The nurse and unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP?

Assist the client to take the beta-blocker.

Transport the client to the intensive care unit via a stretcher

Provide the client going home discharge-teaching instructions

Help position the client who is having a portable x-ray done

Answer and Explanation

The Correct Answer is D

Helping to position a client for a portable x-ray generally involves physically assisting the client in moving into the appropriate position or adjusting their body as needed. This task can be safely delegated to the UAP as long as they have received proper training on how to safely assist with positioning and have a clear understanding of the specific instructions provided by the radiology department.

Assisting the client to take the beta-blocker involves administering medication, which falls within the scope of nursing practice and requires the nurse's expertise in medication administration and monitoring the client's response.

Transporting the client to the intensive care unit via a stretcher involves moving the client to another unit and may require additional monitoring and coordination of care during the transfer. This task is best performed by the nurse, who can assess the client's stability, ensure appropriate documentation, and communicate effectively with the receiving unit.

Providing discharge-teaching instructions to the client going home requires the nurse to provide information about medications, wound care, follow-up appointments, and other important instructions. This task involves comprehensive education and assessment of the client's understanding, and is best performed by the nurse to ensure accurate and complete information is provided.

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Correct Answer is D

Explanation

Hydrochlorothiazide is a diuretic medication commonly prescribed for hypertension. It works by increasing urine output, which helps to reduce ﬂuid volume and lower blood pressure. Taking the medication in the morning is beneﬁcial because the increased urine production during the day can help prevent nighttime disruptions due to frequent urination.

Let's go through the other statements and explain why they are not accurate:

"I will not take this medicine when my blood pressure is okay":

This statement indicates a misunderstanding about the purpose of hydrochlorothiazide. It is important to take prescribed medications consistently, even when blood pressure readings are within the normal range, as they are intended to help maintain blood pressure control.

"I will check blood pressure in both arms and legs before taking the drug":

Checking blood pressure in both arms and legs is not directly related to hydrochlorothiazide use. Blood pressure should be monitored regularly, but it is not necessary to perform these measurements speciﬁcally before taking the medication.

"I will decrease potassium foods such as bananas in my diet":

Hydrochlorothiazide can cause potassium loss as a side effect. However, reducing potassium-rich foods without healthcare provider guidance may not be appropriate. It is important for the client to discuss dietary adjustments and potassium supplementation with their healthcare provider if needed.

A. "My feet feel like I have pins and needles." B. "When I stand or sit too long, my feet swell." C. "My legs get a painful cramp when I walk over 30 minutes." D. "I get short of breath when I climb a lot of stairs.”

Correct Answer is C

Explanation

The client statement that supports the information of intermittent claudication is: "My legs get a painful cramp when I walk over 30 minutes.": Intermittent claudication is a symptom of peripheral artery disease (PAD) characterized by pain, cramping, or fatigue in the muscles of the lower extremities, typically the calves, thighs, or buttocks. This pain is usually triggered by physical activity, such as walking, and is relieved with rest. The pain is caused by inadequate blood flow and oxygen supply to the muscles due to narrowed or blocked arteries.

The other client statements do not specifically indicate intermittent claudication:

"My feet feel like I have pins and needles": This sensation of pins and needles is often associated with peripheral neuropathy, which is a condition involving nerve damage and does not directly relate to intermittent claudication.

"When I stand or sit too long, my feet swell": This statement suggests the possibility of venous insufficiency rather than intermittent claudication. Venous insufficiency involves impaired blood return from the legs to the heart and may result in swelling, aching, or heaviness in the legs.

"I get short of breath when I climb a lot of stairs": This symptom is more indicative of cardiovascular or respiratory issues, such as heart or lung disease, rather than intermittent claudication. It suggests that the client may experience exercise intolerance due to cardiopulmonary limitations.

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The nurse and unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a hypertensive client who is taking hydrochlorothiazide. What client statement indicates understanding about hydrochlorothiazide?

Correct Answer is D

Explanation

A nurse is assessing a client with intermittent claudication. What client statement supports this information?

Correct Answer is C

Explanation

The nurse is interviewing a client with a complex cardiac history. Which questions related to the client's history are most important to ask? Select all that apply.

The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider?

The nurse is providing discharge teaching to a client with venous insufficiency about compression stockings. Which information is essential for the nurse in the teaching plan?

Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours post-operative abdominal aortic aneurysm repair?

A nurse accompanies a client to an exercise stress test. The client can achieve the target heart rate, but the electrocardiogram indicates ST-segment elevation. Which procedure will the nurse prepare the patient for?

The nurse is assessing a client with a presumptive diagnosis of peripheral arterial disease. The nurse obtains an Ankle-Brachial index of 0.89. Which intervention should the nurse take next?

The nurse is caring for a client with sinus bradycardia at a rate of 32 beats/min, blood pressure (BP) of 80/42 mm Hg, and reports feeling faint. Which is the appropriate action?

The nurse is assessing a client with a heart rate of 124 bpm. What clinical ﬁnding(s) should the nurse assess as causes of tachycardia? Select all that apply.