A nurse and an experienced licensed practical nurse (LPN) are caring for a group of clients. Which of the following tasks should the nurse delegate to the LPN? (Select all that apply)
Plan a plan of care for a client when postoperative from an appendectomy
Provide discharge instructions to a confused client’s spouse
Administer a tap-water enema to a client who is preoperative
Clean vital signs from a client who is 6 hours postoperative
Catheterize a client who has not voided in 8 hours
Correct Answer : C,D,E
Choice A reason: Plan a plan of care for a client when postoperative from an appendectomy
Planning a plan of care for a client, especially postoperatively, is a complex task that requires comprehensive assessment and critical thinking skills. This responsibility typically falls within the scope of practice of a registered nurse (RN) rather than an LPN. The RN is trained to develop individualized care plans based on a thorough assessment of the client’s condition, medical history, and specific needs. This ensures that the care plan is holistic and addresses all aspects of the client’s recovery.
Choice B reason: Provide discharge instructions to a confused client’s spouse
Providing discharge instructions, particularly to a confused client’s spouse, involves detailed communication and education. This task is generally performed by an RN, who has the expertise to ensure that the instructions are clear, comprehensive, and tailored to the client’s specific needs. The RN can also assess the spouse’s understanding and provide additional clarification as needed. This ensures that the client receives appropriate care at home and reduces the risk of complications.
Choice C reason: Administer a tap-water enema to a client who is preoperative
Administering a tap-water enema is a task that can be safely delegated to an LPN. LPNs are trained to perform routine procedures such as enemas, which do not require the advanced assessment skills of an RN. This task involves following established protocols and ensuring the client’s comfort and safety during the procedure. By delegating this task to an LPN, the RN can focus on more complex aspects of client care.
Choice D reason: Clean vital signs from a client who is 6 hours postoperative
Obtaining and recording vital signs is a fundamental skill within the LPN’s scope of practice, as it involves routine data collection without interpretation or care‑planning decisions.
Choice E reason: Catheterize a client who has not voided in 8 hours
Catheterization is a procedure that LPNs are trained to perform. This task involves inserting a catheter to relieve urinary retention, which can be a common issue in postoperative clients. LPNs can perform this procedure safely and effectively, following established protocols to minimize the risk of infection and ensure the client’s comfort. Delegating this task to an LPN allows the RN to focus on other critical aspects of client care.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Reduced chest width: Aging does not typically result in a reduced chest width. Instead, changes in posture and the curvature of the spine can make the chest appear less prominent. The primary musculoskeletal changes with aging involve bone density, muscle mass, and joint flexibility
Choice B reason:
Increased force of isometric contraction: This is incorrect. Aging is associated with a decrease in muscle strength and mass, not an increase. The force of muscle contractions generally diminishes with age due to the loss of muscle fibers and changes in muscle composition.
Choice C reason:
Decreased muscle mass: This is correct. One of the most significant age-related musculoskeletal changes is sarcopenia, which is the loss of muscle mass and strength. This process begins around the age of 30 and accelerates with age, leading to decreased physical strength and increased risk of falls and fractures.
Choice D reason:
Thickened vertebral discs: Aging typically leads to the thinning and dehydration of intervertebral discs, not thickening. This can result in a reduction in height and increased susceptibility to spinal issues such as herniated discs and spinal stenosis.
Correct Answer is B
Explanation
Choice A reason: Induce Sedation
Pancuronium is not used to induce sedation. It is a neuromuscular blocking agent (NMBA) that causes paralysis of skeletal muscles. Sedation is typically achieved using medications such as benzodiazepines or propofol, which act on the central nervous system to produce a calming effect.
Choice B reason: Suppress Respiratory Effort
Pancuronium is used to suppress respiratory effort in patients with ARDS who require mechanical ventilation. By causing muscle paralysis, pancuronium helps to synchronize the patient’s breathing with the ventilator, reducing the risk of ventilator-induced lung injury and improving oxygenation. This is particularly important in severe cases of ARDS where patient-ventilator dyssynchrony can be detrimental.
Choice C reason: Decrease Chest Wall Compliance
Decreasing chest wall compliance is not a purpose of pancuronium. In fact, pancuronium does not directly affect chest wall compliance. Instead, it works by blocking the transmission of nerve impulses to the muscles, leading to muscle relaxation and paralysis.
Choice D reason: Decrease Respiratory Secretions
Pancuronium does not decrease respiratory secretions. Medications such as anticholinergics (e.g., atropine) are used to reduce secretions. Pancuronium’s primary role is to facilitate mechanical ventilation by ensuring complete muscle relaxation.
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