A nurse is delegating care to an assistive personnel. Which of the following assignments should the nurse make?
Taking the vital signs of a client who is experiencing acute angina
Collecting a urine specimen from a client who is experiencing dysuria
Answering a telephone inquiry about NPO status from a client who is scheduled for a procedure
Reinforcing teaching with a client about stool specimen collection
The Correct Answer is B
A. Taking the vital signs of a client who is experiencing acute angina. Acute angina is a potentially unstable condition requiring assessment by a nurse.
B. Collecting a urine specimen from a client who is experiencing dysuria. APs can perform routine specimen collection tasks.
C. Answering a telephone inquiry about NPO status from a client who is scheduled for a procedure. Only licensed nurses should provide pre-procedure instructions.
D. Reinforcing teaching with a client about stool specimen collection. Reinforcement of teaching involves assessment and evaluation, which are the nurse’s responsibilities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. A nurse tells a client's health care surrogate that the client might require restraints if diversion activities are ineffective: This does not meet the criteria for slander, as it involves a potential clinical plan of care rather than false statements.
B. A staff member reports to the unit supervisor during a private meeting that a coworker is possibly impaired: Communication during a private meeting does not constitute slander.
C. A nurse documents that a client was shouting and directly quotes the client's words: Documenting client behavior accurately in the medical record does not qualify as slander.
D. A client overhears an assistive personnel make a false statement about the assigned nurse and requests a different nurse: Slander involves making false verbal statements that harm someone's reputation. If overheard, this constitutes slander.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"B"}}
Explanation
|
Client |
Tag colour |
Rationale |
|
Client 1 |
Red |
The significant blood loss and tourniquet application indicate immediate life-threatening injuries that are survivable with prompt intervention. The heart rate of 54/min is concerning for hypovolemic shock. |
|
Client 2 |
Black |
Fixed and dilated pupils, no pulse, and no spontaneous respirations indicate the client is deceased or has non-survivable injuries. |
|
Client 3 |
Red |
Disorientation, multiple lacerations with significant bleeding, and elevated heart and respiratory rates indicate hemodynamic instability requiring immediate intervention. |
|
Client 4 |
Yellow |
The client is stable, with a suspected arm fracture and minor abrasions. Treatment can be delayed without significant risk of deterioration. |
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