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

A patient has a reddened area on the sacrum that does not blanch when pressed. What is the priority action?

1. AKeep the patient lying on the back to protect the area
2. BApply a heat pad to the area to increase circulation
3. CRelieve pressure on the area by changing position regularly
4. DMassage the area firmly to improve the blood flow to the skin

During an infusion of a thrombolytic drug for stroke, the patient develops a severe headache and starts vomiting. What should the nurse do first?

1. AContinue the infusion, because headache is expected
2. BGive a dose of aspirin for the headache
3. CSlow the infusion and give an antiemetic as prescribed
4. DStop the infusion and inform the provider at once

A nurse who wears prescription glasses must irrigate a wound where splashing is likely. Which eye protection is suitable?

1. ANo eye protection, if the nurse stands to one side
2. BGoggles or a face shield worn over the glasses
3. CThe glasses with a surgical mask
4. DThe prescription glasses alone

During a procedure, a nurse sees that the team is about to start without a time-out. What should the nurse do?

1. AReport it to the manager at the end of the week
2. BSay nothing, because the surgeon is responsible for the procedure
3. CSpeak up clearly and stop the start until the time-out is done
4. DWait and raise the issue after the procedure is finished

Why is a baseline platelet count taken before starting heparin therapy?

1. ASo a later fall from heparin-induced thrombocytopenia is detected
2. BBecause heparin increases the platelet count to dangerous levels
3. CSo that the INR can be calculated from the platelet count later
4. DBecause heparin is given at a dose based on the platelet count

Which cerebrospinal fluid (CSF) pattern most strongly suggests bacterial meningitis?

1. AClear fluid, high glucose, low protein, many red cells
2. BClear fluid, normal glucose, mildly raised protein, lymphocytes
3. CClear fluid, normal glucose, normal protein, no white cells
4. DCloudy fluid, low glucose, high protein, many neutrophils

What is the main benefit of pulmonary rehabilitation for patients with COPD?

1. AA cure for the disease within months
2. BReversal of the lung damage caused by smoking
3. CNo further need for inhalers
4. DBetter exercise capacity and quality of life

The fluid in an underwater seal chest drain has stopped swinging with breathing. What could this mean?

1. AThe patient's breathing has become normal and the drain can be pulled out by the nurse
2. BThe tube may be kinked or blocked, or the lung may have fully re-expanded
3. CThe drain is working perfectly and needs no checks
4. DThe water seal has been set up correctly for the first time

During airway suctioning, when should suction be applied?

1. ABefore the catheter enters the airway
2. BOnly while withdrawing the catheter
3. CContinuously for at least 30 seconds
4. DOnly while inserting the catheter

An older patient's varicose vein bursts at the ankle and bleeds heavily. What is the most effective first aid?

1. AStand the patient up so the blood flows away and clots faster
2. BLie the patient down, raise the leg and press firmly on the site
3. CKeep the leg hanging down over the bed
4. DApply a hot compress to the leg to help the vein close up

Why are tacrolimus blood levels checked regularly?

1. AThe levels show whether the patient has diabetes
2. BThe drug only works if levels are as high as possible
3. CToo high harms the kidney; too low risks rejection
4. DThe levels show how much urine the kidney is making

Trong khi chạy thận nhân tạo, huyết áp của bệnh nhân tụt xuống 80/50 mmHg và bệnh nhân chóng mặt, buồn nôn. Hành động điều dưỡng đầu tiên phù hợp nhất là gì?

1. ACho ngay liều thuốc hạ huyết áp thường dùng của bệnh nhân
2. BCho bệnh nhân nằm phẳng, giảm lượng dịch lấy ra và gọi hỗ trợ
3. CCho bệnh nhân ngồi thẳng và khuyến khích đi bộ ngắn
4. DTăng tốc độ lấy dịch để buổi lọc kết thúc sớm hơn

Why are antiemetics usually given before chemotherapy starts?

1. AAntiemetics make the chemotherapy work better
2. BThey stop the chemotherapy from causing hair loss and mouth sores
3. CPreventing nausea works better than treating it later
4. DThey cannot be given once nausea has started

Xử trí nào nhìn chung được khuyến cáo cho vảy hoại tử đen khô, ổn định, còn nguyên ở gót chân bệnh nhân tuần hoàn kém?

1. APhủ bằng băng ép chặt
2. BNgâm nước mỗi ngày để làm mềm
3. CCắt lọc bằng dụng cụ sắc tại giường ngay hôm nay
4. DĐể nguyên, giảm tì đè lên gót và chuyển đánh giá