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

Trong phân loại START tại hiện trường thương vong hàng loạt, một nạn nhân có thể đi đến khu vực chỉ định khi được yêu cầu. Nạn nhân được xếp loại nào?

1. AVàng (trì hoãn)
2. BĐỏ (cấp cứu ngay)
3. CXanh lá (nhẹ)
4. DĐen (chờ đợi)

A patient with Guillain-Barré syndrome has weakness that is spreading up from the legs. Which assessment has the highest priority?

1. ABreathing strength, such as vital capacity and the ability to cough
2. BThe patient’s mood and coping
3. CMuscle strength in the feet and ankles at the start of each morning
4. DSkin condition over the heels

Which measure is part of the bundle for inserting a central venous catheter to prevent bloodstream infection?

1. AGiving antibiotics to every patient before insertion
2. BRoutine replacement of the catheter on a fixed schedule, such as every three days
3. CChoosing the femoral vein as the first site in adults
4. DChlorhexidine-alcohol skin antisepsis and maximal sterile barrier precautions

A competent adult patient with pneumonia wants to leave the hospital against medical advice. What should the nurse do?

1. ALock the doors so the patient cannot leave
2. BExplain the risks, notify the provider and follow the policy for leaving against advice
3. CHide the patient’s clothes and belongings so that they cannot leave the ward
4. DApply wrist restraints until the provider arrives to speak with the patient

Một người bệnh rối loạn nhịp thất cho thấy mẫu xoắn đỉnh (torsades de pointes) trên máy theo dõi. Chất điện giải nào thường được cho tĩnh mạch để điều trị?

1. ACalci carbonate
2. BKali phosphate
3. CNatri bicarbonate
4. DMagnesium sulfate

Một người bệnh ung thư vú di căn có canxi 13,2 mg/dL (3,3 mmol/L), lú lẫn và táo bón. Điều dưỡng dự kiến bắt đầu điều trị theo y lệnh nào trước tiên?

1. ABổ sung canxi đường uống
2. BThuốc lợi tiểu thiazide
3. CNằm nghỉ tuyệt đối tại giường
4. DNatri clorid 0,9% truyền tĩnh mạch

Sắp bắt đầu truyền máu. Kiểm tra an toàn quan trọng nhất là gì?

1. AChỉ kiểm tra cân nặng của bệnh nhân
2. BXác định chắc chắn bệnh nhân và đối chiếu với chế phẩm máu tại giường
3. CLàm ấm toàn bộ máu bằng lò vi sóng
4. DKiểm tra sở thích ăn uống của bệnh nhân

Several hours after thyroid surgery, a patient has increasing neck swelling, stridor and difficulty breathing. What is most likely?

1. ANormal postoperative swelling
2. BA haematoma compressing the airway
3. CHypocalcaemia from parathyroid damage
4. DA thyroid storm

A patient's ankle–brachial pressure index (ABPI) is 0,6. What does this suggest?

1. ANormal leg circulation
2. BSignificant peripheral arterial disease
3. CA deep vein thrombosis
4. DStiff, calcified arteries that read falsely high

An adult inhales a peanut while laughing and now has a persistent cough and wheeze on one side. Where is the peanut most likely to have lodged?

1. AThe left main bronchus
2. BThe right main bronchus
3. CThe oesophagus
4. DThe nasal cavity

Which complication is a particular risk in nephrotic syndrome?

1. AHypoglycaemia
2. BVenous thrombosis
3. CBleeding from low platelets
4. DLow cholesterol

A patient with a brain injury has a mean arterial pressure of 80 mmHg and an ICP of 25 mmHg. How should the nurse interpret this?

1. AThe cerebral perfusion pressure is 80 mmHg, which is normal
2. BThe cerebral perfusion pressure is 105 mmHg, which is too high
3. CThe ICP cannot affect brain perfusion if the blood pressure is normal
4. DThe cerebral perfusion pressure is 55 mmHg, below the usual target

Why is a gastrostomy tube with an internal bumper usually advanced and rotated regularly once the tract has healed?

1. ATo remove any feed left in the stomach
2. BTo make the tube longer as the patient grows or gains weight
3. CTo stop the inner bumper becoming buried in the stomach wall
4. DTo check that the patient is still hungry

A surgical patient's MUST score is 3 and the wound is healing slowly. What is the most appropriate action?

1. ARefer to the dietitian, start a nutrition plan and monitor intake
2. BEncourage fasting to reduce wound exudate and the size of the dressing
3. CRestrict protein to help the kidneys
4. DRepeat the score in three months' time