A nurse is making assignments for staff on an inpatient unit. Which of the following tasks can a nurse legally delegate to assistive personnel?
Obtaining the initial assessment of assigned clients
Educating a client and family members on home care
Changing a nonsterile dressing
Interpreting a client's diagnostic laboratory results
The Correct Answer is C
Rationale:
A. Obtaining the initial assessment of assigned clients: The initial assessment requires nursing judgment and clinical decision-making, which are within the scope of practice of a registered nurse only. It involves data interpretation and establishing a baseline for care, tasks that cannot be delegated to assistive personnel.
B. Educating a client and family members on home care: Client and family teaching requires specialized nursing knowledge to ensure understanding and accuracy. This task involves evaluating learning needs and reinforcing critical information, responsibilities that cannot be legally delegated to assistive personnel.
C. Changing a nonsterile dressing: Assistive personnel can safely perform nonsterile procedures such as changing a clean dressing under the supervision of a nurse. This task involves routine care that does not require nursing judgment, making it appropriate for delegation.
D. Interpreting a client's diagnostic laboratory results: Interpretation of laboratory data involves analysis, clinical reasoning, and the ability to make informed nursing decisions. These actions fall strictly within the nurse’s professional scope of practice and cannot be delegated to assistive personnel.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. "Avoid sexual intercourse for 7 days after receiving treatment.": HPV infections often persist in epithelial tissue even after visible lesions are treated, meaning transmission can still occur. Avoiding sexual contact for only 7 days does not eliminate the risk of spreading the virus.
B. "Obtain all recommended immunizations.": Receiving the HPV vaccine is the most effective method of preventing sexual transmission. The vaccine protects against high-risk HPV strains associated with cervical, anal, and oropharyngeal cancers, as well as genital warts. It is most effective when administered before sexual activity begins.
C. "Apply imiquimod ointment to any perineal ulcers.": Imiquimod is used to treat external genital warts caused by HPV, not perineal ulcers. Its use does not prevent infection or transmission and should only be applied to intact wart tissue under provider supervision.
D. "Undergo laser therapy to remove any lesions.": Laser therapy can remove visible warts but does not eradicate the virus itself. While it reduces the number of infectious lesions, HPV can still be transmitted through microscopic viral shedding even after lesion removal.
Correct Answer is D
Explanation
Rationale:
A. Discuss future treatment options with the client's health care surrogate: The client has decision-making capacity and advance directives in place, so the nurse should honor the client’s wishes rather than deferring to the surrogate.
B. Encourage the client to complete a final hemodialysis treatment: Encouraging treatment contradicts the client’s expressed wishes and advance directives, violating the client’s autonomy and right to refuse care.
C. Contact the client's family to discuss the decision: Family input may be supportive, but the client’s decisions take priority. Involving the family without the client’s consent may undermine autonomy.
D. Discuss possible options for discharge with the client: The nurse should focus on supporting the client’s choices, including end-of-life care and hospice or palliative services, and discuss discharge options that align with the client’s wishes.
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