NCLEX 유형 우선순위 설정과 위임: 벼락치기 팩

인수인계 후 간호사가 가장 먼저 만나야 할 환자는 누구인가요?

1. A골관절염이 있고 매일 아침 뻣뻣함을 호소하는 환자
2. B이뇨제를 복용 중이며 08:00 이후 소변을 400 mL 본 환자
3. C방문객이 오기 전에 샤워를 도와 달라는 환자
4. D새 깁스를 했고 발이 저리며 발가락이 차갑다고 말하는 환자

A patient admitted with a stroke this morning asks for a glass of water. What should the nurse do first?

1. AGive the water through a straw so it goes down slowly
2. BAsk the family to help the patient drink while sitting upright in a chair at the bedside
3. CCheck that a swallow screen has been done before giving anything by mouth
4. DGive thickened fluids without checking the swallow

공기주의 환자를 돌본 후 N95 호흡보호구는 언제 벗어야 합니까?

1. A병실 안에서 장갑을 벗기 전에
2. B병실을 나와 문을 닫은 후
3. C벗지 않고 근무가 끝날 때까지 계속 착용한다
4. D병실에 들어간 직후

A patient rescued from a house fire has a headache and confusion, but the pulse oximeter reads 99%. Why might this reading be misleading?

1. APulse oximetry cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin
2. BConfusion and headache make pulse oximetry readings inaccurate in every patient
3. CPulse oximeters always read falsely low after any kind of smoke exposure
4. DThe reading is accurate, so carbon monoxide poisoning is ruled out

A patient takes high-dose furosemide. Besides potassium, which electrolyte is most commonly lowered?

1. AMagnesium
2. BSodium bicarbonate
3. CPhosphate
4. DUric acid

A patient with acute pancreatitis has a rising BUN, a falling calcium and a glucose of 250 mg/dL (13.9 mmol/L) over the first 48 hours. What do these results suggest?

1. AAn unrelated new kidney stone
2. BIncreasingly severe pancreatitis
3. CA resolving, mild pancreatitis
4. DA lab error from lipemic samples

After a laparoscopic cholecystectomy, a patient has pain in the shoulder tip. What is the most likely cause?

1. AAn allergic reaction to the dressing
2. BA heart attack caused by the stress of surgery
3. CA broken collarbone from being moved onto the table
4. DGas used during the operation irritating the diaphragm

A patient with long-standing COPD has an arterial blood gas with pH 7.37, a raised PaCO₂ and a raised bicarbonate. How is this best described?

1. ACompensated respiratory acidosis
2. BUncompensated metabolic alkalosis
3. CAcute respiratory acidosis
4. DMixed metabolic and respiratory alkalosis

환자의 혈압이 200/125 mmHg이며 새로 혼돈과 시야 흐림이 생겼습니다. 보통 어떻게 혈압을 낮춥니까?

1. A새 경구 정제를 주고 일주일 뒤 재방문
2. B용량을 조절하는 정맥 약물로 첫 1시간 동안 최대 약 25%까지
3. C뇌가 이제 높은 압력에 의존하므로 전혀 낮추지 않음
4. D몇 분 안에 정상 수치로 최대한 빠르게

A nurse teaches a patient with heart failure who takes ramipril and spironolactone. Which statement shows a need for further teaching?

1. A"I will call if I gain weight quickly or get more breathless."
2. B"I will weigh myself every morning after I go to the toilet."
3. C"I will use a salt substitute instead of ordinary salt."
4. D"I will avoid ibuprofen for my joint pain."

A conscious patient with a glucose of 3.1 mmol/L (56 mg/dL) can swallow safely. Which is the best first treatment?

1. AA dose of rapid-acting insulin with a sandwich
2. BA chocolate bar and a cup of tea with milk
3. CA glass of milk and two plain biscuits
4. DGlucose tablets or a small glass of fruit juice

22세 제1형 당뇨병 환자의 혈당 28 mmol/L, 케톤 5.2 mmol/L, pH 7.10, 칼륨 5.9 mmol/L입니다. 칼륨에 대해 올바른 설명은?

1. A칼륨 수치를 안정시키려면 인슐린을 보류해야 한다
2. B체내 총 칼륨이 높으므로 지금 칼륨 결합제가 필요하다
3. C체내 총 칼륨은 낮으며 치료하면 수치가 떨어질 것이다
4. D인슐린을 시작한 후에는 칼륨을 다시 확인할 필요가 없다

A patient is starting regular oral morphine. Which bowel advice is most appropriate?

1. AStart a regular laxative at the same time
2. BWait until there has been no stool for a week
3. CStop eating fibre completely
4. DTake a bulk-forming laxative only with very little water

An immobile patient on opioids drinks very little. Which laxative choice is least appropriate?

1. AA stool softener with a stimulant laxative
2. BA bulk-forming laxative used on its own
3. CAn osmotic laxative such as a macrogol
4. DA stimulant laxative taken regularly