Приоритизация и делегирование: лист заданий с ответами

In the FAST stroke check, what does the T stand for?

1. ATremor of the hands
2. BTongue movement
3. CTemperature
4. DTime to call emergency services

Which patient need belongs to the love and belonging level of Maslow’s hierarchy?

1. ANeeding pain relief after surgery
2. BWanting praise for progress in rehabilitation
3. CWanting family members to visit
4. DNeeding the call light within reach

Which task should the registered nurse not delegate to a nursing assistant?

1. AGiving a bed bath to a stable patient
2. BMaking an occupied bed
3. CEvaluating whether the patient understood discharge teaching
4. DWalking a stable patient up and down the corridor after lunch

A patient with schizophrenia says voices are telling him to hurt his roommate. What is the priority?

1. AKeep everyone safe and tell the team, as the risk of harm is high
2. BIgnore the comment, because voices are part of his illness
3. CAsk the roommate to stay in the room with him and help calm him down
4. DTell him the voices are not real and leave him alone

Какая находка неожиданна и требует срочного внимания?

1. AУ пациента с известным циррозом жёлтая кожа без изменений
2. BУ пациента с давней ХОБЛ бочкообразная грудная клетка
3. CУ пациента через день после лапароскопической холецистэктомии боль в правом плече
4. DУ пациента на инфузии гепарина новый чёрный дёгтеобразный стул

A patient on a nasal cannula at 6 L/min still has a low SpO₂. What should the nurse do?

1. ATurn the nasal cannula up to 15 L/min
2. BRecheck the SpO₂ at the next routine set of observations in four hours
3. CRemove the oxygen to see if the SpO₂ changes
4. DReport it, because a different oxygen device is likely to be needed

During birth, the baby’s head delivers but the shoulders do not follow. What should the nurse do first?

1. AHelp with the McRoberts position and give suprapubic pressure as directed
2. BPush firmly on the top of the uterus (fundal pressure)
3. CAsk the mother to stop pushing and wait an hour
4. DPull hard on the baby’s head and neck to free the trapped shoulders quickly

Two hours after a femoral cardiac catheterization, the nurse sees blood spreading from the puncture site. What is the first action?

1. AAsk the patient to bend the leg at the hip to stop the bleeding
2. BRaise the head of the bed so the patient can sit up
3. CApply firm, direct pressure just above the puncture site
4. DRemove the dressing and leave the site open to the air