A nurse is coordinating care of a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse assign to the AP?
A. Assess the pain level of a client who has received acetaminophen.
Check a client's peripheral IV site for redness or swelling.
Measure the intake and output of a client who has received furosemide.
Reinforce teaching with a client about crutch-gait walking.
The Correct Answer is C
Choice A rationale
Assessing pain levels is a nursing task requiring clinical judgment, which is beyond the scope of an assistive personnel's duties.
Choice B rationale
Checking an IV site for redness or swelling also requires clinical assessment skills, which are tasks for the nurse.
Choice C rationale
Measuring intake and output is a routine task that can be safely delegated to an assistive personnel. It involves straightforward measurement and recording.
Choice D rationale
Reinforcing teaching about crutch-gait walking requires specific patient education, which falls under the nurse's responsibilities.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
Cleaning the hearing aid with isopropyl alcohol is not recommended as it can damage the device. Proper cleaning methods involve using specialized cleaning tools and gentle cleaning solutions.
Choice B rationale
Turning the hearing aid off for 5 minutes is not likely to resolve the whistling sound, which is often caused by feedback issues that need to be addressed through other means such as adjusting the fit or volume.
Choice C rationale
Soaking the hearing aid in warm water is inappropriate and can cause irreparable damage. Hearing aids are electronic devices and should not be submerged in water.
Choice D rationale
Decreasing the volume on the hearing aid can help reduce the whistling sound, which is commonly caused by feedback. Proper fitting and volume adjustments are key to preventing this issue.
Correct Answer is D
Explanation
Choice A rationale
Placing one hand over the other against the upper body of the gown increases the risk of contamination. The sterile field must be maintained by keeping hands in a position where they are less likely to come into contact with non-sterile surfaces.
Choice B rationale
Clasping hands behind the body at the waist can also lead to contamination, as the hands may inadvertently touch the gown, which may not be sterile in that area. It’s essential to keep hands in a position where they are less likely to become contaminated.
Choice C rationale
Keeping arms at the sides with hands in a relaxed position might cause hands to brush against non-sterile surfaces or clothing, leading to contamination. Therefore, this position is not recommended for maintaining sterility.
Choice D rationale
Interlocking fingers and holding hands away from the body above the waist is the proper technique for maintaining sterility. This position ensures that the hands are kept in the sterile field and away from non-sterile surfaces, reducing the risk of contamination.
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