Lembaran kerja Pemberian keutamaan & delegasi dengan jawapan

Dalam rangka kerja ABC untuk menetapkan keutamaan kejururawatan, keperluan manakah yang ditangani dahulu?

1. APeredaran (Circulation)
2. BPernafasan (Breathing)
3. CKesakitan
4. DSaluran udara (Airway)

An adult arrives at the emergency department with chest pain. Which test should be done within about 10 minutes of arrival?

1. AA chest CT scan
2. BAn exercise stress test
3. CA lipid profile
4. DA 12-lead ECG

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

1. AFully competent
2. BExercising autonomy
3. CLacking decision-making capacity
4. DProviding valid informed consent

Seorang pembantu jururawat menolak tugas yang didelegasikan, dengan berkata dia belum dilatih melakukannya. Apakah respons terbaik daripada jururawat?

1. AMemberitahu pembantu bahawa ia ada dalam huraian kerja dan mesti dilakukan
2. BBerterima kasih kepada pembantu, pastikan tugas dilakukan dengan selamat dan aturkan latihan
3. CMelaporkan pembantu kepada pengurus kerana menolak tugas
4. DMeninggalkan tugas itu untuk syif seterusnya, apabila ada orang terlatih yang bertugas

Which action by a nursing assistant needs the nurse to step in?

1. ALowering the bed to its lowest position and locking the wheels after care
2. BPutting the call light within the patient’s reach
3. CTaking an oral temperature just after the patient drank cold water
4. DCleaning hands before entering the room

A patient at 35 weeks of pregnancy with high blood pressure calls the clinic. Which symptom needs urgent assessment?

1. AMild ankle swelling at the end of the day
2. BA severe headache with blurred vision
3. CBackache after a long walk
4. DNeeding to pass urine more often

Seorang pembantu jururawat mengukur tanda vital 15 minit selepas dos pertama morfin pesakit. Mereka melaporkan kadar pernafasan 10/min dan berkata pesakit sukar dikejutkan. Apakah yang patut dilakukan oleh jururawat?

1. AMendokumenkan dapatan dan memberitahu pembekal penjagaan pada pusingan berjadual seterusnya
2. BPergi serta-merta, kejutkan pesakit, sokong pernafasan dan sediakan nalokson mengikut arahan
3. CMeminta pembantu memeriksa semula kadar pernafasan dalam 15 minit dan melapor semula
4. DMenelefon pembekal penjagaan untuk arahan sebelum pergi melihat pesakit

A patient on peritoneal dialysis has cloudy fluid draining out and abdominal pain. What does this most likely mean?

1. APeritonitis, which needs prompt reporting and a fluid sample
2. BA normal finding at the end of each exchange
3. CConstipation that will settle with a laxative later today or tomorrow
4. DToo much fluid left in the abdomen after the drain