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

A patient is admitted with diabetic ketoacidosis. Which prescribed treatment is usually started first?

1. AIV isotonic fluid such as 0,9% sodium chloride
2. BSubcutaneous long-acting insulin only, given once
3. CA high-carbohydrate meal
4. DOral potassium tablets

A patient with MRSA in a wound is on contact precautions. Which instruction to the nursing assistant is correct?

1. AWear a gown and gloves for contact with the patient or the room, and use dedicated equipment
2. BNo special precautions are needed if the wound is covered with a dressing
3. CWear a respirator mask in the room, because MRSA in a wound spreads through the air to others
4. DOnly wear gloves when touching the wound itself; skin and bedding are safe

Why are some patients screened with a nasal swab for MRSA on admission?

1. ATo find carriers so precautions or decolonization can be used
2. BTo diagnose a sinus infection
3. CTo check whether the patient is allergic to penicillin before surgery
4. DTo measure the patient’s immunity to MRSA

While preparing a chemotherapy infusion, the drug splashes onto a nurse’s forearm. What should the nurse do first?

1. AWipe the skin with an alcohol swab and continue preparing the infusion
2. BFinish hanging the infusion and then wash the skin
3. CCover the area with a dressing and report later
4. DRemove contaminated PPE and wash the skin with soap and water at once

A patient has a hot, swollen big toe. The serum uric acid is normal. Which statement is correct?

1. AGout can only be diagnosed with a CT scan of the foot
2. BGout is ruled out, as uric acid is always high in an attack
3. CGout is still possible, as urate can be normal in an attack
4. DGout is certain, as a normal urate proves the diagnosis

Một người bệnh hạ natri máu mạn (natri 118 mEq/L) đang được điều trị. Vì sao natri phải được nâng từ từ?

1. ACó thể gây mất myelin do thẩm thấu, một tổn thương não nghiêm trọng
2. BĐiều chỉnh chậm chỉ cần để giảm chi phí bệnh viện
3. CĐiều chỉnh nhanh gây hạ kali máu, là nguy cơ duy nhất
4. DĐiều chỉnh nhanh làm natri lại giảm thêm nữa

Why is an urgent brain scan needed before thrombolysis for a suspected stroke?

1. ATo rule out bleeding in the brain
2. BTo check for brain tumours only
3. CTo confirm the patient's age
4. DTo measure the size of the ventricles

A patient two days after abdominal surgery coughs and says something "gave way". The wound has opened and bowel is visible. What should the nurse do first?

1. AApply dry gauze tightly and ask the patient to keep coughing
2. BGently push the bowel back into the abdomen and tape the wound edges firmly closed
3. CSit the patient fully upright and offer a hot drink
4. DCover the wound with sterile, saline-moistened dressings and get urgent surgical help

After an acute coronary syndrome, a patient with a normal cholesterol level is prescribed a high-intensity statin. Why?

1. AStatins reduce further events whatever the starting cholesterol
2. BStatins are needed only if the cholesterol level is very high
3. CStatins work as painkillers for chest pain
4. DStatins are given after an ACS mainly to lower the blood pressure

Ống dẫn lưu ngực của bệnh nhân bị tuột khỏi bình dẫn lưu. Điều dưỡng nên làm gì trước tiên?

1. ARút ống dẫn lưu khỏi ngực và che vị trí
2. BĐể hở ra không khí cho đến khi bác sĩ đến xem
3. CNối lại, hoặc nhúng đầu ống vào nước vô khuẩn, rồi đánh giá
4. DKẹp ống vài giờ và kiểm tra lại bệnh nhân sau

A patient with severe vomiting and diarrhoea takes ramipril, furosemide and metformin. Which advice is correct?

1. AAdd ibuprofen to treat the abdominal cramps
2. BDouble the furosemide to prevent fluid retention
3. CKeep taking everything as normal and drink less
4. DPause these medicines until eating and drinking again

Một bệnh nhân cao tuổi đái tháo đường type 2 có đường huyết 48 mmol/L, áp lực thẩm thấu 365 mOsm/kg, không có ceton đáng kể và lú lẫn. Ưu tiên đầu tiên là gì?

1. AGlucose đường uống để phòng hạ đường huyết khi điều trị
2. BHạn chế dịch nghiêm ngặt để tránh phù não
3. CTiêm nhanh một liều insulin tĩnh mạch lớn để đưa đường huyết về bình thường trong một giờ
4. DDịch tĩnh mạch cẩn thận với kiểm tra sát áp lực thẩm thấu, natri và đường huyết

Which advice helps a patient with haemorrhoids?

1. ASit on the toilet for long periods to empty fully
2. BEat more fibre, drink enough fluid and avoid straining
3. CTake a codeine-based painkiller every day
4. DEat less fibre so that stools are smaller

After surgery, a patient says they have "no pain" but grimaces, breathes shallowly and refuses to move or cough. What should the nurse do?

1. ATell the patient firmly that they must stop hiding their pain from staff
2. BExplore their beliefs and explain how analgesia aids recovery
3. CAccept the statement and record a pain score of 0
4. DInsist they walk without any analgesia