उत्तरों सहित प्राथमिकता निर्धारण और प्रत्यायोजन वर्कशीट

In which situation can a pulse oximeter give a falsely normal reading?

1. ACarbon monoxide poisoning
2. BA healthy adult at rest
3. CA patient breathing room air normally
4. DA warm, well-perfused finger

Which serum lithium level suggests toxicity?

1. A0.7 mEq/L
2. B1.0 mEq/L
3. C0.8 mEq/L
4. D2.2 mEq/L

Which patient is unstable?

1. AA patient with long-standing arthritis pain of 3/10
2. BA patient waiting for a planned hip X-ray
3. CA patient with a healing leg wound and normal vital signs this morning
4. DA patient with a new irregular pulse who says they feel dizzy

On the first day after abdominal surgery, a patient has a temperature of 37.9 °C and reduced breath sounds at the lung bases. Which nursing action is most helpful?

1. ARestrict oral fluids so that the lungs do not fill up with extra fluid
2. BGive a cough suppressant so that the incision is not strained
3. CKeep the patient lying flat in bed to rest the incision fully
4. DEncourage deep breathing, coughing and use of the incentive spirometer

A nurse has given rapid-acting insulin, and then learns that the patient’s meal tray will be 45 minutes late. What should the nurse do?

1. AAsk the patient to walk around the ward until the food arrives
2. BTell the patient to wait and do nothing until the tray comes
3. CGet the patient some carbohydrate food now and check the glucose
4. DGive a second, smaller dose of insulin when the meal tray finally arrives

Which postoperative patient should the nurse see first?

1. APain of 4/10 one hour after an oral analgesic
2. BWants help with washing her hair before her visitors arrive this afternoon
3. CDressing soaked with bright red blood and a heart rate rising to 118/min
4. DAsking when the urinary catheter will be removed

A patient with diabetes is sweaty and confused, and no glucose meter is available. The patient can swallow. What should the nurse do?

1. ATreat for hypoglycemia with fast-acting oral carbohydrate
2. BAsk the patient to lie down and sleep it off
3. CWithhold all food and fluids until a meter is found
4. DGive a dose of rapid-acting insulin in case the glucose is high

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

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