Prioritization & delegation worksheet with answers

A patient has a Glasgow Coma Scale score of 8. What is the main concern?

1. AThe patient may not be able to protect the airway
2. BThe patient is fully alert and oriented
3. CThe patient can safely eat and drink without help
4. DThe patient only has a mild headache

In mass-casualty triage, what does a black tag mean?

1. AThe highest treatment priority of all victims
2. BContaminated, needing full decontamination before any care is given
3. CDeceased, or unlikely to survive with the resources available
4. DMinor injuries that can wait for many hours

Which statement best describes delegation in nursing?

1. AAsking the physician to take over a task the nurse is too busy to do
2. BGiving a competent person authority for a selected task, while the nurse stays accountable
3. CRefusing a task because it falls outside your own role
4. DHanding all responsibility and accountability for a patient to another person

A nursing assistant reports on four patients. Which report needs the nurse’s attention first?

1. AA patient one day after abdominal surgery is newly restless and has a heart rate of 124/min
2. BA patient has passed 300 mL of urine in the past 6 hours
3. CA patient with COPD has an SpO₂ of 90% at rest, which matches their usual values
4. DA patient asks for an extra pillow

Using the Emergency Severity Index, which patient receives the highest acuity level?

1. AA patient with chest pain and normal vital signs
2. BA patient with a sore throat for three days and normal vital signs
3. CAn unresponsive patient with gasping, irregular breaths
4. DA patient with a possible ankle fracture

A patient with a spinal cord injury at T4 suddenly has a severe headache, flushing above the injury and a blood pressure of 200/110 mmHg. What does the nurse do first?

1. AGive a warm drink and recheck the blood pressure in an hour
2. BLay the patient flat with the legs raised
3. CApply extra blankets to keep the patient warm and calm
4. DSit the patient upright with the legs lowered

During START triage, a non-walking adult breathes 28 times a minute, has no radial pulse and has a capillary refill of 4 seconds. Which category is the victim given?

1. ARed (immediate)
2. BGreen (minor)
3. CBlack (expectant)
4. DYellow (delayed), because the respiratory rate is under 30/min

A patient with a severe asthma attack had a PaCO₂ of 32 mmHg (4.3 kPa) on arrival. An hour later it is 46 mmHg (6.1 kPa), and the patient seems tired. What does this suggest?

1. ARespiratory muscle fatigue with possible impending respiratory failure
2. BThe asthma is improving, because the PaCO₂ is now near normal
3. CA laboratory error that should be ignored
4. DThe patient is hyperventilating even more than before and needs calming