정답이 있는 우선순위 설정과 위임 학습지

What is the purpose of the “time-out” just before a surgical procedure?

1. ATo let the family say goodbye to the patient
2. BTo give the surgeon a short rest before the operation starts
3. CTo count the swabs at the end of the operation
4. DTo confirm the correct patient, procedure and site

Using the RACE fire response, what does the nurse do first when finding a fire in a patient’s room?

1. APull the fire alarm
2. BUse an extinguisher on the fire
3. CClose doors to contain the fire and smoke
4. DRescue patients in immediate danger

Which patient concern belongs to the esteem level of Maslow’s hierarchy?

1. AMissing friends from home
2. BWorry about body image after a mastectomy
3. CFear of slipping in the shower
4. DThirst after a long period of fasting before a test

During an IV vancomycin infusion, a patient develops flushing and itching of the face and neck. What should the nurse do first?

1. AIgnore it, because flushing is always harmless and passes
2. BSpeed up the infusion to finish it quickly
3. CApply a warm compress to the face and neck
4. DStop or slow the infusion and inform the provider

A patient with mild dysphagia after a stroke is eating. Which technique helps make swallowing safer?

1. ALying flat with the head tilted back
2. BSitting upright with the chin tucked down while swallowing
3. CDrinking thin fluids quickly through a straw between bites
4. DTalking while eating to stay alert

A nurse teaches a patient about storing insulin at home. Which statement shows a need for further teaching?

1. A“I will check the expiry date on the label before I use the vial.”
2. B“I will not leave my insulin in a hot car.”
3. C“I will keep unopened insulin in the fridge.”
4. D“I will keep my spare insulin in the freezer so it lasts longer.”

Which finding after a laparoscopic cholecystectomy is expected and needs only reassurance and comfort measures?

1. ARight shoulder pain from the gas used during surgery
2. BA heart rate of 125/min with a falling blood pressure
3. CYellow skin with dark urine on the second day
4. DIncreasing abdominal pain with a temperature of 39 °C

큰 수술을 받은 환자의 소변량이 2시간 동안 시간당 15 mL, 심박수 분당 115회, 손이 차갑습니다. 간호사가 가장 먼저 해야 할 일은 무엇인가요?

1. A도뇨관을 세척하고 내일 아침 소변량을 다시 확인한다
2. B출혈 같은 쇼크 징후를 사정하고 보고한다
3. C소변량이 나아지는지 두 시간 더 기다린다
4. D환자에게 물을 더 마시도록 권하고 나중에 다시 확인한다