Ustalanie priorytetów i delegowanie: karta pracy z odpowiedziami

W triażu masowych zdarzeń, którą kategorię zwykle oznacza zielona karta?

1. ADrobne obrażenia: „ranni chodzący”
2. BZmarły lub oczekujący (expectant)
3. COdroczona: poważne, ale obecnie stabilne obrażenia
4. DNatychmiastowa pomoc: wymaga leczenia od razu

Which finding meets the usual definition of orthostatic hypotension?

1. ABlood pressure is the same lying and standing
2. BSystolic pressure rises by 20 mmHg or more within 3 minutes of standing up
3. CSystolic pressure falls by 20 mmHg or more within 3 minutes of standing
4. DHeart rate falls by 5/min after lying down

Zadanie, które wymaga oceny, osądu pielęgniarskiego lub ewaluacji, powinno być:

1. AWykonane przez pielęgniarkę dyplomowaną (RN)
2. BZdelegowane najbardziej doświadczonemu asystentowi pielęgniarskiemu
3. CPrzekazane rodzinie pacjenta
4. DZawsze zdelegowane LPN/LVN

Straight after birth, what is the first priority for a healthy-looking newborn?

1. AWeigh and measure the baby on the scale
2. BDry and warm the baby while checking that it is breathing
3. CGive the vitamin K injection before anything else is done
4. DGive the first bath to remove the blood and vernix

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

A patient taking warfarin has an INR of 5,2 and no signs of bleeding. What should the nurse do?

1. AGive the usual dose and recheck the INR next month
2. BEncourage the patient to take aspirin for pain
3. CGive a double dose to correct the result
4. DHold the warfarin dose and inform the provider

Four stable patients need routine morning care. To reduce the spread of infection, which patient should the nurse visit first?

1. AA patient with neutropenia after chemotherapy
2. BA patient with C. difficile diarrhea
3. CA patient with an MRSA wound infection
4. DA patient with influenza on droplet precautions

A day after a femur fracture, a young patient becomes confused and breathless, with small red spots on the chest. What should the nurse suspect?

1. ANormal pain after a fracture
2. BAn allergic reaction to the cast
3. CFat embolism syndrome
4. DAlcohol withdrawal