NCLEX 유형 우선순위 설정과 위임: 벼락치기 팩

갑상선 수술 4시간 후 간호사가 가장 먼저 조치해야 할 환자 소견은 무엇인가요?

1. A마시기 위해 일어나 앉고 싶다는 요청
2. B점점 더 쉬어 가는 목소리와 새로 생긴 시끄러운 호흡
3. C목 드레싱에 보이는 소량의 장액성 배액
4. D절개 부위 통증 4/10

간호사가 처방된 용량이 안전하지 않다고 생각합니다. 처방자는 그래도 주라고 합니다. 간호사는 어떻게 해야 하나요?

1. A용량을 보류하고 보고 체계를 통해 상급자에게 알린다
2. B이제 처방자가 책임지므로 용량을 투여한다
3. C절충안으로 절반 용량을 주고 이유를 기록한다
4. D갈등을 피하려고 아무 말 없이 조용히 건너뛴다

밀봉 방사성 삽입물이 있는 환자에게 배정하면 안 되는 간호사는?

1. A방사선 안전 교육을 받은 간호사
2. B이 병동에서 2년간 근무한 간호사
3. C임신한 간호사
4. D선량계 배지를 착용한 간호사

A handwritten order is hard to read, and the nurse is not sure of the drug name. What should the nurse do?

1. AContact the prescriber to clarify before giving anything
2. BHold the drug until the next day without telling anyone
3. CAsk a colleague to guess what it says
4. DChoose the drug that seems most likely from the diagnosis

A patient taking phenazopyridine for bladder pain has bright orange urine. What should the nurse know about urine tests?

1. AThe color shows severe liver failure is present
2. BThe dye can interfere with dipstick color readings
3. CThe color proves blood is present in the urine
4. DThe drug improves the accuracy of all dipsticks

A patient has painless jaundice, itching, dark urine and pale stools. ALP is markedly raised, conjugated (direct) bilirubin is high and ALT is only mildly raised. What is the most likely cause?

1. ABlockage of bile flow, for example by a tumor in the bile duct
2. BGilbert syndrome, a harmless inherited bilirubin disorder
3. CAcute viral hepatitis with widespread liver cell damage
4. DIncreased breakdown of red blood cells (hemolytic anemia)

A patient says they are "allergic" to codeine because it made them constipated. How should this be recorded?

1. AAs a side effect or intolerance, not a true allergy
2. BAs an allergy to all painkillers
3. CIt should not be recorded at all
4. DAs a severe anaphylactic allergy to all opioids

A patient has a full-thickness burn all the way round the forearm. Which complication must be watched for closely?

1. AHypoglycaemia caused by the body using glucose to heal the burn
2. BExcessive bleeding from the burn surface needing an urgent blood transfusion
3. CDelayed hair growth on the arm
4. DLoss of circulation to the hand as swelling builds under tight burned skin

How does varenicline help people stop smoking?

1. AIt makes cigarettes taste of metal so smoking feels unpleasant
2. BIt replaces nicotine through the skin, like a nicotine patch
3. CIt speeds the clearance of nicotine by the liver
4. DIt partly stimulates and partly blocks nicotine receptors

Why is the cuff pressure of an endotracheal or tracheostomy tube checked regularly?

1. AThe cuff pressure sets the ventilator's breathing rate
2. BThe cuff must be kept fully deflated in every ventilated patient
3. CThe cuff pressure directly controls the patient's oxygen saturation
4. DToo high a pressure damages the trachea; too low allows aspiration

급성 신손상 중이거나 위험이 있는 환자의 요오드 조영제 검사 전후에 메트포르민을 보통 보류하는 이유는?

1. A축적되어 젖산산증의 위험을 높일 수 있기 때문
2. B조영제를 차단하여 영상을 판독할 수 없게 하기 때문
3. C조영제와 함께 쓰면 심한 저혈당을 일으키기 때문
4. D신장이 손상되면 고칼륨혈증을 일으키기 때문

A patient with CKD has a potassium of 6.5 mmol/L. Which medicine combination is the most likely contributor?

1. AAmlodipine, simvastatin and aspirin
2. BRamipril, spironolactone and trimethoprim
3. CParacetamol (acetaminophen), omeprazole and senna
4. DFurosemide, salbutamol and insulin

간경변에서 나트륨 제한과 스피로노락톤의 역할은?

1. A혈압을 올리고 신장 혈류를 개선하는 것
2. B칼륨 소실을 늘려 고칼륨혈증을 예방하는 것
3. C혈중 암모니아를 낮추고 뇌병증을 치료하는 것
4. D나트륨과 수분 저류를 줄이고 복수를 조절하는 것

Which preoperative blood result should the nurse report to the team before elective surgery?

1. ASodium 139 mmol/L
2. BPotassium 2.9 mmol/L
3. CFasting glucose 5.4 mmol/L (97 mg/dL)
4. DHaemoglobin 138 g/L (13.8 g/dL) in a man