Užduočių lapas tema Prioritetų nustatymas ir delegavimas su atsakymais

What is a transient ischemic attack (TIA)?

1. AA stroke that leaves permanent weakness or paralysis on one side of the body
2. BA heart attack that affects the brain
3. CBrief stroke-like symptoms that resolve, warning of a possible stroke
4. DA type of migraine with no link to stroke

Which statement belongs in the Background part of an SBAR report?

1. A“I am calling about Mr Khan because his blood pressure has dropped.”
2. B“He was admitted three days ago with pneumonia and also has COPD.”
3. C“I would like you to see him within the next 15 minutes.”
4. D“I think he may be developing sepsis.”

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

1. ASlaugytojo padėjėjo paprašymas nueiti ir patikrinti pacientą
2. BSkambinimas gydytojui, prieš pamatant pacientą
3. CPaciento įvertinimas daugiau informacijos surinkti
4. DSusirūpinimo užrašymas medicininiuose dokumentuose

On the first day after abdominal surgery, a patient has a temperature of 37,9 °C and reduced breath sounds at the lung bases. Which nursing action is most helpful?

1. AEncourage deep breathing, coughing and use of the incentive spirometer
2. BRestrict oral fluids so that the lungs do not fill up with extra fluid
3. CKeep the patient lying flat in bed to rest the incision fully
4. DGive a cough suppressant so that the incision is not strained

A nurse needs to give report on a patient to a colleague. Which information is the most important to include?

1. AThe patient’s current condition, recent changes and pending tasks
2. BThe patient’s favorite television programs and hobbies
3. CDetails of the nurse’s own break times that shift
4. DPersonal opinions about the patient’s family members and their visiting habits

Two nursing assistants argue loudly at the station about their assignments. What is the charge nurse’s best first step?

1. AMeet both of them privately to hear each side
2. BReport them to human resources at once
3. CIgnore it and hope they sort it out
4. DChange both of their assignments without any discussion

A 2-month-old infant has a spiral fracture of the femur. The parents say the baby rolled off the sofa. What should the nurse recognize?

1. AInfants of this age often roll off furniture and break bones in this way
2. BThe injury does not fit the infant’s development, so possible abuse must be reported
3. CNo further action is needed once the fracture is treated
4. DA spiral fracture in an infant is always caused by birth trauma

A patient opens their eyes only to pain, uses inappropriate words and withdraws from pain. What is the Glasgow Coma Scale score?

1. A9
2. B13
3. C7
4. D11