Lembaran kerja Pemberian keutamaan & delegasi dengan jawapan

Seorang pembantu jururawat melaporkan empat dapatan. Yang manakah patut diperiksa dahulu oleh jururawat?

1. APesakit yang meminta selimut tambahan
2. BPesakit yang tiba-tiba tidak dapat menggerakkan lengan kanannya
3. CPesakit yang dulang sarapannya tidak dihabiskan
4. DPesakit yang mahu menelefon saudara

When a charge nurse makes patient assignments, what does a patient’s “acuity” mean?

1. AHow many visitors the patient is expected to have
2. BHow long the patient has been in the hospital since admission
3. CHow ill the patient is and how much nursing care they need
4. DHow far the patient’s room is from the nurses’ station

In the FAST stroke check, what does the T stand for?

1. ATemperature
2. BTremor of the hands
3. CTime to call emergency services
4. DTongue movement

A patient with diabetes is unresponsive and has a blood glucose of 40 mg/dL (2.2 mmol/L). What should the nurse do first?

1. AWait 15 minutes and recheck the glucose
2. BPour orange juice into the patient’s mouth
3. CGive IV dextrose or glucagon as prescribed
4. DGive the scheduled dose of insulin

A patient is receiving a blood transfusion. Which task can the nurse delegate to a nursing assistant?

1. ADeciding whether to stop the transfusion if the patient has chills
2. BMeasuring and reporting vital signs at the times set by the nurse
3. CStarting the transfusion once the blood arrives
4. DAssessing the patient for signs of a transfusion reaction

Seorang pembantu jururawat melaporkan bahawa tekanan darah pesakit ialah 168/98 mmHg (tadi 130/80) dan pesakit mengalami sakit kepala. Apakah yang patut dilakukan oleh RN?

1. AMeminta pembantu memeriksa semula tekanan darah dalam sejam
2. BMeminta pembantu memberi ubat antihipertensi apabila diperlukan sekarang
3. CMendokumenkan nilai itu dan meneruskan pusingan ubat
4. DMenilai pesakit, memeriksa semula tekanan darah dan mencari gejala

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

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

Pesakit manakah di unit renal yang patut dilihat dahulu oleh jururawat?

1. APesakit yang meminta nasihat tentang diet rendah fosfat
2. BPesakit hemodialisis yang terlepas sesi semalam dan kini mengalami kelemahan otot dan nadi tidak teratur
3. CPesakit yang fistula arteriovenanya mempunyai getaran (thrill) dan bruit yang kuat
4. DPesakit dialisis peritoneal yang cecair saliran keluarnya jernih