ورقة عمل تحديد الأولويات والتفويض مع الإجابات

في إطار ABC، أي مشكلة هي مشكلة دورة دموية؟

1. Aمعدل تنفس 32/min
2. Bالقلق
3. Cنزف غير مسيطر عليه
4. Dالصرير

When is the Apgar score usually assessed?

1. AAt the first postnatal clinic visit
2. BAt 1 and 5 minutes after birth
3. CBefore the baby is born
4. DOnly at 24 hours after birth

What is the main purpose of a rapid response team?

1. ATo review medication errors and falls after they have happened on the unit
2. BTo handle complaints from patients and families
3. CTo transport stable patients between hospital units
4. DTo assess and treat a deteriorating patient before an arrest happens

A patient coughs hard after abdominal surgery, and loops of bowel appear through the opened wound. What does the nurse do first?

1. APush the bowel gently back into the abdomen with a gloved hand
2. BCover the wound with sterile dressings moistened with saline
3. CLeave the wound uncovered so the surgeon can see it on arrival
4. DHelp the patient walk to the toilet to relieve abdominal pressure

A patient is raising his voice, pacing and clenching his fists. What should the nurse do first?

1. ATurn away and ignore the behavior
2. BSpeak calmly, keep a safe distance and invite him to talk about what is wrong
3. CStand very close to him and tell him firmly and loudly to sit down and be quiet
4. DApply physical restraints at once

The day after a total thyroidectomy, a patient reports tingling around the mouth and in the fingers. What should the nurse do first?

1. AReassure the patient that this is normal after neck surgery
2. BGive the patient’s routine oral iron supplement early
3. CEncourage deep breaths into a paper bag until it passes
4. DCheck for signs of low calcium and inform the provider

An 85-year-old resident becomes newly confused and is falling, but has no fever. Which cause should the nurse consider first?

1. ABoredom from not having enough activities
2. BA sudden worsening of long-standing dementia that needs no tests
3. CAn infection, such as a urinary tract infection, presenting atypically
4. DNormal aging that needs no assessment

A patient was knocked out briefly in a fall, then woke and talked normally. Two hours later the patient becomes drowsy and one pupil is larger. What is the most likely cause?

1. AAn epidural hematoma
2. BLow blood sugar from missing a meal
3. CA mild concussion that is settling
4. DNormal tiredness after a fall