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

An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?

1. ANormal aging that needs no assessment
2. BAn infection, such as a urinary tract infection, presenting atypically
3. CA sudden worsening of long-standing dementia that needs no tests
4. DBoredom from not having enough activities

A cup of water is spilled over an infusion pump plugged into the wall. What should the nurse do?

1. ATurn the pump upside down to drain it while running
2. BLeave it running and place a towel over it until it dries
3. CSwitch it off and unplug it safely, then have it checked before reuse
4. DWipe it dry quickly with a towel and keep using it for the infusion

간호사가 환자의 수액 펌프가 처방보다 10배 빠른 속도로 설정된 것을 발견했습니다. 환자는 괜찮아 보입니다. 첫 번째 행동은?

1. A환자에게 느낌이 다른지 묻고 계속한다
2. B속도는 그대로 두고 소견을 기록지에 기록한다
3. C부작용이 생기는지 지켜본다
4. D주입을 중단하거나 바로잡은 다음 환자를 사정한다

만성 콩팥병 환자는 칼슘 아세트산염이나 세벨라머 같은 인산염 결합제를 언제 복용해야 하나요?

1. A일주일에 한 번만
2. B식사와 함께
3. C몸이 안 좋을 때만
4. D취침 시 공복에

In the first 24 hours after a major burn, which laboratory pattern is most expected?

1. AHigh potassium and high hematocrit
2. BLow sodium and low hematocrit
3. CHigh calcium and high albumin
4. DLow potassium and low hematocrit

After a total hip replacement through a posterior approach, which movement should the patient usually avoid in the early weeks?

1. ADoing gentle ankle exercises
2. BWalking short distances with a frame and a physiotherapist
3. CLying on their back
4. DBending the hip beyond 90 degrees or crossing the legs

급성 위장관 출혈 환자의 심박수가 120회/분이고 혈압이 90/60 mmHg입니다. 도움을 요청한 후 간호 우선순위는?

1. A에너지를 회복하도록 많은 식사를 준다
2. B굵은 정맥로를 확보하고 수액이나 혈액 보충을 준비한다
3. C혼자 화장실까지 걷도록 권한다
4. D대변 색을 확인할 때까지 조치를 미룬다

Which side effect is particularly common with verapamil?

1. AHair loss
2. BDiarrhoea
3. CDry cough
4. DConstipation

A patient has been on continuous NIV via a full-face mask for two days. Which nursing measure helps prevent the most common complication?

1. ARemove the mask for an hour each time the alarm sounds
2. BTighten the straps as far as they will go to stop any leak
3. CCheck mask fit and protect the bridge of the nose
4. DUse the same mask size for every patient

Which symptoms are typical of hypokalaemia?

1. AMuscle weakness, cramps and palpitations
2. BExcess thirst and very high glucose
3. CHeat intolerance and weight loss
4. DTingling lips and facial twitching

A patient with myasthenia gravis is admitted with pneumonia. Which newly prescribed antibiotic should the nurse question?

1. AGentamicin
2. BCeftriaxone
3. CAmoxicillin
4. DBenzylpenicillin

Why are antimotility drugs such as loperamide avoided in C. difficile infection?

1. AThey may keep toxin in the bowel and risk toxic megacolon
2. BThey make the stool sample test positive falsely
3. CThey cause serious liver failure in most patients who take them
4. DThey kill the normal bowel bacteria

After forearm fracture surgery, a patient has severe pain not eased by opioids, made worse by passively moving the fingers. What should the nurse do?

1. ARaise the arm as high as possible and give a further dose of opioid
2. BApply ice and a tighter bandage to reduce the swelling
3. CLoosen any tight dressing, keep the arm at heart level and escalate
4. DReassure the patient that this pain is expected