Приоритизация и делегирование: лист заданий с ответами

Which task is appropriate to delegate to a nursing assistant for an immobile but stable patient?

1. ADeciding whether a pressure injury has got worse since yesterday
2. BPlanning the patient’s skin care
3. CChoosing which wound dressing to use
4. DTurning and repositioning the patient every 2 hours

Which term describes a patient who is unable to understand and decide about their own care?

1. AExercising autonomy
2. BLacking decision-making capacity
3. CFully competent
4. DProviding valid informed consent

Which body temperature is a fever in an adult?

1. A38,5 °C
2. B36,4 °C
3. C37,1 °C
4. D36,8 °C

A patient has heart failure. Which instruction about daily weights is best to give the nursing assistant?

1. A“Weigh him each morning before breakfast, on the same scale, and tell me the result.”
2. B“Weigh him at any time today, on whichever scale is free.”
3. C“Only weigh him if his ankles look more swollen than they did yesterday afternoon.”
4. D“Weigh him after lunch, fully dressed, with his shoes on.”

A patient coughs hard after abdominal surgery, and loops of bowel appear through the opened wound. What does the nurse do first?

1. APush the bowel gently back into the abdomen with a gloved hand
2. BCover the wound with sterile dressings moistened with saline
3. CHelp the patient walk to the toilet to relieve abdominal pressure
4. DLeave the wound uncovered so the surgeon can see it on arrival

Which infant with gastroenteritis should the nurse see first?

1. ATwo loose stools today, feeding well
2. BAlert, crying with tears, had a wet diaper an hour ago
3. CMild diaper rash, otherwise playful
4. DLethargic, sunken fontanel, no wet diaper for 8 hours

An RN sees an LPN/LVN crushing an extended-release metoprolol tablet to mix with applesauce. What should the RN do?

1. AReport the LPN/LVN at the end of the month without saying anything now
2. BStop the LPN/LVN and contact the prescriber or pharmacist about another form
3. CTell the LPN/LVN to give half of the crushed tablet now and the other half at lunchtime
4. DLet the LPN/LVN continue, since crushing makes the tablet easier to swallow

A patient with severe sepsis starts oozing blood from IV sites and the gums, and bruises appear on the skin. What should the nurse suspect?

1. ANormal bruising from blood tests
2. BVitamin C deficiency
3. CDisseminated intravascular coagulation (DIC)
4. DAn allergic reaction to the adhesive tape