A nurse is planning to assign care activities to nursing assistive personnel (NAP) on her team. Which of the following activities can the nurse assign to the NAP? [SELECT ALL THAT APPLY]
Accompany a client who has depression to occupational therapy.
Initiate soft wrist restraints on a client who is at risk for self-harm.
Sit with a client who has alcohol use disorder and whose last drink was five days ago.
Set limits with a client who has mania.
Work a jigsaw puzzle with a client who has dementia.
Assess a client who has hypomania for exhaustion.
Correct Answer : A,E
A. This is a routine task that can be safely delegated to a NAP. It does not require complex decision- making or assessment skills.
B. This task requires the ability to assess the client's condition and determine the appropriate level of restraint. It is a task that should be performed by an RN or licensed practical nurse (LPN).
C. While this may seem like a simple task, it requires the ability to monitor the client for signs of withdrawal and to intervene if necessary. It is a task that should be performed by an RN or LPN.
D. This task requires the ability to assess the client's behavior and to intervene if necessary. It is a task that should be performed by an RN or LPN.
E. This is a therapeutic activity that can be delegated to a NAP. It can help to stimulate the client's cognitive function and provide social interaction.
F. This task requires the ability to assess the client's condition and identify potential complications. It is a task that should be performed by an RN or LPN.
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Correct Answer is D
Explanation
A. While state boards of nursing do have regulatory authority over nursing practice and can take action against nurses who abuse substances, this does not negate the need for an internal program. Organizations should proactively address substance abuse to support employee health and safety, rather than relying solely on external authorities.
B. While safety is a critical concern, emphasizing punishment can create a culture of fear and may discourage employees from seeking help. A punitive approach may lead to further issues, such as hiding problems rather than addressing them.
C. While confidentiality is important, the involvement of the personnel department alone may not be sufficient to address the complexities of substance abuse. A comprehensive program should include input from healthcare professionals, mental health experts, and employee assistance programs to effectively manage and support affected employees.
D. This is the most appropriate consideration. A program focusing on screening, prevention, and early intervention can help identify issues before they escalate, support employees in getting the help they need, and create a healthier workplace culture.
Correct Answer is C
Explanation
A. While track marks could indicate drug use, this alone does not necessitate a report to an outside agency unless there is evidence of harm to self or others, or if there are suspicions of a substance abuse issue that warrants intervention.
B. Emancipated minors have the legal right to make their own medical decisions, including refusing treatment. In this case, the nurse would ensure the patient is informed of the risks of leaving and document the refusal, but there’s no requirement to disclose to an outside agency.
C. A spiral fracture can be indicative of abuse, particularly if the mechanism of injury is not consistent with the explanation provided. In many jurisdictions, healthcare providers are mandated reporters for suspected abuse or neglect in dependent adults.
D. This situation typically does not involve any legal or ethical obligation to report to outside agencies. Glomerulonephritis is a medical condition and does not indicate any need for disclosure, as it does not suggest abuse or neglect.
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