A nurse is assisting with planning care for a group of clients. Which of the following tasks should the nurse delegate to an assistive personnel?

Changing the dressing on a client's IV site

Suctioning a client's new tracheostomy

Evaluating a client's risk for developing pressure injuries

Administering a large-volume enema to a client

Answer and Explanation

The Correct Answer is D

A. Changing the dressing on a client's IV site: This is a sterile procedure and requires the nurse’s clinical expertise. It cannot be delegated to assistive personnel (AP).

B. Suctioning a client's new tracheostomy: Suctioning a tracheostomy, especially a new one, is a sterile procedure requiring clinical judgment and skill, which is beyond the scope of assistive personnel.

C. Evaluating a client's risk for developing pressure injuries: This is an assessment task that requires clinical judgment and critical thinking. It falls under the nurse’s scope of practice and should not be delegated to AP.

D. Administering a large-volume enema to a client: Assisting with or administering an enema is a task that can be delegated to assistive personnel, as it is within their scope of practice, provided the client is stable and the procedure does not require complex judgment.

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Correct Answer is B

Explanation

A. Incorrect. Digoxin typically decreases heart rate by increasing vagal tone and reducing the conduction velocity through the atrioventricular node.
B. Correct. Digoxin is a positive inotrope, meaning it increases the force of myocardial contraction, leading to increased cardiac output.
C. Incorrect. Decreased urinary output is not a common effect of digoxin.
D. Incorrect. Digoxin can lead to hyperkalemia, not hypokalemia, as it competes with potassium at the cellular level.

A. A client who has a history of pancreatitis and reports severe abdominal pain B. A client who has heart failure and reports severe dyspnea C. A client who is scheduled for abdominal surgery in 1 hr D. A postoperative client who has diabetes mellitus and a blood glucose of 280 mg/dL

Correct Answer is B

Explanation

A. While severe abdominal pain in a client with a history of pancreatitis requires urgent assessment, severe dyspnea in a client with heart failure may indicate impending respiratory distress, requiring immediate intervention.
B. Severe dyspnea in a client with heart failure is a critical situation that requires immediate assessment and intervention to prevent respiratory compromise or failure.
C. While a client scheduled for surgery may need preparation and assessment, the client with severe dyspnea takes priority due to the potential for respiratory distress.
D. While a high blood glucose level in a postoperative client with diabetes mellitus requires monitoring and intervention, the client with severe dyspnea requires immediate attention due to the potential for respiratory compromise.

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A nurse is assisting with planning care for a group of clients. Which of the following tasks should the nurse delegate to an assistive personnel?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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