A charge nurse is making staff assignments on a medical-surgical unit. Which of the following tasks should the nurse plan to delegate to an assistive personnel?
Pouching a client's ostomy bag for a new colostomy
Performing nasal hygiene for a client who has an NG tube
Measuring oxygen saturation for a client who has dyspnea
Inserting a rectal suppository for a client who is vomiting
The Correct Answer is B
A. Pouching a client's ostomy bag for a new colostomy requires specialized training and should typically be performed by a nurse.
B. Performing nasal hygiene for a client with an NG tube involves basic hygiene tasks that can be safely delegated to an assistive personnel after proper training and supervision.
C. Measuring oxygen saturation for a client who has dyspnea requires a basic skill that can be delegated to an assistive personnel.
D. Inserting a rectal suppository for a vomiting client involves a nursing task that should be performed by a nurse due to the client's condition and the nature of the task.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Inadequate food supply is a basic physiological need that directly affects recovery, wound healing, and overall postoperative outcomes after coronary artery bypass grafting. Ensuring access to adequate nutrition is essential for physical recovery and takes priority in discharge planning.
B. Limited social support is important for long-term recovery and adherence to care but does not address an immediate physiological need. It is typically addressed after basic needs are secured.
C. Low pain tolerance affects comfort and recovery experience but is managed through pain control strategies and does not take priority over essential survival needs like nutrition.
D. Decreased self-esteem is a psychosocial concern that, while important for holistic recovery, is addressed after physiological and safety needs have been met.
Correct Answer is C
Explanation
A. While religious beliefs may influence a client's decision, they are not the deciding factor. Clients have the right to refuse treatment regardless of the reason, as long as they are competent and informed.
B. The partner’s role as the durable power of attorney for health care is only relevant if the client is unable to make decisions due to incompetence or incapacitation. If the client is competent, their decision takes precedence over the wishes of their partner or any legal proxy.
C. Ensuring the client understands the risks of refusing the procedure is the deciding factor. A competent client has the right to refuse any medical treatment, including surgery, after being informed of the potential consequences. The nurse and provider must ensure the client’s decision is informed and voluntary.
D. The facility ethics committee may provide guidance in complex cases, but they do not override a competent client’s autonomy. The client’s informed decision is the ultimate determinant in whether the surgery is performed.
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