A nurse is planning care for a client who is preoperative for a surgical procedure. The nurse should identify that which of the following tasks is outside of their scope of practice?

Collecting a clean catch urine specimen.

Explaining the risks of the procedure.

Reinforcing preoperative teaching.

Performing a preoperative skin preparation.

Answer and Explanation

The Correct Answer is B

Rationale:

A. Collecting a clean catch urine specimen: This is within the nurse’s scope of practice and is a routine part of preoperative preparation to screen for infection or other abnormalities before surgery.

B. Explaining the risks of the procedure: Explaining surgical risks is the responsibility of the provider performing the procedure. Nurses may reinforce information but are not authorized to introduce or explain risks, as this constitutes part of informed consent.

C. Reinforcing preoperative teaching: Reinforcement of teaching provided by the surgeon or anesthesiologist is within the nurse’s role. The nurse can clarify instructions or ensure the client understands how to prepare for surgery based on what was already explained.

D. Performing a preoperative skin preparation: Nurses are responsible for tasks like preoperative skin prep, which helps reduce infection risk. This is a common nursing duty that supports surgical readiness.

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Correct Answer is D

Explanation

Rationale:

A. Erythema toxicum: This is a common and benign rash seen in newborns. It is not infectious, poses no public health risk, and does not require mandatory reporting.

B. Bacterial vaginosis: Although it is a vaginal infection, bacterial vaginosis is not classified as a reportable condition. It does not pose the same level of public health concern as sexually transmitted infections like gonorrhea.

C. Molluscum contagiosum: Molluscum contagiosum is a viral skin infection that is generally self-limiting and not considered a reportable disease. It does not require public health intervention in most cases.

D. Gonorrhea: Gonorrhea is a nationally notifiable disease in many countries, including the United States, due to its infectious nature and potential for serious complications. Public health reporting is required to track, treat, and prevent its spread.

A. Severe immunodeficiency B. Asymptomatic HIV C. Mild febrile illness D. Egg allergy

Correct Answer is A

Explanation

Rationale:

A. Severe immunodeficiency: The MMR vaccine is a live attenuated vaccine and is contraindicated in clients with severe immunodeficiency, such as those undergoing chemotherapy or with advanced HIV/AIDS. These individuals cannot mount an appropriate immune response, placing them at risk for vaccine-related complications.

B. Asymptomatic HIV: Clients with asymptomatic HIV and adequate CD4 counts may safely receive the MMR vaccine. It is not contraindicated unless the client is significantly immunocompromised.

C. Mild febrile illness: Mild illnesses, such as low-grade fever or upper respiratory infections, do not contraindicate vaccine administration. The MMR vaccine can still be safely given, as minor illness does not significantly alter vaccine response or increase risks.

D. Egg allergy: Although the MMR vaccine is cultured in chick embryo fibroblasts, it does not contain significant egg protein, and studies have shown it can be safely administered to individuals with egg allergies. An egg allergy is not a valid reason to withhold the vaccine.

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A nurse is planning care for a client who is preoperative for a surgical procedure. The nurse should identify that which of the following tasks is outside of their scope of practice?

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