Приоритизация и делегирование: лист заданий с ответами

Which adult blood glucose result needs treatment straight away?

1. A110 mg/dL (6,1 mmol/L) after a snack
2. B130 mg/dL (7,2 mmol/L) two hours after a large lunch
3. C98 mg/dL (5,4 mmol/L) before breakfast
4. D52 mg/dL (2,9 mmol/L) with sweating and shakiness

In US patient-safety terms (The Joint Commission), what is a sentinel event?

1. AAn unexpected event that causes death or serious harm
2. BA planned admission to intensive care
3. CA routine handover between shifts
4. DA minor error that was noticed but caused no harm at all

Which capillary refill time is prolonged in an adult?

1. A1 second
2. B2 seconds
3. C4 seconds
4. DLess than 1 second

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

A nurse has called the rapid response team for a deteriorating patient. What should the nurse do while waiting for the team?

1. AStay with the patient, give oxygen as prescribed and have recent vital signs ready
2. BLeave the patient for a few minutes to find the relatives and explain what is happening
3. CGive a dose of every as-needed medication on the chart
4. DGo to the station to finish documentation for other patients

During labor, the nurse sees the umbilical cord in the vagina after the membranes rupture. What is the first action?

1. ARelieve pressure on the cord by lifting the presenting part with a gloved hand
2. BWait for the next contraction before acting
3. CPush the cord back into the uterus
4. DAsk the patient to walk around the room to bring the baby lower and speed up labor

An adult choking on food is coughing forcefully and can speak a little. What should the nurse do?

1. AGive abdominal thrusts straight away until the food comes out
2. BEncourage the patient to keep coughing and stay with them
3. CSweep the mouth blindly with a finger
4. DGive the patient water to wash the food down

Во время непрерывного зондового питания у пациента внезапно начинается кашель, одышка и падает SpO₂. Каково первое действие медсестры?

1. AОстановить питание, посадить пациента вертикально и оценить дыхание
2. BУвеличить скорость питания, чтобы закончить раньше
3. CУложить пациента плашмя, чтобы он отдохнул
4. DПромыть зонд 50 mL воды, затем продолжить питание как прежде