NCLEX Trivia

Mr. Lopez, 68, is postoperative day 2 after a right total hip arthroplasty. He suddenly develops pleuritic chest pain and dyspnea while ambulating with PT.He is tachycardic (HR 124), mildly hypotensive (BP 98/62), RR 30, SpO₂ 86%on room air, and anxious. Lungs are clear; he has new right-calf tenderness and swelling. ECG shows sinus tachycardia. What is the nurse’s first priority?

• Call rapid response and prepare for intubation

• Apply high-flow oxygen and raise HOB

• Start a large-bore IV and give a fluid bolus

• Draw D-dimer and troponin levels

Which diagnostic is most urgent to confirm PE?

• D-dimer

• CT pulmonary angiography

• V/Q scan

• Point-of-care ultrasound of the leg

Which initial orders do you anticipate? (Select all that apply)

• IV unfractionated heparin infusion

• Thrombolysis with alteplase

• Arterial blood gas

• Lower-extremity duplex ultrasound

• Immediate warfarin loading

Which finding is a major contraindication to thrombolysis?

• Age >65

• Post-op day 2 after major surgery

• Prophylactic heparin today

• SpO₂ <88%

Which change signals worsening obstructive shock?

• Anxiety subsides

• BP drops to 78/48 with cool mottled skin

• RR falls to 20 with new wheeze

• Calf tenderness improves

Why is IV unfractionated heparin (UFH) often preferred initially?

• It is more effective than LMWH

• It has no bleeding risk

• It can be rapidly titrated and reversed

• It cures PE faster than DOACs

Mr. C., 52, presents 12 hours after his last drink with tremors, diaphoresis, nausea, anxiety, and insomnia. Vitals: BP 168/98, HR 122, RR 24, T 99.9°F. He reports drinking a fifth of liquor daily. Oriented ×2, distractible, restless. Labs pending. Which medication should be administered before IV dextrose?

• Lorazepam

• Thiamine

• Haloperidol

• Clonidine

Which tool best standardizes withdrawal severity?

• PHQ-9

• COWS

• CIWA

• GAD-7

Which nursing interventions are most appropriate now? (Select all that apply)

• Seizure precautions

• Quiet, low-stimulation room

• PRN haloperidol as first-line

• Replace Mg and K

• Dextrose before thiamine

Which change most strongly suggests progression to Delirium Tremors (DTs)?

• Increased tremor

• Visual hallucinations + disorientation + 103°F

• Sleepiness and improving vitals

• Mild anxiety, BP 140/88