Lembaran kerja Pemberian keutamaan & delegasi dengan jawapan

Which patient usually fits ESI level 5?

1. AAn adult in cardiac arrest
2. BA stable adult who only needs a repeat prescription
3. CAn adult with chest pain suggesting a heart attack
4. DA stable adult who needs blood tests and an X-ray of the chest

Which patient concern belongs to the esteem level of Maslow’s hierarchy?

1. AFear of slipping in the shower
2. BThirst after a long period of fasting before a test
3. CWorry about body image after a mastectomy
4. DMissing friends from home

Which type of stroke is the most common?

1. AVenous sinus thrombosis
2. BIschemic stroke
3. CHemorrhagic stroke
4. DSubarachnoid hemorrhage

A patient taking clozapine reports a sore throat and fever. What is the priority action?

1. AOffer throat lozenges and continue the usual dose
2. BHold the dose and report so the white cell count can be checked
3. CIncrease the dose because the symptoms suggest a relapse
4. DAdvise the patient to gargle with warm salt water and rest in bed

A patient is raising his voice, pacing and clenching his fists. What should the nurse do first?

1. AStand very close to him and tell him firmly and loudly to sit down and be quiet
2. BTurn away and ignore the behavior
3. CApply physical restraints at once
4. DSpeak calmly, keep a safe distance and invite him to talk about what is wrong

A conscious patient with hypoglycemia drank juice 15 minutes ago. The glucose is now 62 mg/dL (3.4 mmol/L). What should the nurse do next?

1. ARecord the result and recheck the glucose at the usual time before the evening meal
2. BGive another serving of fast-acting carbohydrate and recheck in 15 minutes
3. CGive the next scheduled dose of rapid-acting insulin with the meal
4. DWait another hour, because juice can take a long time to work

Several patients on a unit develop diarrhea within two days. What should the nurse do first?

1. APlace affected patients on contact precautions and inform infection control
2. BGive all patients antidiarrheal drugs without assessment
3. CMove the affected patients into shared rooms with other patients to free up beds
4. DWait to see if more patients become unwell

A patient is deteriorating quickly. The nurse has called the provider twice, but the provider has not come. What is the best action?

1. AActivate the rapid response team
2. BAsk the patient’s family to call the provider
3. CWait another hour and call the provider again
4. DDocument the concern and continue routine care