A charge nurse is reviewing the list of tasks that have been delegated to the assistive personnel (AP) by the staff nurse. Which of the following tasks should the charge nurse reassign to a licensed nurse?
Removing and cleaning the cannula of a client who has a new tracheostomy
Providing a back rub to a client who has right-sided paralysis
Transporting a client who experienced a stroke 72 hr ago to the radiology department
Performing oral hygiene for a client who is 1 day postoperative following an amputation of the right arm
The Correct Answer is A
A. Removing and cleaning the cannula of a tracheostomy requires specialized training and should be performed by a licensed nurse or respiratory therapist.
B. Providing a back rub is within the scope of practice for assistive personnel and does not require specialized training.
C. Transporting a client to the radiology department does not require specialized nursing skills and can be safely performed by assistive personnel.
D. Performing oral hygiene for a client postoperative following an amputation does not require specialized nursing skills and can be safely performed by assistive personnel.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
A. Sustaining hyperglycemia is not recommended. Instead, blood glucose levels should be controlled to prevent complications.
B. Smoking cessation is important in reducing the risk of complications such as cardiovascular disease, which is already increased in individuals with diabetes.
C. Maintaining optimal blood pressure is crucial for preventing kidney damage, which is a common complication of diabetes.
D. Reducing cholesterol and saturated fat intake helps in managing cardiovascular risk factors, which are elevated in individuals with diabetes.
E. Increasing physical activity and daily exercise helps in improving insulin sensitivity and managing blood glucose levels.
Correct Answer is ["A","B","E"]
Explanation
A. Glucose at 1130 - A fingerstick blood glucose level of 55 mg/dL indicates hypoglycemia and requires attention. This has to be addressed to prevent complications.
B. Client report of shakiness - Shakiness, hunger, cool skin, and diaphoresis are classic symptoms of hypoglycemia, which requires immediate intervention to prevent further deterioration.
C. Temperature - While changes in temperature may indicate infection or other issues, the client's symptoms of hypoglycemia are more urgent.
D. Oxygen saturation - While oxygen saturation is important, it is not typically affected in hypoglycemic episodes and is therefore not the priority in this case.
E. Heart rate - Tachycardia is a common symptom of hypoglycemia and should be addressed immediately
F. HbA1c - HbA1c reflects long-term blood glucose control and does not require immediate follow-up in this acute situation.
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