A nurse is caring for four postoperative clients. The nurse can delegate obtaining vital signs to an assistive personnel (AP) for which of the following clients?

A client who is 3 days postoperative following a craniotomy

A client who is 3 days postoperative following gastric bypass surgery

A client who is 2 hr postoperative following an abdominal hysterectomy

A client who is 1 hr postoperative following a thyroidectomy

Answer and Explanation

The Correct Answer is B

Rationale:

A. A client who is 3 days postoperative following a craniotomy requires careful monitoring due to potential complications from brain surgery, so vital signs should be taken by a nurse.

B. A client who is 3 days postoperative following gastric bypass surgery is stable enough for an AP to obtain vital signs, as the risk of immediate postoperative complications is lower compared to more recent surgeries.

C. A client who is 2 hr postoperative following an abdominal hysterectomy requires close monitoring due to the recent surgery, so vital signs should be obtained by a nurse.

D. A client who is 1 hr postoperative following a thyroidectomy requires vigilant monitoring for potential complications from recent surgery, which should be done by a nurse.

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Correct Answer is B

Explanation

Rationale:

A. "I want you to review the facility's policy on personal attire before you begin the shift." does not address the specific concern regarding infection risk related to artificial nails.

B. "There is a higher risk of infection for our clients associated with artificial nails." provides a clear and factual explanation of why artificial nails are not appropriate, focusing on client safety rather than personal appearance or policy.

C. "Why would you wear artificial nails to work when you know it's against the rules?" is confrontational and does not address the issue in a constructive manner.

D. "You should know that artificial nails have a very unprofessional appearance." focuses on appearance rather than the potential risk to clients' health.

A. Check the client's medical record for the provider's prescription. B. Inform the charge nurse that the client refused the enema. C. Explain to the client that the provider prescribed the procedure. D. Assure the client that enemas are commonly prescribed for constipation.

Correct Answer is A

Explanation

Rationale:

A. Check the client's medical record for the provider's prescription is the appropriate action to confirm whether the enema was indeed ordered and to ensure that the client’s concerns are addressed.

B. Inform the charge nurse that the client refused the enema might be premature without first verifying the order and addressing the client's concerns.

C. Explain to the client that the provider prescribed the procedure is not appropriate if you have not confirmed the order. It may be premature if the order is not documented.

D. Assure the client that enemas are commonly prescribed for constipation does not address the client’s specific concern about whether the enema was actually ordered.

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A nurse is caring for four postoperative clients. The nurse can delegate obtaining vital signs to an assistive personnel (AP) for which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An assistive personnel (AP) comes to work with a new set of artificial nails. The nurse takes the AP to a private location to discuss the issue. Which of the following statements by the nurse is appropriate?

Correct Answer is B

Explanation

A nurse is preparing to administer a soap suds enema to a client who has constipation. As the nurse explains the procedure, the client states, "The doctor didn't tell me I was supposed to receive an enema." Which of the following nursing actions is appropriate at this time?

Correct Answer is A

Explanation

A nurse is planning client care for herself and an assistive personnel (AP) working with her. Which of the following tasks should the nurse plan to perform?

A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?

A nurse is planning to assign tasks for a group of clients. Which of the following tasks should the nurse plan to assign to an assistive personnel (AP)? (Select all that apply.)

A nurse finds that a client did not receive a scheduled dose of furosemide (Lasix). Which of the following should the nurse include in the incident/variance report? (Select all that apply.)

A nurse is caring for a client who is scheduled to have surgery. In preparing the client for surgery, which of the following actions is considered outside the nurse's responsibilities?

A nurse and an assistive personnel (AP) are providing care for four clients who were admitted to the medical-surgical unit on the previous shift. The nurse should delegate meal assistance for which of the following clients to the AP?

A nurse is caring for a group of clients. The nurse demonstrates adherence to the ethical principle of fidelity by doing which of the following?