정답이 있는 우선순위 설정과 위임 학습지

What is status epilepticus?

1. AA seizure lasting 5 minutes or more, or repeated seizures without recovery
2. BA seizure that happens only during sleep
3. CA faint caused by standing up too quickly
4. DA single short seizure that stops on its own within a minute or two

Which of these is one of the standard “rights” of medication administration?

1. ARight patient
2. BRight ward
3. CRight brand
4. DRight colleague

ABC 틀에서 순환 문제에 해당하는 것은 무엇인가요?

1. A분당 32회의 호흡수
2. B불안
3. C조절되지 않는 출혈
4. D천명(stridor)

A patient with schizophrenia says voices are telling him to hurt his roommate. What is the priority?

1. ATell him the voices are not real and leave him alone
2. BIgnore the comment, because voices are part of his illness
3. CAsk the roommate to stay in the room with him and help calm him down
4. DKeep everyone safe and tell the team, as the risk of harm is high

A patient taking lisinopril develops swelling of the lips and tongue. What should the nurse do first?

1. AApply a cold pack and recheck in an hour
2. BGive the next dose of lisinopril with water
3. CAssess the airway and call for urgent help
4. DTell the patient this is a common, harmless effect

Two hours after birth, the nurse finds the uterus firm but above the umbilicus and pushed to the right. What should the nurse do first?

1. AHelp the patient empty her bladder
2. BMassage the uterus firmly for ten minutes
3. CGive a dose of oxytocin straight away
4. DAsk the patient to lie still for another hour

A patient at 36 weeks of pregnancy has sudden severe abdominal pain, a hard, board-like uterus and dark vaginal bleeding. What should the nurse suspect?

1. APlacenta previa, which is usually painless
2. BA urinary tract infection
3. CPlacental abruption, which is an emergency
4. DNormal labor contractions starting

During birth, the baby’s head delivers but the shoulders do not follow. What should the nurse do first?

1. APush firmly on the top of the uterus (fundal pressure)
2. BAsk the mother to stop pushing and wait an hour
3. CHelp with the McRoberts position and give suprapubic pressure as directed
4. DPull hard on the baby’s head and neck to free the trapped shoulders quickly