NCLEX 유형 우선순위 설정과 위임: 벼락치기 팩

Two nursing assistants argue loudly at the station about their assignments. What is the charge nurse’s best first step?

1. AMeet both of them privately to hear each side
2. BReport them to human resources at once
3. CIgnore it and hope they sort it out
4. DChange both of their assignments without any discussion

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

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

경구 액제 약물을 표준 정맥 주사기가 아니라 경구용 또는 경장용 주사기로 주는 이유는?

1. A안전상 이유는 없고 단지 관행일 뿐이다
2. B정맥 주사기는 경구 액제의 소량을 정확하게 잴 수 없다
3. C경구용 주사기는 정맥 용량을 더 정확하게 잰다
4. D경구용 주사기는 정맥 라인에 맞지 않아 잘못된 경로의 오류를 막는다

Which position is especially dangerous for a patient in physical restraints?

1. ALying face down (prone)
2. BLying on the back with the head raised
3. CSitting upright in bed
4. DLying on the side

환자의 절대 호중구 수가 0.4 × 10³/µL입니다. 적절한 조치는 무엇인가요?

1. A철저한 손 위생, 체온 확인, 감염이 있는 방문객 금지
2. B폐렴으로 치료 중인 다른 환자와 같은 방을 쓴다
3. C환자의 기분을 북돋도록 신선한 꽃을 병실에 가져온다
4. D측정이 더 정확하므로 직장으로 체온을 잰다

오래된 폐 질환이 있는 환자의 혈청 중탄산염이 32 mEq/L, 동맥 PaCO₂가 늘 높고 pH는 7.36입니다. 어떤 상태가 가장 잘 맞나요?

1. A심한 탈수와 구토를 동반한 급성 당뇨병성 케톤산증
2. B빠른 호흡을 동반한 급성 아스피린 과다 복용
3. C만성 CO₂ 저류와 대사성 보상을 동반한 COPD
4. D많은 중탄산염 손실을 동반한 급성 중증 설사

골절된 다리에 깁스를 한 뒤 구획증후군을 가장 잘 찾아내는 평가는?

1. A발의 강한 맥박
2. B깁스 밑의 가벼운 가려움
3. C손상에 비해 지나친 통증, 특히 수동 신전 시
4. D따뜻하고 분홍빛인 발

Which finding suggests hypocalcaemia?

1. AA slow, irregular pulse with nausea and yellow-tinged vision
2. BSevere thirst with a large urine output and constipation
3. CSpasm of the hand when a blood pressure cuff is inflated on the arm
4. DA flapping tremor of the outstretched hands

A patient stops ramipril because of a troublesome dry cough. Which drug class is a common alternative?

1. AA loop diuretic such as furosemide
2. BA nitrate such as isosorbide mononitrate
3. CAn angiotensin II receptor blocker such as losartan
4. DA non-selective beta-blocker such as propranolol

A frightened young woman is breathing fast and has tingling fingers. Her blood gas shows pH 7.50 and a low PaCO₂. SpO₂ is 99% on air. What does this show?

1. ARespiratory alkalosis from hyperventilation
2. BMetabolic alkalosis from vomiting
3. CMetabolic acidosis from kidney failure
4. DRespiratory acidosis from hypoventilation

A patient is starting lamotrigine. Which teaching point is most important?

1. ADouble the dose if a seizure happens
2. BReport any skin rash promptly, especially in the first weeks
3. CExpect an orange tint to tears and urine
4. DTake it with a glass of grapefruit juice to improve its absorption

A patient with diabetic neuropathy has a hot, red, swollen foot that is barely painful. The skin is intact, and there is no fever. What should the nurse suspect?

1. ANormal swelling from standing too long
2. BAn acute Charcot foot, needing urgent offloading
3. CGout, which only needs pain relief
4. DA sprained ankle that will settle with walking

출혈성 소화성 궤양의 내시경 치료 후 산을 줄이는 데 흔히 쓰는 약물군은?

1. A고리 이뇨제
2. B양성자 펌프 억제제
3. C세티리진 같은 H1 항히스타민제
4. D베타차단제

A patient with a platelet count of 8 × 10⁹/L (8,000/µL) develops a sudden severe headache and confusion. What should the nurse suspect?

1. AIntracranial bleeding
2. BA tension headache from stress
3. CNormal effects of chemotherapy
4. DDehydration from poor intake