BỔ loét tiết dịch ở cẳng chân trước với phù lõm của chân
3. CỔ loét nông, ẩm phía trên mắt cá trong với da nâu
4. DỔ loét đau, nhợt, như bị đục khoét ở ngón chân, mạch bàn chân yếu

As the defibrillator charges, a nurse sees a colleague still holding the patient's bed rail. What should the nurse do?

1. ADeliver the shock now, as the bed rail is not part of the patient
2. BTurn off the defibrillator and start a new cycle of CPR
3. CCall clearly for everyone to stand clear and check before the shock
4. DAsk the colleague to hold the patient's hand instead

Một bệnh nhân thức dậy với triệu chứng đột quỵ. Họ đi ngủ khỏe mạnh lúc 23:00 và thức dậy lúc 06:30. Thời điểm nào được dùng làm thời điểm khởi phát?

1. AThời điểm đến bệnh viện
2. B06:30, khi triệu chứng được nhận ra lần đầu
3. CThời điểm chụp CT
4. D23:00, lần cuối biết là bình thường

After a TURP, a patient on bladder irrigation has bladder spasms. The drainage has slowed and contains clots, and the bag holds less than the irrigant given. What should the nurse do first?

1. ATurn off the irrigation and leave the catheter alone
2. BEncourage the patient to strain to pass the clots
3. CSuspect a clot in the catheter and follow the protocol
4. DGive an antispasmodic and recheck in four hours

A patient with a new colostomy asks what to eat at home. Which advice is most appropriate?

1. ADrink as little fluid as possible to reduce output
2. BEat a normal, balanced diet and introduce foods gradually
3. CEat only liquids until the stoma is removed
4. DAvoid all fruit and vegetables for the rest of their life

After two days of large volumes of IV 5% glucose, a postoperative patient becomes confused with a headache. Sodium is 124 mmol/L. What is the likely cause?

1. AHypoglycaemia from the glucose
2. BHyponatraemia from hypotonic fluids
3. CNormal confusion after any anaesthetic
4. DHypernatraemia from too much salt