A nurse is planning assignments for the upcoming shift. Which of the following tasks should the nurse delegate to an assistive personnel? (Select all that apply.)
Insert an NG tube for a client who requires enteral feedings.
Record a client's intake after each meal.
Obtain a client's vital signs every 4 hr.
Instruct a client on the use of an incentive spirometer.
Transfer a client to physical therapy.
Correct Answer : B,C,E
A. Insert an NG tube for a client who requires enteral feedings. This is incorrect because inserting an NG tube requires assessment and skill beyond the scope of practice of assistive personnel. This task should be performed by a nurse.
B. Record a client's intake after each meal. This is correct because recording intake is a non-clinical task within the scope of an assistive personnel’s role.
C. Obtain a client's vital signs every 4 hr. This is correct because measuring and documenting vital signs is a standard duty that assistive personnel can perform.
D. Instruct a client on the use of an incentive spirometer. This is incorrect because client education is a nursing responsibility and cannot be delegated to assistive personnel.
E. Transfer a client to physical therapy. This is correct because assistive personnel can safely assist with client transfers as long as no clinical judgment is required.
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Related Questions
Correct Answer is D
Explanation
A. Varicella vaccine is given at 12–15 months and a second dose at 4–6 years. It is not given at 2 months.
B. Influenza vaccine is recommended annually starting at 6 months of age. It is not given at 2 months.
C. Hepatitis A vaccine is given at 12–23 months, with a second dose 6 months later. It is not given at 2 months.
D. Rotavirus vaccine is routinely given at 2 months and again at 4 months (and possibly 6 months depending on the vaccine type). This is the correct answer.
Correct Answer is D
Explanation
A. Constipation is a common side effect of risperidone due to its anticholinergic effects. However, it is not the priority because it is not immediately life-threatening.
B. Visual disturbances can occur with risperidone, but they are not as urgent as cardiovascular abnormalities.
C. Dry mouth is another anticholinergic side effect, but it is not a priority concern compared to an irregular pulse.
D. Irregular pulse is the priority finding because risperidone can prolong the QT interval, increasing the risk of serious cardiac arrhythmias, including torsades de pointes, which can be life-threatening. Therefore, this finding should be reported to the provider immediately.
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