An unlicensed assistive personnel (UAP) is assisting with the care of a client with a peripherally inserted central venous catheter (PICC). Which guidance should the practical nurse (PN) provide to the UAP?
Be sure to keep the head of the client's bed elevated.
Change the dressing over the catheter insertion site.
Feed the client all meals to reduce arm movement.
Use the opposite arm for blood pressure measurement.
The Correct Answer is D
A. Keeping the head of the bed elevated is not specifically related to the care of a PICC line. The elevation may be a general comfort measure but is not a specific instruction for PICC line management.
B. Changing the dressing over the PICC line insertion site is a sterile procedure that should be performed by a licensed nurse, not a UAP. This task requires specific training and adherence to infection control practices.
C. Feeding the client all meals to reduce arm movement is not necessary and may be overly restrictive. The UAP’s role does not include limiting the client's activity beyond reasonable measures.
D. Using the opposite arm for blood pressure measurement is the correct guidance. It prevents potential interference with the PICC line and helps avoid complications such as dislodgement or infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A preschooler who had an emergency appendectomy should be checked first. Children are at higher risk for complications due to their size and the stress of emergency surgery, so close monitoring is essential.
B. An adult with osteomyelitis post-surgery is important to monitor but is generally at lower immediate risk compared to a young child following emergency surgery.
C. A post-menopausal client with breast cancer who had a lumpectomy is also a priority, but the immediate postoperative period for a child in emergency surgery takes precedence.
D. An adolescent with type 1 diabetes who had cholecystectomy requires careful monitoring, but the child’s higher risk in the immediate postoperative phase makes them the priority.
Correct Answer is A
Explanation
A. Explaining that the advanced directives form helps identify personal health care wishes for any future health event is crucial because it clarifies the importance of the form in planning for future health care decisions, even if the client is not currently ill.
B. Acknowledging the client’s concerns and notifying the healthcare provider is less immediate and does not directly address the client's understanding of the advanced directives form.
C. Asking a family member about the client's wishes is unnecessary since the client has communicated his own wishes and concerns, and the focus should be on informing the client about the form.
D. Documenting the client’s refusal is important but secondary to educating the client on the purpose and importance of advanced directives.
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