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

Một điều dưỡng thường làm ở khoa sản được điều động sang khoa nội người lớn. Người bệnh nào phù hợp nhất để phân công cho điều dưỡng này?

1. ANgười bệnh đang truyền insulin liên tục vì nhiễm toan ceton do đái tháo đường
2. BNgười bệnh viêm phổi ổn định dùng kháng sinh đường uống
3. CNgười bệnh mới mở khí quản
4. DNgười bệnh đang chảy máu tiêu hóa trên tiến triển

Trong phân loại START, một người lớn không đi được thở 28 lần/phút, không có mạch quay và thời gian đổ đầy mao mạch 4 giây. Nạn nhân được xếp loại nào?

1. AVàng (trì hoãn), vì tần số thở dưới 30 lần/phút
2. BXanh lá (nhẹ)
3. CĐỏ (cấp cứu ngay)
4. DĐen (chờ đợi)

Before inserting a peripheral IV, the nurse cleans the skin with chlorhexidine-alcohol. What should the nurse do next?

1. AFeel for the vein again with an ungloved finger
2. BWipe it off with a dry gauze straight away
3. CLet it dry fully and do not touch the site again
4. DBlow on the site so it dries faster

A competent patient at high risk of falls insists on walking to the bathroom alone. What is the best nursing approach?

1. ATell the patient that walking alone is against hospital law
2. BApply wrist restraints so the patient stays in bed
3. CExplain the risks, agree on ways to reduce them, respect the decision and document
4. DRemove the patient’s shoes and walking aid so that they cannot walk alone

In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?

1. AAt about 38–40 weeks of pregnancy
2. BAt about 24–28 weeks of pregnancy
3. CAt about 6–8 weeks of pregnancy
4. DOnly after the baby is born

A patient with thalassemia major has received regular red cell transfusions for years. The ferritin is now very high. What does this most likely show, and what treatment is used?

1. AAcute infection, treated with broad-spectrum antibiotics
2. BLiver failure, treated with a liver transplant at once
3. CIron overload, treated with iron chelation therapy
4. DIron deficiency, treated with IV iron supplements

A patient with sickle cell disease is admitted with a painful crisis. What is a key early nursing priority?

1. ADelaying pain relief until a diagnosis is confirmed
2. BApplying cold packs to the painful areas
3. CGiving prompt, effective analgesia
4. DRestricting oral fluids

How should pain be assessed in a patient with advanced dementia who cannot describe it?

1. ABy assuming the patient has no pain unless they are crying out or calling for help
2. BBy checking the blood pressure only
3. CBy asking the patient to rate their pain on a numerical scale from 0 to 10
4. DWith an observational pain tool that scores facial expression, behaviour and body language

Why is a raised serum lactate concerning in a patient with shock?

1. AIt shows only that the patient has eaten a large meal in the past hour
2. BIt confirms a bacterial infection is present
3. CIt suggests tissues are short of oxygen and using anaerobic metabolism
4. DIt means the kidneys are working harder than normal to clear fluid

A patient with both COPD and heart disease is more breathless, with bilateral basal crackles, raised JVP, ankle swelling and a markedly raised NT-proBNP. Which problem is most likely driving this episode?

1. AA primary spontaneous pneumothorax
2. BHyperventilation from anxiety
3. CAn asthma attack
4. DDecompensated heart failure

What is the dexamethasone suppression test used for?

1. ATo measure kidney function
2. BTo check thyroid function
3. CTo diagnose diabetes insipidus
4. DTo help diagnose Cushing's syndrome

A 74-year-old falls forward and hits their chin. Their arms are much weaker than their legs, and they have burning pain in the hands. Which injury is most likely?

1. ACentral cord syndrome
2. BA complete lumbar cord injury
3. CBrown-Séquard syndrome
4. DCauda equina syndrome

A patient takes co-codamol at home (a combination tablet sold under different names in different countries). Why should the nurse check this before giving regular paracetamol (acetaminophen)?

1. AParacetamol and codeine cause a severe allergic reaction when combined
2. BIt already contains paracetamol, so overdose could occur
3. CCo-codamol stops paracetamol from working
4. DCo-codamol must be stopped a week before any paracetamol

After a coughing fit, the external mark on a patient's nasogastric tube has moved 10 cm. Feed is due. What should the nurse do?

1. AGive the medicines only and save the feed for later
2. BPush the tube back to the original mark and start the feed
3. CDo not use the tube until its position is confirmed by policy
4. DStart the feed at a slow rate and watch for coughing