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.)

Transfer a client to physical therapy.

Obtain a client's vital signs every 4 hr.

Instruct a client on the use of an incentive spirometer.

Insert an NG tube for a client who requires enteral feedings.

Record a client's intake after each meal.

Answer and Explanation

Correct Answer : A,B,E

Choice A rationale:

Transferring a client to physical therapy is a task that can be safely delegated to an assistive personnel (AP) as long as the client does not have any specific medical restrictions or requires specialized assistance during the transfer. APs are trained to assist with activities of daily living, including transferring clients from one place to another. However, it is essential for the nurse to assess the client's condition and provide clear instructions to the AP to ensure a safe transfer.

Choice B rationale:

Obtaining a client's vital signs every 4 hours is a routine task that can be delegated to an assistive personnel. APs are trained to measure vital signs such as blood pressure, heart rate, respiratory rate, and temperature under the supervision of licensed healthcare providers. Regular monitoring of vital signs is crucial in assessing the client's overall health status and detecting any changes that might require immediate medical attention.

Choice E rationale:

Recording a client's intake after each meal is a task that can be delegated to an assistive personnel. APs can document the amount and type of food and fluids consumed by the client. Monitoring the client's intake is important, especially if the client has specific dietary restrictions, allergies, or medical conditions that require close monitoring of their food and fluid intake.

Choice C rationale:

Instructing a client on the use of an incentive spirometer requires specialized knowledge and assessment of the client's respiratory status. This task should be performed by a licensed healthcare provider, such as a nurse or respiratory therapist, who can properly assess the client's lung function, demonstrate the correct technique, and ensure the client's safety during the process. Delegating this task to an AP could result in improper use of the spirometer, potentially leading to complications or ineffective therapy.

Choice D rationale:

Inserting an NG tube for a client who requires enteral feedings is a complex medical procedure that should be performed by a licensed nurse or healthcare provider with appropriate training and expertise. This procedure carries risks, including the risk of aspiration if not done correctly. Delegating this task to an AP is outside their scope of practice and could jeopardize the client's safety.

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Correct Answer is C

Explanation

A. Canned black beans are a good source of fiber and protein, but they are not specifically recommended for hypertension.
B. Cheese is often high in saturated fat and sodium, which can contribute to hypertension and cardiovascular risk.
C. Correct. Fish, especially fatty fish like salmon, mackerel, and trout, are rich in omega-3 fatty acids, which have been associated with cardiovascular benefits, including reducing blood pressure.
D. Red meat is often high in saturated fat and is not typically recommended for individuals with hypertension.

A. Determine if the client's health care surrogate is aware of the risks and benefits of the procedure. B. Ensure that the client's family supports the provider's decision for surgery. C. Determine if the procedure is medically necessary for the client. D. Send the unsigned informed consent form to the facility's risk manager.

Correct Answer is A

Explanation

A. Correct. In cases where the client is unable to provide informed consent due to incapacitation, the health care surrogate or legally authorized representative should be involved in the decision-making process.
B. Incorrect. While family support is important, the decision for surgery should primarily be based on medical necessity and the best interests of the client.
C. Incorrect. Determining medical necessity is the responsibility of the medical team, not the nurse.
D. Incorrect. Sending the unsigned informed consent form to the risk manager is not a standard nursing responsibility and does not address the issue of informed consent.

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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.)

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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.)