A charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol when discarding contaminated linens. Which of the following actions should the nurse take first?

Reinforce facility protocols at the next staff meeting.

Discuss the issue with the AP.

Alert the infection control department.

Notify the unit manager about the incident.

Answer and Explanation

The Correct Answer is B

Choice A Reason:
Reinforcing facility protocols at the next staff meeting, is important for reminding all staff members of the importance of following protocols, but it may not address the immediate issue at hand.
Choice B Reason:
Discussing the issue with the AP is correct. When a charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol, the first action should be to directly address the issue with the AP. This allows for immediate feedback and correction of behavior, helping to ensure that proper procedures are followed in the future.
Choice C Reason:
Alerting the infection control department, may be necessary if the violation poses a risk of infection transmission, but it may not be the first step. Directly addressing the issue with the AP allows for immediate correction and prevents potential harm.
Choice D Reason:
Notifying the unit manager about the incident, is also important, but addressing the issue with the AP directly is the immediate action needed to correct the behavior.

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Correct Answer is B

Explanation

A.Abiteblockisnottypicallyneededforaclientwithdysphagia,asitismorecommonlyusedinsituationswheretheairwayneedstobeprotected,suchasduringseizuresorcertaindentalprocedures.

B. A Yankauer suction device should be readily available for a client with dysphagia. Dysphagia increases the risk of aspiration, which can lead to choking or pneumonia. A Yankauer suction device allows for oral suctioning to clear secretions or food particles from the mouth and airway to help prevent aspiration and maintain a patent airway.

C. While large-handled utensils may be helpful for clients with limited dexterity or mobility (such as those with arthritis), they are not essential equipment for managing dysphagia.

D. Nasal cannula and oxygen: Oxygen therapy is not a routine intervention for dysphagia unless the client has respiratory complications that require supplemental oxygen. While aspiration can lead to respiratory issues like aspiration pneumonia, a nasal cannula and oxygen are not immediate necessities in the room for a client with dysphagia.

A. Reinforce the potential consequences of not having this information on record to the nursing staff. B. Remind nurses to obtain this information during the admission process. C. Meet with nursing staff to review the policy regarding advance directives. D. Ask nurses who are caring for clients without this information in the medical record to obtain it.

Correct Answer is D

Explanation

Choice A Reason:
Reinforcing the potential consequences of not having advance directives on record is important, but the immediate priority is to ensure that the missing documentation is obtained.
Choice B Reason:
Reminding nurses to obtain advance directive information during the admission process is a proactive approach to preventing future instances of missing documentation. However, the priority now is to address the current gap in documentation for clients already admitted.
Choice C Reason:
Meeting with nursing staff to review the policy regarding advance directives can provide clarification and reinforcement of expectations, but again, the immediate priority is to address the missing documentation for current clients.
Choice D Reason:
Asking nurses who are caring for clients without this information in the medical record to obtain it. The priority action for the nurse manager is to ensure that advance directives, which are critical documents outlining a patient's wishes regarding medical treatment, are obtained for clients who currently lack documentation. This ensures that patients' preferences and choices regarding their care are respected, especially in critical situations.

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A charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol when discarding contaminated linens. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse is assessing the room of a newly admitted client who has dysphagia. Which of the following pieces of equipment should the nurse ensure is available in the client's room?

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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