A nurse on a medical unit is making staff assignments. Which of the following tasks should the nurse delegate to an assistive personnel?

Inserting a straight urinary catheter for a client

Performing perineal care for a client who has an indwelling urinary catheter

Showing a client how to use an incentive spirometer

Increasing oxygen flow for a client who has a nasal cannula

Answer and Explanation

The Correct Answer is B

A. Inserting a straight urinary catheter for a client:

Inserting a urinary catheter involves a sterile procedure and requires the specialized skills of a licensed nurse. This task should not be delegated to assistive personnel.

B. Performing perineal care for a client who has an indwelling urinary catheter.

Delegating tasks should align with the education, training, and scope of practice of the assistive personnel. Performing perineal care for a client with an indwelling urinary catheter is a task that can be appropriately delegated to assistive personnel. This task involves basic hygiene and does not require the advanced skills or knowledge of a licensed nurse.

C. Showing a client how to use an incentive spirometer:

Educational tasks, such as demonstrating how to use an incentive spirometer, require knowledge and understanding of the device, as well as the ability to assess and respond to the client's needs. This task is best performed by a licensed nurse.

D. Increasing oxygen flow for a client who has a nasal cannula:

Adjusting oxygen flow involves assessing the client's condition and making decisions based on the client's oxygenation needs. This task requires the clinical judgment of a licensed nurse and should not be delegated to assistive personnel.

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Correct Answer is D

Explanation

A. A staff member places a midstream urine sample in a specimen refrigerator after collecting it:

This is a proper practice. Refrigerating the sample after collection helps preserve its integrity and prevents bacterial growth until it can be analyzed.

B. A staff member wipes a countertop with chlorhexidine solution to clean the area following a blood spill:

This is a proper infection control practice. Chlorhexidine is an effective disinfectant, and cleaning the area following a blood spill helps prevent the spread of infectious agents.

C. A nurse uses alcohol-based antiseptic to clean his hands after talking with a client who has varicella zoster:

This is a proper practice. Alcohol-based antiseptic is effective in killing a broad spectrum of germs, and hand hygiene is crucial, especially after contact with a client who may have an infectious condition.

D. A nurse pours sterile 0.9% sodium chloride irrigation solution on an open pressure wound prior to collecting a specimen for culture:

This is an infection control hazard. Sterile saline irrigation should not be poured onto an open wound before specimen collection, as it can introduce contaminants and interfere with the accuracy of culture results. Specimens should be collected using aseptic technique to avoid contamination.

A. Perform CPR on the client. B. Assist with airway intubation. C. Maintain IV access. D. Place defibrillator pads on the client.

Correct Answer is A

Explanation

A. Perform CPR on the client:

CPR (Cardiopulmonary Resuscitation) is a critical and time-sensitive intervention during a cardiac arrest. An assistive personnel trained in CPR can initiate chest compressions while awaiting further medical assistance.

B. Assist with airway intubation:

Airway intubation is a more advanced skill typically performed by healthcare providers such as physicians or advanced practice nurses. It is beyond the scope of practice for most assistive personnel.

C. Maintain IV access:

Maintaining IV access may require specific skills and knowledge about medications and fluids. While some assistive personnel may be trained in certain aspects of IV care, the level of expertise needed during a cardiac arrest may be beyond their scope.

D. Place defibrillator pads on the client:

Applying defibrillator pads involves handling medical equipment and making critical decisions about when to deliver a shock. This task is typically performed by healthcare providers trained in advanced cardiac life support (ACLS).

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