A nurse should assign which of the following tasks to an assistive personnel?

Giving oral care to a client who cannot take oral fluids

Checking intravenous insertion sites for signs of infiltration

Assessing a client's ability to ambulate

Demonstrating to a client with diabetes mellitus how to use the glucometer

Answer and Explanation

The Correct Answer is A

A.   Giving oral care to a client who cannot take oral fluids is a task that can be safely delegated to an assistive personnel.
B.   Checking intravenous insertion sites for signs of infiltration requires nursing judgment and assessment skills and should be performed by a licensed nurse.
C.   Assessing a client's ability to ambulate involves clinical judgment and should be performed by a licensed nurse.
D.   Demonstrating how to use a glucometer to a client with diabetes requires nursing knowledge and education skills and should be performed by a licensed nurse.

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Correct Answer is A

Explanation

A. Positioning the client for secretion drainage by gravity is a key component of postural drainage to facilitate the removal of respiratory secretions.
B. Postural drainage is typically done before meals to avoid potential nausea during the procedure.
C. Bronchodilators are often administered before postural drainage to open the airways and improve the effectiveness of the procedure.
D. Encouraging fluid intake is important to help thin respiratory secretions and promote their removal during postural drainage. Fluid restrictions are not typically indicated in this context.

A. A client who has diminished vision ambulating in well-lit areas B. A client who received a diuretic 30 min ago C. A client who requires assistance with ambulation D. A client who had a tonic-clonic seizure 2 hr ago

Correct Answer is D

Explanation

A. A client with diminished vision ambulating in well-lit areas may be at risk for falling but is not at the greatest risk among the options provided.
B. A client who received a diuretic 30 min ago may experience orthostatic hypotension, which can increase the risk of falling, but it is not the highest risk.
C. A client who requires assistance with ambulation is generally at a lower risk than a client who has recently experienced a tonic-clonic seizure.
D. A client who had a tonic-clonic seizure 2 hr ago is at the greatest risk for falling due to potential residual weakness, disorientation, or postictal state following the seizure.

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A nurse should assign which of the following tasks to an assistive personnel?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is performing postural drainage for a client. Which of the following is an appropriate intervention?

Correct Answer is A

Explanation

A nurse is caring for four clients. Which of the following clients is at the greatest risk for falling?

Correct Answer is D

Explanation

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