Lembar kerja Prioritas & delegasi dengan jawaban

Pasien mana yang paling stabil?

1. APasien dengan nyeri dada baru
2. BPasien yang tekanan darahnya turun dari 132/80 menjadi 90/56 mmHg
3. CPasien yang baru menjadi bingung
4. DPasien dua hari setelah operasi lutut dengan nyeri 3/10 dan tanda vital normal

In a three-level triage system, what does “urgent” mean?

1. ASerious but stable for now, and needs care soon
2. BLife-threatening and needs care immediately
3. CMinor, and can safely wait for several hours
4. DAlready deceased on arrival

Which statement about pulse oximetry is correct?

1. AIt measures the carbon dioxide in the blood
2. BCold fingers or nail polish can give an inaccurate reading
3. CIt shows the patient’s blood glucose
4. DThe reading is always correct, whatever finger or hand is used

On a postpartum unit, which patient is the most appropriate to assign to an LPN/LVN?

1. ADay 1 after an uncomplicated vaginal birth, stable vital signs
2. BA new admission transferred from the labor ward with a fever of 38,6 °C
3. COne hour after birth with heavy bleeding and a boggy uterus
4. DSevere pre-eclampsia on a magnesium sulfate infusion

Seorang perawat melihat asisten keperawatan mengukur tekanan darah dengan manset yang jelas terlalu kecil. Apa yang harus dilakukan perawat?

1. AMenyebutkannya nanti pada penilaian tahunan asisten berikutnya
2. BSegera turun tangan, mengoreksi teknik dengan bijaksana, dan mengukur ulang
3. CMencopot asisten dari perawatan pasien untuk hari itu
4. DMengabaikannya, karena satu pembacaan tinggi tidak akan berarti

A patient with a valid do-not-resuscitate order (DNR; called DNACPR in the UK) stops breathing and has no pulse. What should the nurse do?

1. AStart chest compressions but not rescue breaths
2. BFollow the DNR order and do not start CPR
3. CCall the cardiac arrest team and let them decide
4. DStart CPR and stop when the family arrives

Laporan asisten keperawatan mana yang harus segera ditindaklanjuti perawat?

1. ASetelah fusi tulang belakang lumbal pagi ini, tidak dapat merasakan atau menggerakkan tungkai
2. BPasien diabetes mengatakan kakinya sering terasa kesemutan, seperti biasanya
3. CPasien pneumonia mengeluarkan dahak kuning
4. DPasien tirah baring meminta pispot

A visitor on the ward becomes threatening and shows a knife. What is the nurse’s priority?

1. AMove away to safety, keep others away and call security or the police
2. BIgnore the visitor and carry on with patient care
3. CTry to take the knife away from the visitor straight away before anyone is hurt
4. DArgue with the visitor to persuade them to leave