Lembar kerja Prioritas & delegasi dengan jawaban

A patient has a Glasgow Coma Scale score of 8. What is the main concern?

1. AThe patient only has a mild headache
2. BThe patient can safely eat and drink without help
3. CThe patient may not be able to protect the airway
4. DThe patient is fully alert and oriented

Temuan pada orang dewasa mana yang harus ditindaklanjuti perawat lebih dulu?

1. AFrekuensi napas 8/menit dan mengantuk
2. BDenyut jantung 98/menit
3. CTekanan darah 138/88 mmHg dan sepenuhnya waspada
4. DSuhu 37,8 °C (100 °F)

Tugas mana yang harus dipegang sendiri oleh perawat terdaftar dan tidak didelegasikan kepada tenaga asisten tanpa lisensi?

1. AMembantu pasien yang stabil berjalan ke kamar mandi dan kembali
2. BMemandikan pasien yang stabil
3. CPengkajian awal pasien yang baru masuk
4. DMengukur dan mencatat asupan dan keluaran cairan

Selama infus antibiotik IV, seorang pasien mengalami biduran, mengi, dan suara serak. Apa yang pertama kali dilakukan perawat?

1. AMemperlambat infus menjadi setengah kecepatan
2. BMemberikan difenhidramin oral
3. CMendokumentasikan reaksi dalam rekam medis
4. DMenghentikan infus

Seorang dewasa stabil mengalami nyeri perut dan tanda vital normal. Ia akan memerlukan pemeriksaan darah dan CT scan. ESI level berapa yang sesuai?

1. ALevel 3
2. BLevel 1
3. CLevel 4
4. DLevel 5

A woman calls to say her husband suddenly has a drooping face and slurred speech. What should the nurse advise?

1. ALet him lie down and see if it improves
2. BDrive him to the hospital yourself after he has eaten dinner
3. CBook an appointment with his doctor next week
4. DCall emergency services now and note the time it started

After a vaginal birth, the uterus is firm and central, but bright red blood keeps trickling steadily. What should the nurse suspect?

1. ANormal lochia for the first hour
2. BUterine atony that needs more massage
3. CA full bladder pushing the uterus aside
4. DA tear in the birth canal or cervix

An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?

1. ALarge-volume IV fluids with close monitoring of urine output
2. BStarting physiotherapy to prevent contractures straight away
3. CGiving a high-protein meal to support healing
4. DApplying antibiotic cream to all the burns before anything else