Lembaran kerja Pemberian keutamaan & delegasi dengan jawapan

What should the nurse try before using physical restraints on a confused patient?

1. AAsking the family to bring restraints from home
2. BUsing restraints at once and removing them later if they turn out not to be needed
3. CRestraining all four limbs to be fully safe
4. DLess restrictive measures, such as more frequent checks or a bed alarm

What is the purpose of an early warning score, such as the National Early Warning Score (NEWS)?

1. ATo decide the patient’s diet
2. BTo measure the patient’s satisfaction with care
3. CTo calculate the correct drug doses for each patient
4. DTo spot deterioration early from routine vital signs

What is a “critical value” in laboratory testing?

1. AA result that the patient has asked to see
2. BA result that may be life-threatening and must be reported at once
3. CA result that is needed only for research
4. DA result that is slightly outside the normal range and can wait for the ward round

A patient is admitted with diabetic ketoacidosis. Which prescribed treatment is usually started first?

1. ASubcutaneous long-acting insulin only, given once
2. BIV isotonic fluid such as 0.9% sodium chloride
3. CA high-carbohydrate meal
4. DOral potassium tablets

A nursing assistant offers to suction a patient’s new tracheostomy. Which response from the RN is best?

1. A“Suctioning a new tracheostomy is my task; I will do it myself.”
2. B“Ask the patient’s family to do the suctioning today.”
3. C“Leave the suctioning until the next shift arrives.”
4. D“Thank you, please suction him as needed and tell me how it went.”

Pesakit manakah yang boleh dilihat terakhir dengan selamat oleh jururawat?

1. APesakit COPD dengan oksigen 1 L/min, SpO₂ 90% (sasaran 88–92%), bercakap dalam ayat penuh
2. BPesakit dengan sakit kepala teruk yang mendadak
3. CPesakit dengan krepitasi baharu dan kahak berbuih merah jambu
4. DPesakit dua jam selepas pembedahan dengan kadar denyutan jantung meningkat daripada 88 kepada 118/min

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

A patient has a wrist restraint. The nurse finds the fingers on that hand pale, cool and tingling. What should the nurse do first?

1. ADocument the finding and continue with the medication round
2. BRaise the arm on a pillow and check again in two hours
3. CLoosen the restraint and assess the circulation
4. DTighten the restraint so the patient moves less