A nurse is teaching a class about providing care within the legal scope of practice to a group of nurses.
The nurse should include that which of the following procedures is outside the legal scope of practice for an RN?

Changing the inner cannula on a tracheostomy.

Inserting a tunneled central venous catheter.

Irrigation of an external ear canal.

Administering a platelet transfusion.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Changing the inner cannula on a tracheostomy is within the legal scope of practice for registered nurses. Nurses are trained to perform tracheostomy care, including changing the inner cannula. This procedure is within the nursing scope of practice and does not require a physician's intervention.

Choice B rationale:

Inserting a tunneled central venous catheter (such as a Hickman line) is a specialized procedure that generally falls under the scope of practice for advanced practice nurses (such as nurse practitioners or clinical nurse specialists) or physicians. RNs typically do not have the required training or authority to perform this invasive procedure.

Choice C rationale:

Irrigation of an external ear canal is within the legal scope of practice for registered nurses. Ear irrigation is a common nursing procedure used to remove impacted cerumen (earwax) and foreign bodies from the ear canal. Nurses are trained to perform this procedure safely and effectively.

Choice D rationale:

Administering blood products, including platelet transfusions, is within the legal scope of practice for an RN. RNs are responsible for preparing, verifying, and administering blood products according to institutional policies and procedures. This includes monitoring the patient during and after the transfusion for any adverse reactions.

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Correct Answer is C

Explanation

Choice A rationale:

Watery stool is not indicative of paralytic ileus. Paralytic ileus is a condition characterized by the inhibition of bowel peristalsis, leading to symptoms such as abdominal distention, constipation, and lack of bowel sounds.

Choice B rationale:

Dizziness is not a specific symptom of paralytic ileus. Dizziness can be caused by various factors and is not directly related to the gastrointestinal condition.

Choice C rationale:

Abdominal distention is the correct choice. Paralytic ileus often presents with abdominal distention due to the accumulation of gas and fluids in the intestines. This distention can cause discomfort and a visible increase in the size of the abdomen.

Choice D rationale:

Oliguria, a decreased urine output, is not a typical symptom of paralytic ileus. It is more indicative of kidney-related issues or dehydration rather than gastrointestinal problems.

A. "I can give you information about respite care if you are interested." B. "I am sure you're doing a great job taking care of your mother." C. "You should consider taking a sleeping pill before bed each night." D. "It is always difficult caring for someone who is terminally ill."

Correct Answer is A

Explanation

A. Correct. Offering information about respite care provides the son with an option to take a break and get some rest while ensuring his mother's care is still managed by professionals.

B. Incorrect. While supportive, this statement does not offer a solution to the son's sleep deprivation.

C. Incorrect. Suggesting a sleeping pill might not address the underlying issue of the son's caregiving responsibilities.

D. Incorrect. While empathetic, this statement does not offer a practical solution or support for the son's situation.

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A nurse is teaching a class about providing care within the legal scope of practice to a group of nurses. The nurse should include that which of the following procedures is outside the legal scope of practice for an RN?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is postoperative following orthopedic surgery.Which of the following findings should the nurse identify as an indication of paralytic ileus?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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A nurse is teaching a class about providing care within the legal scope of practice to a group of nurses.
The nurse should include that which of the following procedures is outside the legal scope of practice for an RN?