A nurse is providing an in-service about repositioning clients and the use of lift pads for immobile clients. What is the rationale for placing lift pads under an immobile client?

Choice A Reason:

Providing a bed bath is a task that can be delegated to unlicensed assistive personnel (UAP). This task is routine and does not require clinical judgment or advanced nursing skills. UAPs are trained to perform basic care activities such as bathing, which helps maintain the client’s hygiene and comfort.

Choice B Reason:

Assisting in toileting is another task that can be delegated to UAPs. This task involves helping clients with their toileting needs, which is within the scope of practice for UAPs. It does not require the clinical judgment or assessment skills that are reserved for licensed nurses.

Choice C Reason:

Evaluating the effectiveness of a treatment is a task that cannot be delegated to UAPs. This task requires clinical judgment and the ability to assess the client’s response to treatment, which are responsibilities of licensed nurses. Only licensed nurses have the training and expertise to evaluate treatment outcomes and make necessary adjustments.

Choice D Reason:

Assessment of a stoma is a task that cannot be delegated to UAPs. Assessing a stoma involves evaluating its appearance, function, and any signs of complications, which requires clinical judgment and expertise. This task is within the scope of practice for licensed nurses, who are trained to perform comprehensive assessments.

Choice E Reason:

Discharge teaching is a task that cannot be delegated to UAPs. Discharge teaching involves providing clients with important information about their care after leaving the healthcare facility, including medication instructions, follow-up appointments, and lifestyle modifications. This task requires clinical knowledge and the ability to educate clients effectively, which are responsibilities of licensed nurses.

Choice A reason: Administering the medication within 90 minutes of the provider prescribing it aligns with the definition of a “NOW” order. A “NOW” order is intended to be given promptly but not as urgently as a STAT order, which requires immediate administration. This timeframe ensures that the medication is given in a timely manner to address the client’s needs without unnecessary delay.

Choice B reason: Administering the medication at specific times until directed by the provider is not appropriate for a “NOW” order. This approach is more suitable for routine or scheduled medications, where the timing is predetermined and consistent. A “NOW” order requires prompt action rather than adherence to a fixed schedule.

Choice C reason: Administering the medication at every 4-hour intervals is incorrect for a “NOW” order. This frequency is typical for PRN (as needed) medications or those requiring regular dosing intervals. A “NOW” order is a one-time directive that necessitates timely administration soon after the order is given.

Choice D reason: Administering the medication whenever the client reports specific manifestations, such as pain, is characteristic of PRN orders. PRN orders are given based on the client’s symptoms and needs at the time. A “NOW” order, however, is a one-time order that should be carried out promptly, regardless of the client’s immediate symptoms.