Užduočių lapas tema Prioritetų nustatymas ir delegavimas su atsakymais

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

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

A patient’s respiratory rate is 30/min at rest. How should the nurse classify this finding in an adult?

1. AWithin the normal adult range
2. BNormal after a meal
3. CSlow, and expected while the patient is asleep
4. DAbnormally fast and needing assessment

Which protective equipment is needed for airborne precautions?

1. AA fit-tested N95 or FFP3 respirator
2. BA plastic apron only
3. CGloves only
4. DA simple surgical mask worn loosely

A patient is in skeletal traction. Which finding needs the nurse to act?

1. AThe weights are hanging freely
2. BThe weights are resting on the floor
3. CThe ropes are in the pulleys
4. DThe patient’s body is in line with the traction

Praėjus keturioms valandoms po skydliaukės operacijos, kuriuo paciento radiniu slaugytojas turėtų pirmiausia imtis veiksmų?

1. A4/10 skausmas pjūvio vietoje
2. BBalsas vis labiau užkimsta ir atsirado naujas triukšmingas kvėpavimas
3. CPrašymas atsisėsti, kad galėtų atsigerti
4. DNedidelis serozinio skysčio kiekis matomas ant kaklo tvarsčio

A patient has a blood pressure of 210/120 mmHg. Which finding would make this a hypertensive emergency?

1. ANew chest pain or confusion suggesting organ damage
2. BForgetting to take the blood pressure tablet this morning
3. CA history of high blood pressure for ten years
4. DMild anxiety about the high reading on the monitor

A patient at 36 weeks of pregnancy has sudden severe abdominal pain, a hard, board-like uterus and dark vaginal bleeding. What should the nurse suspect?

1. APlacental abruption, which is an emergency
2. BNormal labor contractions starting
3. CPlacenta previa, which is usually painless
4. DA urinary tract infection

A patient suddenly has severe pain in one leg. The leg is pale and cold with no pedal pulse. What does this suggest?

1. AA muscle cramp that will pass with stretching
2. BChronic venous insufficiency that needs elevation
3. CA deep vein thrombosis that can be treated next week
4. DAcute arterial occlusion, which is an emergency