NCLEX 유형 우선순위 설정과 위임: 벼락치기 팩

A parent of a child with influenza talks with the nurse. Which statement shows a need for further teaching?

1. A“I will give my child aspirin to bring the fever down.”
2. B“I will give my child plenty of fluids.”
3. C“I will call if my child has trouble breathing.”
4. D“I will keep my child home from school and away from others while unwell.”

환자가 말초 정맥로로 정맥 염화칼륨을 투여받으며 부위가 화끈거린다고 호소하고 부위가 붉습니다. 간호사가 가장 먼저 해야 할 일은 무엇인가요?

1. A용량을 빨리 끝내도록 주입 속도를 높인다
2. B작열감은 예상되는 것이라고 말하고 계속한다
3. C주입을 중단하고 정맥 주사 부위를 사정한다
4. D온찜질을 하고 주입을 계속한다

A newly hired nurse had BCG vaccine as a child. Which TB screening test is usually preferred?

1. ANo screening, because BCG prevents all TB
2. BA tuberculin skin test, which is read 24 hours after it is placed
3. CAn interferon-gamma release assay (IGRA) blood test
4. DA chest x-ray every month for the first year

A toddler has bruises of different ages and a burn, and the parent’s explanation does not fit the injuries. What should the nurse do?

1. ADocument only and say nothing to anyone
2. BWait until there is clear proof of abuse before reporting anything at all
3. CConfront the parent and ask them to admit to abuse
4. DReport the concern following child-protection (safeguarding) procedures

A patient on a heparin infusion has blood in the urine and an aPTT far above the target. The nurse stops the infusion and informs the provider. Which antidote should the nurse anticipate?

1. ANaloxone
2. BCalcium gluconate
3. CVitamin K (phytonadione)
4. DProtamine sulfate

Weeks after neck surgery, a patient has muscle cramps and tingling. Calcium is low, phosphate is high and parathyroid hormone (PTH) is low. Which condition fits best?

1. AHypoparathyroidism
2. BChronic kidney disease
3. CPrimary hyperparathyroidism
4. DVitamin D toxicity

Why is it important to prevent hypothermia during and after surgery?

1. AIt makes the patient wake up too quickly and become agitated in recovery
2. BIt causes high blood glucose only
3. CIt makes the patient's pain disappear
4. DIt increases the risk of wound infection, bleeding and cardiac complications

An older patient has fallen several times since starting a new medicine. Which drug group is most likely to contribute?

1. AEmollient creams applied to the legs
2. BLubricating eye drops
3. CBenzodiazepine sleeping tablets
4. DVitamin D supplements

환자가 심부정맥혈전증으로 와파린을 시작합니다. 처음 며칠 동안 헤파린이나 저분자량 헤파린도 함께 투여하는 이유는?

1. A와파린이 완전한 효과에 이르기까지 며칠이 걸리기 때문
2. B헤파린이 와파린으로 인한 출혈을 막아 주기 때문
3. C헤파린이 와파린의 흡수를 개선하기 때문
4. D두 약을 평생 항상 함께 유지해야 하기 때문

심근경색 3주 후 환자에게 열, 앞으로 기울이면 완화되는 흉막성 흉통, 심낭 마찰음이 있습니다. 가장 가능성 높은 질환은?

1. A다른 동맥의 새로운 STEMI
2. B급성 좌심실부전
3. C심근경색 후(Dressler) 증후군
4. D급성 대동맥 박리

복막투석액은 사용 전에 어떻게 데워야 합니까?

1. A냉장고에서 꺼내 차가운 채로 사용한다
2. B전자레인지에서
3. C뜨거운 수돗물이 담긴 대야에서
4. D전용 건열 가온기에서

A nurse teaches a woman with recurrent UTIs. Which statement shows a need for further teaching?

1. A"I will hold my urine for as long as I can."
2. B"I will pass urine soon after sex."
3. C"I will wipe from front to back."
4. D"I will drink enough fluids during the day."

Aspirate from a nasogastric tube has a pH of 7. What should the nurse do?

1. ADo not use it; re-test later or arrange an X-ray as per policy
2. BStart the feed slowly and watch the patient closely for coughing
3. CFlush with 50 mL of air and start the feed
4. DGive the medicines but not the feed

A patient has had a large terminal ileum resection for Crohn's disease. Which long-term problems should the nurse anticipate?

1. AVitamin B₁₂ deficiency and bile-acid diarrhoea
2. BIron overload and constipation
3. CInsulin deficiency and high blood glucose from loss of the islets
4. DExcess vitamin D and calcium kidney stones in the first year