A nurse on a pediatric unit is working with an assistive personnel (AP). Which of the following tasks should the nurse have the AP perform first?
Feed a school-age client who has burns on both upper extremities.
Collect a stool sample for ova and parasites from a toddler.
Bathe an adolescent client who is disabled.
Ambulate a preschooler who is postoperative to the playroom.
The Correct Answer is A
The nurse should have the AP perform the task of feeding a school-age client who has burns on both upper extremities first. This task is a high priority because it addresses the client's immediate need for nutrition and hydration. The client's burns may make it difficult for them to feed themselves, so the assistance of the AP is necessary to ensure that the client receives adequate nourishment.
The other tasks are also important, but they are not the highest priority in this situation. Collecting a stool sample for ova and parasites from a toddler [b] and bathing an adolescent client who is disabled [c] are routine tasks that can be performed as time permits. Ambulating a preschooler who is postoperative to the playroom [d] is also important for promoting mobility and recovery, but it is not as urgent as addressing the immediate need for nutrition and hydration.
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Related Questions
Correct Answer is B
Explanation
The nurse should intervene when the AP tears a document with client information in half before disposing of it in a waste basket. This is because client information is confidential and should be disposed of properly to protect the client's privacy. Tearing a document in half is not sufficient to ensure that the information is protected.
Option A is incorrect because logging off the computer after entering a client's intake and output totals is an appropriate action.
Option C is incorrect because denying a request by another AP to use her password to enter the client's vital signs is an appropriate action to protect the client's information.
Option D is incorrect because removing a clipboard with client information from the room during visiting hours may be necessary to protect the client's privacy.
Correct Answer is A
Explanation
If a nurse is assisting with the care of a group of pediatric clients, the first action the nurse should take is to deliver a breakfast tray to a child who has been administered regular insulin. This is because regular insulin is a fast-acting insulin that begins to lower blood sugar levels within 15 minutes of administration. It is important for the child to eat shortly after receiving regular insulin to prevent hypoglycemia.
Option B is incorrect because completing pin site care for a child who is in skeletal traction is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option C is incorrect because providing clear liquids to a child who is 4 hr postoperative following a laparoscopic appendectomy is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option D is incorrect because administering acetaminophen to a child who has a temperature of 101.2°F (38.4°C) is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
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