Lembar kerja Prioritas & delegasi dengan jawaban

Tugas yang memerlukan pengkajian, pertimbangan keperawatan, atau evaluasi harus:

1. ASelalu didelegasikan kepada LPN/LVN
2. BDilakukan oleh perawat terdaftar
3. CDiberikan kepada keluarga pasien
4. DDidelegasikan kepada asisten keperawatan yang paling berpengalaman

Before giving a medication, how many patient identifiers should the nurse check?

1. ANone, if the nurse already knows the patient well
2. BAt least two, such as name and date of birth
3. COne, the bed number
4. DOne, the room number

What does a “STAT” order mean?

1. ACarry it out at the next routine round
2. BCarry it out immediately
3. CCarry it out within the next 24 hours
4. DCarry it out only if the patient asks for it

An anxious patient is breathing very fast and has tingling fingers. The blood gas shows pH 7,51 and PaCO₂ 29 mmHg (3,9 kPa). What should the nurse do first?

1. AGive oxygen at the highest flow and leave the room
2. BGive IV sodium bicarbonate as soon as it can be found
3. CStay with the patient and coach slow, calm breathing
4. DEncourage the patient to breathe even faster

A drowsy patient has an arterial blood gas with pH 7,30, PaCO₂ 58 mmHg (7,7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?

1. APoor ventilation causing carbon dioxide to build up
2. BLoss of bicarbonate from the bowel through severe diarrhea
3. CToo much bicarbonate from antacids
4. DHyperventilation caused by anxiety

Seorang pasien dewasa yang sedang makan di ruang bersama tiba-tiba mencengkeram lehernya dan tidak dapat berbicara, bernapas, atau batuk. Apa yang pertama kali harus dilakukan perawat?

1. AMengorek mulut dengan jari secara buta
2. BMemberi pasien segelas air untuk mendorong makanan
3. CMemanggil bantuan dan memberikan tepukan punggung serta hentakan perut
4. DMenunggu untuk melihat apakah pasien dapat membatukkannya

A severely malnourished patient started nutrition two days ago and now has weakness and confusion. Which laboratory result should the nurse check first?

1. ASerum cholesterol
2. BThyroid hormone
3. CSerum phosphate
4. DSerum amylase

A patient with COPD on 2 L/min oxygen becomes drowsy and hard to wake. The SpO₂ is 93%. What is the priority?

1. ALet the patient sleep, because the saturation is above target
2. BAssess breathing and escalate for a blood gas, as carbon dioxide may be rising
3. CGive the as-needed sedative so the patient rests comfortably
4. DIncrease the oxygen to 6 L/min so that the saturation goes even higher than now