Prioritization & delegation worksheet with answers

What are Kussmaul respirations?

1. ASlow, shallow breathing after an opioid overdose
2. BShort pauses in breathing during normal sleep
3. CDeep, rapid breathing seen in metabolic acidosis such as DKA
4. DNoisy, high-pitched breathing caused by a blocked upper airway

When a priority question asks what to do “first”, what is it asking for?

1. AThe action that takes the most time to complete
2. BThe action that nurses perform most often during a typical shift
3. CThe step that comes before the others, even if all are correct
4. DThe only option that is correct; the others are wrong

In the AVPU scale, what does the P mean?

1. APulse present and regular
2. BPupils equal and reactive
3. CResponds only to pain
4. DPain score below 5

A young adult has just started an SSRI antidepressant for major depression. What should the nurse monitor most closely in the first weeks?

1. AThoughts of suicide or self-harm
2. BWeight loss from too much appetite
3. CRising blood glucose levels
4. DHair growth and skin color

A patient has a sudden nosebleed, is alert and is breathing normally. What does the nurse do first?

1. ATilt the head back and apply ice to the back of the neck
2. BLie the patient flat on their back with a pillow under the knees
3. CSit the patient up, lean them forward and pinch the soft part of the nose
4. DAsk the patient to blow the nose hard to clear the clots

A patient receiving IV magnesium sulfate for pre-eclampsia has absent knee reflexes and a respiratory rate of 10/min. What does the nurse do first?

1. AIncrease the infusion to prevent a seizure
2. BStop the magnesium infusion and call for help
3. CTurn the patient onto her back and recheck later
4. DGive oral fluids to help clear the drug faster

Four patients arrive at the emergency department at the same time. Who should be seen first?

1. AAn adult with kidney stone pain of 9/10 and stable vital signs
2. BAn older adult with weakness on one side that began 40 minutes ago
3. CA young adult with a swollen, painful ankle after a fall on the stairs
4. DA child with a temperature of 39 °C who is alert and drinking

A patient receiving comfort-focused end-of-life care is distressed by breathlessness. Which approach is most appropriate?

1. AWithhold all opioids because they may slow breathing
2. BStart a series of aggressive tests to find the exact cause of the breathlessness
3. CGive prescribed opioids and use positioning and a fan to relieve breathlessness
4. DLeave the patient alone so they can rest