Ustalanie priorytetów i delegowanie: karta pracy z odpowiedziami

W trzystopniowym systemie triażu pacjent ze skręconą kostką, prawidłowymi parametrami życiowymi i łagodnym bólem jest zwykle zaklasyfikowany jako:

1. APilny
2. BOczekujący (expectant)
3. CNiepilny
4. DNagły (emergent)

What should the nurse try before using physical restraints on a confused patient?

1. ARestraining all four limbs to be fully safe
2. BUsing restraints at once and removing them later if they turn out not to be needed
3. CLess restrictive measures, such as more frequent checks or a bed alarm
4. DAsking the family to bring restraints from home

Który objaw jest problemem dróg oddechowych?

1. ABól brzucha oceniany na 8/10
2. BObrzęk języka i warg z chrypką
3. CSłabe, nitkowate tętno na tętnicy promieniowej
4. DDrobne trzeszczenia słyszalne u podstawy obu płuc podczas wdechu

Which postoperative patient should the nurse see first?

1. AAsking when the urinary catheter will be removed
2. BWants help with washing her hair before her visitors arrive this afternoon
3. CDressing soaked with bright red blood and a heart rate rising to 118/min
4. DPain of 4/10 one hour after an oral analgesic

A patient has a nasogastric tube on suction. Which task can the nurse delegate to a nursing assistant?

1. AIrrigating the tube when it blocks
2. BGiving mouth care
3. CChecking the tube’s position
4. DAssessing the drainage for blood

A patient has a serum potassium of 6,8 mEq/L. Which action comes first?

1. ARecheck the level next week
2. BPlace the patient on a cardiac monitor
3. CGive the patient’s scheduled potassium supplement
4. DEncourage foods high in potassium

After a head injury, a patient has clear fluid dripping from the nose. Which action should the nurse avoid?

1. AInforming the provider about the drainage
2. BInserting a tube or suction catheter through the nose
3. CChecking the fluid for glucose or a halo sign on gauze
4. DPlacing a loose gauze under the nose

A toddler with tetralogy of Fallot becomes very blue and breathless while crying. What should the nurse do first?

1. AEncourage the child to keep crying to open the lungs
2. BGive a large drink of water to calm the child
3. CLay the child flat on their back
4. DPlace the child in a knee-to-chest position