A nurse on the pediatric unit is providing room assignments for children who are to be admitted to the unit. The nurse should plan to place a child who is postoperative from an appendectomy with which of the following clients?

A child who has a head injury

A child who is experiencing sickle cell crisis

A child who has streptococcal pharyngitis

A child who has a new diagnosis of type 1 diabetes mellitus

Answer and Explanation

The Correct Answer is D

A.   A child with a head injury may require close monitoring for neurological changes, which could involve frequent assessments and interventions. While not directly related to infection risk, the needs of this child may be different from those of a postoperative child, making this pairing less ideal due to differing care needs and potential disruptions.
B.   A child in sickle cell crisis is likely experiencing significant pain and requires specialized care for pain management and hydration. This condition is not contagious but can be complex and may require frequent interventions, making it less ideal to room with a postoperative patient who needs a controlled environment for recovery.
C.   Streptococcal pharyngitis is a contagious infection caused by Group A Streptococcus. To minimize the risk of postoperative infection, it is generally advisable to avoid placing a postoperative patient in the same room with someone who has a contagious infection. This would help in preventing the potential spread of infection to the postoperative child, who is already vulnerable.
D.   A child with a new diagnosis of type 1 diabetes mellitus requires education and management of blood glucose levels. This condition is not contagious and does not pose a risk of infection to a postoperative patient. Therefore, the needs of this child align well with the postoperative child, as both are managing chronic conditions rather than dealing with infections.

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Correct Answer is C

Explanation

A. This task is generally appropriate for an assistive personnel (AP) if it is within their scope of practice and if proper training has been provided. Glucometer monitoring is a routine task that APs can often perform, assuming they are trained in using the glucometer and understanding the importance of accurate readings.

B. Assigning two APs to ambulate all clients might be seen as overdelegation if the task requires more clinical judgment or if there are other tasks that need to be managed concurrently. Ambulating clients can sometimes be complex depending on their condition, and it’s essential to ensure that APs are appropriately trained and that the workload is balanced.
C. Assigning a new graduate nurse to perform a wet-to-dry dressing change could be considered overdelegation if the task requires advanced skills and experience that the new graduate might not yet possess. Wet-to-dry dressing changes can be complex and require a certain level of expertise to ensure proper technique and patient safety.
D. This task is typically appropriate for an RN with the necessary competencies and experience. A central line dressing change requires specific skills and knowledge, and delegating this task to the most competent RN ensures that it is performed correctly and safely. This is not considered overdelegation because it matches the task to the skill level of the RN.

A. Assisting others B. Medication administration C. Meal breaks D. Charting

Correct Answer is B

Explanation

A. While assisting others is an important aspect of nursing care, it generally does not directly reflect the acuity of clients. Assisting colleagues might involve helping with tasks, offering support, or collaborating on care, but it is more related to teamwork and overall unit dynamics rather than directly indicating the complexity or intensity of care needed by individual clients.

B. Medication administration is a significant factor in determining client acuity. The complexity and frequency of medications, the need for monitoring and adjustments, and the administration of high-risk medications (e.g., anticoagulants, insulin) all contribute to the overall acuity level. High acuity clients often require more complex medication management, which demands more time and attention from nursing staff.
C. Meal breaks are a necessary part of a nurse’s schedule but are not related to client acuity. Meal breaks are periods of rest and are essential for maintaining the nurse’s well-being and productivity. However, they do not affect the level of care required by clients or the determination of client acuity.
D. Charting is a crucial component of nursing care that reflects the time spent documenting client information, assessments, and care provided. While charting is essential for legal documentation, communication, and continuity of care, it is not a direct indicator of client acuity.

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A nurse on the pediatric unit is providing room assignments for children who are to be admitted to the unit. The nurse should plan to place a child who is postoperative from an appendectomy with which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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