解答つき優先順位の決定と委任ワークシート

看護の優先順位を決める ABC の枠組みでは、どのニーズが最初に対処されますか？

1. A呼吸（Breathing）
2. B痛み
3. C循環（Circulation）
4. D気道（Airway）

優先順位の一般原則として正しいのはどれですか？

1. A簡単に解決できる問題が常に先である
2. B局所の問題は、通常、全身性の問題より先に扱う
3. C全身性の問題は、通常、局所の問題より先に扱う
4. D心理的な問題は、常に身体的な問題より先に扱う

In a patient with sepsis, what does a raised blood lactate level suggest?

1. AThe kidneys are working harder than usual
2. BThe patient has eaten recently
3. CThe tissues are not getting enough oxygen
4. DThe liver is making too much bile

ESI を用いたとき、最も高い緊急度レベルになるのはどの患者ですか？

1. A足首の骨折の疑いがある患者
2. B3 日間のどが痛く、バイタルサインが正常な患者
3. C反応がなく、あえぐような不規則な呼吸をしている患者
4. D胸痛があり、バイタルサインが正常な患者

Several patients on a gastroenterology unit need care. Which patient should the nurse see first?

1. ALong-standing back pain, asking for the usual analgesic
2. BTwo hours after a colonoscopy: rigid abdomen and severe new pain
3. CCrohn disease, waiting to be taken down for a scheduled CT scan
4. DUlcerative colitis, asking about diet changes for home

A patient with diabetes is unresponsive and has a blood glucose of 40 mg/dL (2.2 mmol/L). What should the nurse do first?

1. AWait 15 minutes and recheck the glucose
2. BGive the scheduled dose of insulin
3. CGive IV dextrose or glucagon as prescribed
4. DPour orange juice into the patient’s mouth

A nurse returns to the station to find four messages. Which one is answered first?

1. AA family member wants an update on their father’s progress
2. BThe laboratory is calling with a critical potassium result of 2.6 mEq/L
3. CThe pharmacy asks when the next delivery should be scheduled
4. DA colleague asks to swap shifts with them next week because of a family wedding

Which patient needs airborne precautions rather than droplet precautions?

1. AA child with pertussis (whooping cough)
2. BAn adult with influenza
3. CA child with chickenpox (varicella)
4. DA teenager with mumps