Lembar kerja Prioritas & delegasi dengan jawaban

Temuan mana yang merupakan masalah jalan napas?

1. ANyeri perut dengan skala 8/10
2. BNadi radialis yang lemah dan halus
3. CPembengkakan lidah dan bibir dengan suara serak
4. DRonki basah halus terdengar di dasar kedua paru saat inspirasi

Using the RACE fire response, what does the nurse do first when finding a fire in a patient’s room?

1. AClose doors to contain the fire and smoke
2. BPull the fire alarm
3. CUse an extinguisher on the fire
4. DRescue patients in immediate danger

Apa itu triase?

1. AMembagi pasien secara merata di antara perawat yang bertugas
2. BMenangani pasien secara ketat sesuai urutan kedatangan
3. CMemindahkan pasien antarunit berdasarkan ketersediaan tempat tidur
4. DMemilah pasien menurut seberapa mendesak mereka membutuhkan perawatan

Pada henti jantung di bangsal, tindakan mana yang pertama setelah memastikan pasien tidak responsif dan tidak bernapas normal?

1. AMemberikan dua napas buatan, lalu memeriksa nadi selama satu menit
2. BMemanggil bantuan dan memulai kompresi dada
3. CMencari rekam medis pasien untuk memeriksa status resusitasi sebelum memanggil bantuan
4. DMengukur tekanan darah

A nursing assistant offers to suction a patient’s new tracheostomy. Which response from the RN is best?

1. A“Thank you, please suction him as needed and tell me how it went.”
2. B“Ask the patient’s family to do the suctioning today.”
3. C“Leave the suctioning until the next shift arrives.”
4. D“Suctioning a new tracheostomy is my task; I will do it myself.”

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

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

A patient is going home on a new oral anticoagulant. There is only a short time for teaching. Which topic is most important?

1. AWhich television programs help with relaxation
2. BHow to choose comfortable walking shoes
3. CHow to cook low-fat meals
4. DSigns of bleeding and when to seek help

Four laboratory results come back at once. Which one should the nurse report first?

1. ACreatinine 1,3 mg/dL in an older adult, unchanged from last week
2. BHemoglobin 6,5 g/dL (65 g/L) in a patient with a GI bleed
3. CPotassium 3,4 mEq/L in a patient on a diuretic
4. DGlucose 180 mg/dL after a meal in a patient with diabetes