Lembar kerja Prioritas & delegasi dengan jawaban

Which patient usually fits ESI level 5?

1. AAn adult with chest pain suggesting a heart attack
2. BA stable adult who only needs a repeat prescription
3. CA stable adult who needs blood tests and an X-ray of the chest
4. DAn adult in cardiac arrest

Dalam sistem triase tiga tingkat, pasien dengan pergelangan kaki terkilir, tanda vital normal, dan nyeri ringan biasanya digolongkan sebagai:

1. ATidak mendesak
2. BEkspektan
3. CGawat darurat
4. DMendesak

Which adult blood glucose result needs treatment straight away?

1. A52 mg/dL (2,9 mmol/L) with sweating and shakiness
2. B130 mg/dL (7,2 mmol/L) two hours after a large lunch
3. C110 mg/dL (6,1 mmol/L) after a snack
4. D98 mg/dL (5,4 mmol/L) before breakfast

A patient is in skeletal traction. Which finding needs the nurse to act?

1. AThe patient’s body is in line with the traction
2. BThe weights are hanging freely
3. CThe ropes are in the pulleys
4. DThe weights are resting on the floor

An older patient becomes confused over a few hours, with attention that comes and goes. What does this suggest?

1. ADelirium, which needs the cause found quickly
2. BLong-standing dementia that is expected
3. CNormal aging that needs no action
4. DA personality change that is permanent and expected

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. BEncourage deep breaths into a paper bag until it passes
3. CCheck for signs of low calcium and inform the provider
4. DGive the patient’s routine oral iron supplement early

A nurse teaches a patient to inject enoxaparin at home. Which statement shows a need for further teaching?

1. A“I will change the injection site each time.”
2. B“I will inject into the fat of my abdomen, away from the navel.”
3. C“I will tell my doctor if I notice unusual bruising or bleeding.”
4. D“I will rub the area after the injection to help it absorb.”

Selama pemberian makan lewat selang secara kontinu, seorang pasien tiba-tiba batuk, sesak napas, dan SpO₂ turun. Apa tindakan pertama perawat?

1. AMembilas selang dengan 50 mL air, lalu melanjutkan pemberian makan seperti sebelumnya
2. BMembaringkan pasien datar agar dapat beristirahat
3. CMenaikkan kecepatan pemberian makan agar selesai lebih cepat
4. DMenghentikan pemberian makan, mendudukkan pasien tegak, dan mengkaji pernapasan