A nurse is assisting with the care of a group of pediatric clients. Which of the following actions should the nurse take first?
Deliver a breakfast tray to a child who has been administered regular insulin.
Complete pin site care for a child who is in skeletal traction.
Provide clear liquids to a child who is 4 hr postoperative following a laparoscopic appendectomy.
Administer acetaminophen to a child who has a temperature of 101.2°F (38.4°C).
The Correct Answer is A
If a nurse is assisting with the care of a group of pediatric clients, the first action the nurse should take is to deliver a breakfast tray to a child who has been administered regular insulin. This is because regular insulin is a fast-acting insulin that begins to lower blood sugar levels within 15 minutes of administration. It is important for the child to eat shortly after receiving regular insulin to prevent hypoglycemia.
Option B is incorrect because completing pin site care for a child who is in skeletal traction is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option C is incorrect because providing clear liquids to a child who is 4 hr postoperative following a laparoscopic appendectomy is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option D is incorrect because administering acetaminophen to a child who has a temperature of 101.2°F (38.4°C) is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Assistive personnel (AP), also known as unlicensed assistive personnel (UAP), can perform tasks such as recording vital signs ¹. Collecting intake and output [a] is a task that can be delegated to an AP.
The other options are not tasks that should be delegated to an AP.
Evaluating pain relief after administering pain medication [b] involves assessing the effectiveness of a medical intervention, which is typically the responsibility of a licensed nurse.
Providing a central line dressing change [c] is a complex task that requires specialized knowledge and skills.
Selecting a menu for a low-sodium diet [d] involves dietary planning, which is typically the responsibility of a licensed nurse or a registered dietitian.
Correct Answer is A
Explanation
If a nurse manager notices that a nurse who has a history of being resistant to change is not delivering care according to a new policy, the appropriate action for the nurse manager to take is to encourage the nurse to verbalize the reasons for their resistance to the change. This will allow the nurse manager to understand the nurse's concerns and work with them to address any issues and facilitate their acceptance of the new policy.
Option B is incorrect because ignoring the resistance and allowing peer pressure to facilitate a change in the nurse's behavior is not an effective or respectful way to address the issue.
Option C is incorrect because explaining the importance and rationale of implementing the new policy to the nurse may be necessary, but it should not be the first action taken.
Option D is incorrect because indicating that there will be disciplinary consequences if the nurse does not implement the new policy may be necessary, but it should not be the first action taken.
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