Užduočių lapas tema Prioritetų nustatymas ir delegavimas su atsakymais

A patient’s platelet count is 18,000/mm³ (18 × 10⁹/L). Which risk is the nursing priority?

1. AFluid overload
2. BBleeding
3. CInfection
4. DBlood clots

Ką delegavime reiškia „teisingi nurodymai ir bendravimas"?

1. AUžduoties įrašymas tik į paciento medicinos dokumentus
2. BPasakymas deleguojamam asmeniui naudotis savo sprendimu
3. CAiškūs, konkretūs nurodymai: ką daryti, kada ir apie ką pranešti
4. DPrašymas deleguojamam asmeniui pranešti apie neįprastus radinius pamainos pabaigoje

Which patient usually fits ESI level 5?

1. AA stable adult who needs blood tests and an X-ray of the chest
2. BAn adult in cardiac arrest
3. CAn adult with chest pain suggesting a heart attack
4. DA stable adult who only needs a repeat prescription

Which SBAR recommendation is the clearest?

1. A“He seems a bit off tonight, so maybe you could come up and do something about it.”
2. B“I just wanted to let you know about him.”
3. C“I will keep watching him and call again tomorrow.”
4. D“I would like you to see him within 15 minutes and consider a fluid bolus.”

A patient has a serum potassium of 2,9 mEq/L. Which finding should the nurse expect?

1. AFlushed, warm skin and a slow heart rate
2. BTall, peaked T waves and muscle twitching
3. CA rise in urine output and thirst only
4. DMuscle weakness and U waves on the ECG

A patient with type 1 diabetes has vomited since morning and cannot eat. Which action is most important?

1. AStop all insulin until the patient is able to eat normally again
2. BEncourage a large meal to settle the stomach
3. CCheck the blood glucose and ketones and contact the provider
4. DWait until tomorrow to see if the vomiting settles

A visitor on the ward becomes threatening and shows a knife. What is the nurse’s priority?

1. ATry to take the knife away from the visitor straight away before anyone is hurt
2. BMove away to safety, keep others away and call security or the police
3. CArgue with the visitor to persuade them to leave
4. DIgnore the visitor and carry on with patient care

A patient with anorexia nervosa is admitted. Which finding is the priority?

1. ASays she feels fat although she is very thin
2. BRefuses to eat in front of other people
3. CHas fine, downy hair on her arms
4. DHeart rate 38/min and potassium 2,8 mEq/L