Lembar kerja Prioritas & delegasi dengan jawaban

What is status epilepticus?

1. AA faint caused by standing up too quickly
2. BA seizure lasting 5 minutes or more, or repeated seizures without recovery
3. CA seizure that happens only during sleep
4. DA single short seizure that stops on its own within a minute or two

In nursing management, what is an “assignment”?

1. AA written order from a prescriber for a treatment
2. BGiving staff care activities that are within their own role and scope
3. CHanding legal accountability for a patient over to a nursing colleague
4. DAsking a colleague to do a task outside their usual scope

What does a “PRN” medication order mean?

1. AGive the drug when needed, within the prescribed limits
2. BGive the drug at exactly the same time every single day
3. CGive the drug only before surgery
4. DGive the drug once only, immediately

Which action by a nursing assistant needs the nurse to step in?

1. ATaking an oral temperature just after the patient drank cold water
2. BCleaning hands before entering the room
3. CLowering the bed to its lowest position and locking the wheels after care
4. DPutting the call light within the patient’s reach

A patient with schizophrenia says voices are telling him to hurt his roommate. What is the priority?

1. ATell him the voices are not real and leave him alone
2. BAsk the roommate to stay in the room with him and help calm him down
3. CKeep everyone safe and tell the team, as the risk of harm is high
4. DIgnore the comment, because voices are part of his illness

A patient coughs hard after abdominal surgery, and loops of bowel appear through the opened wound. What does the nurse do first?

1. ALeave the wound uncovered so the surgeon can see it on arrival
2. BPush the bowel gently back into the abdomen with a gloved hand
3. CHelp the patient walk to the toilet to relieve abdominal pressure
4. DCover the wound with sterile dressings moistened with saline

During JumpSTART triage, a child is not breathing after the airway is opened but has a palpable pulse. What is the next step?

1. AGive five rescue breaths; if breathing starts, tag the child red
2. BTag the child green and return to them after the others
3. CStart full CPR on the child and stay with them until more help arrives
4. DTag the child black at once and move on to the next victim

Seorang pasien setelah operasi besar memiliki keluaran urine 15 mL/jam selama dua jam, denyut jantung 115/menit, dan tangan dingin. Apa yang pertama kali dilakukan perawat?

1. AMenganjurkan pasien minum lebih banyak air dan memeriksa lagi nanti
2. BMengkaji tanda-tanda syok, seperti perdarahan, dan melakukan eskalasi
3. CMembilas kateter dan memeriksa keluaran besok pagi
4. DMenunggu dua jam lagi untuk melihat apakah keluaran membaik