NCLEX 风格的优先排序与委派：速成包

A patient has a nasogastric tube on suction. Which task can the nurse delegate to a nursing assistant?

1. AAssessing the drainage for blood
2. BGiving mouth care
3. CIrrigating the tube when it blocks
4. DChecking the tube’s position

A child is admitted with a suspected Wilms tumor (nephroblastoma). Which instruction is most important for all staff?

1. AEncourage the child to play contact sports
2. BMeasure abdominal girth by pressing firmly
3. CGive a warm bath with abdominal massage
4. DDo not palpate the abdomen

戴无菌手套时，护士应如何戴上第二只手套？

1. A用裸手调整第一只手套的外面
2. B将已戴手套的手指插入第二只手套的袖口下面并拉上
3. C用裸手捏住指尖把第二只手套拉上
4. D用已戴手套的手抓住第二只手套的内面

A patient restrained because of violent behavior is now calm, oriented and following instructions. What should the nurse do?

1. ARemove one restraint each day to test the patient’s behavior
2. BRemove the restraints, because the reason for them has ended
3. CKeep the restraints until the next provider visit
4. DKeep the restraints until the order expires

A patient with chronic kidney disease has a potassium of 5.6 mEq/L. Which food should the nurse advise the patient to limit?

1. AApples
2. BCabbage
3. CBananas
4. DWhite rice

An RN cares for a patient on a 24-hour urine collection. Which task can be delegated to unlicensed assistive personnel (UAP), such as a nursing or healthcare assistant?

1. ATeaching the patient why the 24-hour collection is needed
2. BDeciding whether to restart the collection after a missed sample
3. CInterpreting the creatinine clearance result when it comes back
4. DSaving all urine in the collection container as instructed

Modern wound care generally aims to keep a healing wound bed:

1. ATightly packed with dry gauze
2. BSoaked in antiseptic solution every day
3. CCompletely dry and open to the air
4. DMoist but not wet

A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?

1. ATo protect the heart muscle directly; the patient must be kept nil by mouth
2. BTo shift potassium into cells; blood glucose must be monitored for hypoglycaemia
3. CTo remove potassium from the body; urine output must be stopped for a time
4. DTo treat hidden diabetes; HbA1c must be checked daily

Which side effect is particularly common with verapamil?

1. AConstipation
2. BDiarrhoea
3. CDry cough
4. DHair loss

A patient with known left-sided lung cancer starts coughing up large amounts of fresh blood. While help is called, how should the patient be positioned?

1. ALying on the left side, with the bleeding lung down
2. BFlat on the back with the head down
3. CProne with the head turned to one side
4. DLying on the right side, with the bleeding lung up

卒中静脉溶栓前，通常采用哪个血压限值？

1. A没有血压限值
2. B低于约 90/60 mmHg
3. C低于约 185/110 mmHg
4. D高于约 200/120 mmHg

A patient has erratic glucose readings. The nurse finds a soft, rubbery lump where they always inject. What is the most important teaching?

1. AMassage the lump firmly after every injection
2. BKeep injecting into the lump, because it hurts less there
3. CUse healthy sites and check glucose often, as less insulin may be needed
4. DDouble the insulin dose because the lump blocks the insulin

Why is it important to prevent perioperative hypothermia?

1. AIt lowers the risk of pain after surgery
2. BIt makes patients wake up from the anaesthetic too quickly
3. CIt increases bleeding, wound infection and heart complications
4. DIt reduces the amount of anaesthetic needed, which is unsafe

After signing the consent form, a patient tells the nurse, "I don't really understand what they are going to do." What should the nurse do?

1. AReassure the patient that the surgeon knows best
2. BExplain the surgical risks in detail without involving the surgeon
3. CInform the surgeon so that the procedure can be explained again
4. DIgnore the comment because the form is already signed