NCLEX 유형 우선순위 설정과 위임: 벼락치기 팩

A pregnant nurse is on the unit. Which patient should the charge nurse avoid assigning to her?

1. AA patient with a sealed radioactive implant for cervical cancer
2. BA patient after a hip replacement
3. CA patient with a fractured wrist
4. DA patient with type 2 diabetes who needs insulin teaching before discharge

A patient taking an MAO inhibitor antidepressant is taught about diet. Which statement shows a need for further teaching?

1. A“I will check with the pharmacist before cold remedies.”
2. B“I can still eat aged cheese and cured salami.”
3. C“I will avoid tap beer and red wine.”
4. D“A sudden severe headache is a warning sign.”

Before a defibrillator shock is delivered, what must the person operating it do?

1. AAsk a colleague to hold the paddles in place
2. BCall “all clear” and check that nobody is touching the patient or bed
3. CHold the patient’s hand to keep them still
4. DKeep the oxygen mask on the patient’s face, held against the chest

A patient with dementia is often found at the exit doors trying to leave the unit. Which measure is most appropriate?

1. ALock the patient alone in a single room so that they cannot reach the exit doors
2. BKeep the patient in a chair with a vest restraint
3. CUse an electronic wander alert, supervise closely and offer meaningful activity
4. DGive a sedative each time the patient goes to the door

디곡신을 투여할 시간이 된 환자의 칼륨이 3.1 mEq/L입니다. 이 결과가 왜 중요한가요?

1. A낮은 칼륨은 디곡신 독성의 위험을 높인다
2. B낮은 칼륨은 디곡신을 무효로 만들므로 용량을 두 배로 해야 한다
3. C낮은 칼륨은 디곡신의 부작용으로부터 심장을 보호한다
4. D칼륨과 디곡신은 상호작용하지 않는다

환자의 크레아티닌 상승이 오래된 만성 콩팥병이 아니라 급성 신손상 때문임을 가장 강하게 시사하는 소견은 무엇인가요?

1. A환자는 수년간 높은 크레아티닌을 보였다
2. B크레아티닌이 사흘 전에는 정상이었고 그 뒤 두 배가 되었다
3. C환자는 초음파에서 작은 신장이 보인다
4. D환자는 오래된 빈혈이 있다

A confused patient keeps trying to climb out of bed. Why are bed rails not automatically the answer?

1. APatients can be seriously injured climbing over or becoming trapped in rails
2. BBed rails stop staff from taking observations
3. CBed rails always make patients more confused, but only during the day
4. DBed rails are illegal in all hospitals and must never be used at all

Why must a unit of red cells be transfused within the set time limit (commonly four hours) after it leaves controlled cold storage?

1. AThe blood group of the cells changes after a few hours
2. BThe red cells break down and turn into plasma
3. CBacteria can grow in the blood at room temperature
4. DThe bag stops dripping after four hours

미리 채워진 주사기의 enoxaparin 피하주사는 어떻게 투여합니까?

1. A먼저 공기 방울을 빼낸 뒤 어깨세모근에
2. B캐뉼라를 통해 빠른 정맥 주입으로
3. C복부에, 공기 방울을 남긴 채, 문지르지 않고
4. D매일 같은 복부 부위에 주사한 뒤 마사지한다

A patient on an unfractionated heparin infusion has a nosebleed that will not stop, and the aPTT is far above the target range. What is the most appropriate action?

1. AStop the infusion, inform the prescriber and anticipate protamine
2. BContinue the infusion at the same rate and pack the nose firmly
3. CGive vitamin K and continue the infusion at a slightly lower rate
4. DIncrease the infusion, as the aPTT will settle

Why are patients on haemodialysis vaccinated against hepatitis B?

1. AShared dialysis units carry a higher infection risk
2. BThe vaccine lowers the potassium level
3. CThe vaccine is needed to make the dialyser work
4. DHepatitis B vaccine improves the fistula flow

A patient with nephrotic syndrome suddenly has loin pain, blood in the urine and a rise in creatinine. What is a likely cause?

1. AToo much dietary protein
2. BRenal vein thrombosis
3. CNormal fluctuation in the disease
4. DA simple bladder infection

Which finding means a patient is usually ready to leave recovery for the ward?

1. ASystolic BP falling steadily over the last hour, with a rising pulse rate
2. BAwake, with a clear airway, stable observations and controlled pain
3. CPain score 9/10 and vomiting repeatedly
4. DStill drowsy and needing a jaw thrust to breathe

만성 통증으로 장기간 아편유사제를 복용하는 환자가 수술을 위해 입원했습니다. 올바른 설명은?

1. A아편유사제 미사용 환자보다 수술 후 아편유사제 용량이 더 낮게 필요하다
2. B중독을 막기 위해 입원 시 모든 아편유사제를 중단해야 한다
3. C수술이 끝난 후에는 파라세타몰만 받아야 한다
4. D내성 때문에 평소 아편유사제를 계속하고 추가 진통을 한다