A home health care nurse is visiting an older adult client who tells the nurse that she is feeling tired, is unable to shop for groceries, and would like the nurse to shop for her. Shopping and performing personal errands for the client is prohibited in the nurse's job description. Which of the following is an appropriate nursing response?

“What I think you should do is wait for the days when you feel better and do your grocery shopping then."

"Let's look at some other resources to solve this problem."

"I would be happy to do whatever I can to help you."

"I won't be able to shop for you today because I have to get home to my family."

Answer and Explanation

The Correct Answer is B

A.   This response dismisses the client’s immediate needs and does not offer a supportive or constructive solution. It puts the responsibility on the client without addressing her request for assistance or exploring alternatives.
B.   This is an appropriate and constructive response. It acknowledges the client’s situation and shows willingness to help find alternative resources, such as community services, meal delivery programs, or assistance from family or friends. This approach empowers the client and provides practical support.
C.   While this response expresses willingness to help, it goes against the nurse's job description by implying that the nurse would perform tasks that are not permitted. It's important for the nurse to maintain professional boundaries and adhere to policies regarding their role.
D.   This response is not appropriate because it focuses on the nurse's personal reasons and does not address the client's needs. It may come off as dismissive and fails to offer any alternative solutions or support.

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Correct Answer is A

Explanation

A. Disinfecting equipment is a routine infection control measure that UAPs can perform after receiving proper training on the protocol. This activity does not require clinical judgment and falls within the
UAP’s responsibilities.
B. While UAPs may assist in educating visitors about hand hygiene, the demonstration of correct hand washing techniques is typically a nursing responsibility. Nurses are trained to provide this education effectively and ensure that the information is conveyed appropriately, especially since it may involve assessing visitors’ understanding.
C. This task requires clinical judgment and assessment skills, which are within the nursing scope of practice. Nurses need to evaluate this information in the context of the client’s overall health and care plan, making it inappropriate for delegation to UAP.
D. Screening for symptoms involves assessment and interpretation, which require a nursing level of knowledge and clinical judgment. While UAPs may collect basic data or report observations, actively screening clients for specific symptoms should be performed by a nurse.

A. Pain B. Anxiety C. Sleeplessness D. Difficulty speaking E. Depression

Correct Answer is ["A","B","C","E"]

Explanation

A. Pain is one of the hallmark symptoms of sickle cell anemia, particularly during a sickle cell crisis. The sickling of red blood cells can obstruct blood flow, leading to ischemia and severe pain in various parts of the body, including the chest, abdomen, and joints.
B. Clients with sickle cell anemia often experience anxiety, especially during pain crises or hospitalizations. The uncertainty surrounding pain episodes, potential complications, and the chronic nature of the disease can contribute to feelings of anxiety.
C. Many individuals with sickle cell anemia may experience sleeplessness due to pain, discomfort, or anxiety related to their condition. Pain episodes can disrupt sleep patterns, leading to fatigue and further complicating their overall health.
D. Difficulty speaking is not a typical manifestation of sickle cell anemia. While severe complications, such as stroke, can occur in individuals with sickle cell disease and may lead to speech difficulties, this is not a direct manifestation of the condition itself.
E. Depression is common among individuals with chronic illnesses, including sickle cell anemia. The ongoing challenges of managing pain, frequent medical visits, and the impact of the disease on daily life can contribute to feelings of depression.

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Naxlex Comprehensive Predictor Exams

Which infection control activity should the nurse delegate to an experienced unlicensed assistive personnel (UAP)?

Correct Answer is A

Explanation

A nurse is admitting a client who has sickle cell anemia. Which of the following manifestations should the nurse expect with this condition?(Select All that Apply.)

Correct Answer is ["A","B","C","E"]

Explanation

A nurse is assessing a child who is in sickle cell crisis. Which of the following findings should the nurse expect?

The care of a client is assigned to a newly-graduated RN. What actions can the newly-graduated RN delegate to the unlicensed assistive personnel (UAP)? [SELECT ALL THAT APPLY]

A nurse enters a client's room and finds the client pulseless. The family has requested a do-not- resuscitate (DNR) order from the provider, but he has not written the order yet. Which of the following actions should the nurse take?

A nurse is reviewing information about the Health Insurance and Portability Act (HIPPA) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?

A client who fell and broke his hip while being assisted to the bathroom by a nurse states he plans to sue the nurse. The nurse should know that, in a legal proceeding, the standard that will be used to determine if the nurse was negligent is which of the following?

A nurse is teaching a newly licensed nurse about reporting suspected child abuse. Which of the following statements indicates an understanding by the newly licensed nurse?

A nurse is providing discharge teaching to a client who had a sickle cell crisis. Which of the following health promotion strategies should the nurse include in the teaching?(Select All that Apply.)

A client with frequent watery stools and a possible Clostridium difficile infection is hospitalized with dehydration. Which nursing action should the charge nurse assign to an LPN?