Lembaran kerja Pemberian keutamaan & delegasi dengan jawapan

Why may a full-thickness burn feel painless at its center?

1. AThe burn only affects the thin surface layer of the skin
2. BThe nerve endings in the skin have been destroyed
3. CThe burn has already fully healed
4. DThe patient has been given too much fluid

Which single action is the most effective way to prevent the spread of infection in hospital?

1. AHand hygiene
2. BKeeping the windows closed
3. CWearing a mask all day
4. DGiving every patient antibiotics

Which serum creatinine result suggests reduced kidney function in an adult?

1. A3.5 mg/dL (about 310 µmol/L)
2. B1.0 mg/dL (about 90 µmol/L)
3. C0.8 mg/dL (about 70 µmol/L)
4. D0.7 mg/dL (about 60 µmol/L)

Which action helps prevent a catheter-associated urinary tract infection?

1. ALeaving the catheter in place longer than needed
2. BDisconnecting the bag every shift to empty it
3. CRaising the drainage bag above the bladder when walking
4. DKeeping the drainage bag below the level of the bladder

A patient has a serum potassium of 6.8 mEq/L. Which action comes first?

1. APlace the patient on a cardiac monitor
2. BRecheck the level next week
3. CEncourage foods high in potassium
4. DGive the patient’s scheduled potassium supplement

Which patient is most suitable for the nurse to assign to a nurse who has just finished orientation?

1. AA patient with stable cellulitis on scheduled IV antibiotics
2. BA patient with sepsis whose blood pressure is falling
3. CA patient with a new tracheostomy who needs frequent suctioning
4. DA patient on a continuous heparin infusion with rising aPTT values

A patient with major depression has been withdrawn for weeks but is suddenly calm and cheerful and gives away her belongings. What should the nurse suspect?

1. AThat she is getting ready for discharge as planned
2. BA side effect of her antidepressant medicine that needs no special action
3. CA full recovery, so observation can be reduced
4. DA raised risk of suicide, because she may have made a decision

Seorang pesakit yang diselamatkan daripada kebakaran rumah mempunyai lecur pada muka, bulu hidung hangus dan suara serak. Apakah keutamaannya?

1. AMemberi pelega sakit
2. BMelindungi saluran udara, bersedia untuk sokongan saluran udara awal
3. CMembersihkan dan membalut lecur muka
4. DMemulakan resusitasi cecair IV yang dikira daripada saiz lecur