A nurse is training a newly licensed nurse. The newly licensed nurse asks if she can delegate the task of weighing several clients to an assistive personnel (AP). Which of the following responses should the nurse make?
"You can delegate this task if the AP has been trained to use our scales."
"You can delegate this task to an AP for new clients before performing a nursing assessment."
"You should not delegate this task because you have the capability to obtain clients' weights."
"You should not delegate this task because it requires nursing judgment."
The Correct Answer is A
A. "You can delegate this task if the AP has been trained to use our scales.": Measuring and recording client weight is a noninvasive, routine task that does not require nursing judgment, making it appropriate to delegate to trained assistive personnel. The nurse remains responsible for ensuring accuracy and proper documentation.
B. "You can delegate this task to an AP for new clients before performing a nursing assessment.": Delegating weight measurement before a nursing assessment may result in incomplete or inaccurate data interpretation. Initial assessments require nursing judgment to identify baseline health status.
C. "You should not delegate this task because you have the capability to obtain clients' weights.": Possessing the ability to perform a task does not preclude delegation. The key consideration is whether the task requires professional judgment, which measuring weight does not.
D. "You should not delegate this task because it requires nursing judgment.": Obtaining a client’s weight is a standard, objective measurement and does not require clinical decision-making, so it does not meet the criteria for tasks that must be performed exclusively by a nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "This type of seizure can be mistaken for daydreaming.": Absence seizures are brief, sudden episodes of impaired consciousness, often with staring and subtle motor activity. Because these episodes are very short and the child resumes normal activity immediately, they can easily be misinterpreted as inattentiveness or daydreaming.
B. "This type of seizure lasts 30 to 60 seconds.": Absence seizures are typically very brief, usually lasting 5 to 10 seconds, rarely up to 15 seconds. A duration of 30 to 60 seconds is longer than expected and more characteristic of other seizure types.
C. "The child usually has an aura prior to onset.": Absence seizures do not usually have a preceding aura. Auras are more commonly associated with focal or partial seizures, not generalized absence seizures.
D. "This type of seizure has a gradual onset.": Absence seizures have a sudden onset and end abruptly. There is no gradual buildup of symptoms, which helps differentiate them from other neurological or behavioral events.
Correct Answer is B
Explanation
A. A 25-gauge needle: Small-gauge needles like a 25-gauge are not suitable for accessing implanted venous ports because they may not provide sufficient flow for infusion and can increase the risk of needle bending or damage.
B. A noncoring needle: Noncoring needles, such as a Huber needle, are specifically designed for accessing implanted ports. They prevent coring of the septum, preserving the integrity of the port and reducing the risk of damage or infection while allowing safe infusion of medications and fluids.
C. A butterfly needle: Butterfly needles are designed for peripheral venous access and are not appropriate for implanted ports. Using them could damage the port septum and compromise long-term functionality.
D. An angiocatheter: Angiocatheters are intended for peripheral or central line insertion and are not designed for repeated access of the septum in implanted ports. Their use could increase the risk of leakage, infection, or port damage.
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