Lembar kerja Prioritas & delegasi dengan jawaban

What does the Braden Scale measure?

1. AThe level of consciousness after a head injury
2. BThe risk of developing a pressure injury
3. CThe severity of alcohol withdrawal symptoms
4. DThe risk of falling during a hospital stay

For a patient with a suspected heart attack and no contraindications, which drug is usually given early?

1. AAcetaminophen (paracetamol)
2. BCodeine
3. CAspirin, chewed
4. DIbuprofen

What is the CIWA scale used to assess?

1. AThe risk of a pressure injury
2. BThe severity of alcohol withdrawal
3. CThe depth of a burn wound
4. DThe severity of a newborn’s jaundice

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

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

Which medication order should the nurse question?

1. APotassium chloride oral solution diluted in juice
2. BPotassium chloride by IV push
3. CPotassium chloride diluted in an IV bag via a pump
4. DOral potassium chloride with food

A patient is receiving opioids after surgery. Which finding usually comes before opioid-induced respiratory depression?

1. AA sudden rise in pain scores
2. BIncreasing sleepiness that is hard to rouse
3. CIncreased appetite and thirst
4. DA rise in blood pressure with flushed cheeks

A patient in hypovolemic shock is receiving IV fluids. Which finding best shows that the treatment is working?

1. ACooler, paler skin on the arms and legs
2. BNew crackles at both lung bases
3. CA heart rate that keeps rising after each bag of fluid
4. DUrine output at least 0,5 mL/kg/h and clearer thinking

Seorang pasien mengalami kesulitan berbicara mendadak 45 menit yang lalu. Tindakan mana yang memiliki prioritas tertinggi?

1. ASegera memberikan aspirin lewat mulut untuk membatasi bekuan
2. BMengaktifkan tim stroke untuk pencitraan segera, dengan mencatat kapan terakhir terlihat baik
3. CMenunggu sampai ahli saraf dapat memeriksa pasien pada visite pagi
4. DMemberikan air agar pasien dapat meminum obat pagi yang biasa