Užduočių lapas tema Prioritetų nustatymas ir delegavimas su atsakymais

Kai prioritetų klausime pateikiami ir vertinimas, ir veiksmas, kuris dažniausiai teisingas pirmiausia, kai situacija nėra skubi?

1. ASkambinimas gydytojui, prieš pamatant pacientą
2. BSusirūpinimo užrašymas medicininiuose dokumentuose
3. CPaciento įvertinimas daugiau informacijos surinkti
4. DSlaugytojo padėjėjo paprašymas nueiti ir patikrinti pacientą

Which term describes a patient who is unable to understand and decide about their own care?

1. AProviding valid informed consent
2. BLacking decision-making capacity
3. CFully competent
4. DExercising autonomy

In the ABC framework, which finding is mainly a breathing problem?

1. AHeart rate 150/min with a low blood pressure and cold skin
2. BShallow breaths with an SpO₂ of 85% on room air
3. CA blood glucose of 60 mg/dL (3,3 mmol/L)
4. DStridor caused by a swollen throat

Stabilus suaugusysis su normaliais gyvybiniais rodikliais turi rankos įpjovimą, kuriam reikia siūlių, ir daugiau nieko. Koks ESI lygis tinka?

1. A3 lygis
2. B4 lygis
3. C2 lygis
4. D5 lygis

Which patient should the RN see first after receiving a report from the night nurse?

1. ADay 2 after bowel surgery, asking to start a soft diet
2. BDay 4 after bowel surgery, waiting for discharge teaching
3. CDay 3 after bowel surgery, wants a shower and hair wash before breakfast
4. DDay 1 after bowel surgery, new chest pain and heart rate 110/min

A nurse teaches foot care to a patient with diabetes. Which statement shows a need for further teaching?

1. A“I will wear shoes that fit well, even at home.”
2. B“I will soak my feet in hot water every evening.”
3. C“I will dry well between my toes after washing.”
4. D“I will check the soles of my feet every day with a mirror.”

A patient taking an MAO inhibitor antidepressant is taught about diet. Which statement shows a need for further teaching?

1. A“I will check with the pharmacist before cold remedies.”
2. B“I can still eat aged cheese and cured salami.”
3. C“I will avoid tap beer and red wine.”
4. D“A sudden severe headache is a warning sign.”

After surgery, a patient who has taken long-term steroids becomes hypotensive and weak, and the blood pressure does not rise with IV fluids. Which problem should the nurse suspect?

1. AAn allergic reaction to the anesthetic
2. BNormal tiredness after anesthesia
3. CFluid overload from too much IV fluid
4. DAdrenal crisis from steroid withdrawal