A nurse is caring for four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)?

- A. Assessing fluid intake every 24 hr is important for a postoperative client, but it is not the priority action. The nurse should monitor fluid intake and output more frequently, such as every 8 hr or every shift, to detect any imbalances or complications.

- B. Ambulating three times a day is beneficial for a postoperative client, but it is not the priority action. The nurse should encourage early and frequent ambulation to promote circulation, prevent thromboembolism, and enhance bowel function, but only after ensuring that the client is stable and has adequate pain control.

- C. Assisting with deep breathing and coughing is the priority action for a postoperative client who had abdominal surgery. The nurse should help the client perform these exercises every 1 to 2 hr to prevent atelectasis, pneumonia, and respiratory failure, which are common and serious complications after abdominal surgery.

- D. Monitoring the incision site for findings of infection is important for a postoperative client, but it is not the priority action. The nurse should inspect the wound for signs of infection, such as redness, swelling, warmth, drainage, or odor, but this can be done during routine dressing changes or as needed.

Choice A rationale:

Suggesting that the client attend adult day care three times per week is incorrect. While social interaction is essential for the elderly, it does not address the specific needs of a client with type 2 diabetes mellitus. Moreover, attending adult day care may not necessarily promote diabetes management.

Choice B rationale:

Reviewing assisted living accommodations with the client is incorrect. Assisted living facilities might be suitable for some elderly individuals, but in this case, the client lives independently. There is no indication in the question stem that the client needs assisted living arrangements at this time.

Choice C rationale:

Discussing a long-term care referral for the client with the provider is incorrect. Long-term care facilities are designed for individuals who require extensive assistance with daily activities. There is no information in the question suggesting that the client's condition has deteriorated to the extent of needing long-term care.

Choice D rationale:

Instructing the client about the use of telehealth services is the correct intervention. Telehealth services, including remote monitoring of blood glucose levels, virtual consultations with healthcare providers, and medication management, can enhance diabetes management for elderly individuals living independently in rural areas. Telehealth provides access to healthcare professionals without the need for frequent travel, addressing the challenges faced by individuals residing in remote areas.