The nurse and unlicensed assistive personnel (UAP) on the telemetry unit are caring for four clients. Which nursing action can be delegated to the UAP?
Checking the client's catheter site after a coronary angiogram
Teaching a patient about exercise electrocardiography
Attaching ECG monitoring electrodes after a patient bathes
Monitoring a client after a transesophageal echocardiogram
The Correct Answer is D
Monitoring a client after a transesophageal echocardiogram involves observing the client for any immediate post-procedure complications or adverse reactions. This may include assessing vital signs, monitoring for signs of bleeding or infection, and reporting any concerning symptoms or changes in the client's condition to the nurse.
Checking the client's catheter site after a coronary angiogram requires assessing the site for bleeding, hematoma, or signs of infection. This task involves more complex assessment skills and would typically be performed by the nurse.
Teaching a patient about exercise electrocardiography involves providing education on the purpose of the test, the procedure itself, and any preparation or precautions the patient needs to take. This task requires specialized knowledge and is best performed by the nurse who can address the patient's specific questions and concerns.
Attaching ECG monitoring electrodes after a patient bathes requires technical knowledge and skill in properly placing the electrodes and ensuring accurate ECG readings. This task also falls within the scope of the nurse's responsibilities.
Delegation should be based on the UAP's skill set, training, and the complexity of the task. While the UAP can provide valuable support in monitoring a client after a transesophageal echocardiogram, the other tasks mentioned require the expertise and knowledge of a nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The importance of ensuring the stockings are applied evenly with no pressure points: Compression stockings are designed to provide graduated pressure to the legs, helping improve blood flow and reduce swelling in individuals with venous insufficiency. It is crucial for the client to understand how to properly apply the stockings to maximize their effectiveness and prevent any complications. The nurse should emphasize the following points:
● Ensure the stockings are applied evenly: The stockings should be applied smoothly and evenly without any folds or wrinkles. This helps ensure that the pressure is distributed uniformly, enhancing their therapeutic effect.
● Check for pressure points: The client should be instructed to pay attention to any areas where the stockings may be causing excessive pressure or discomfort. Pressure points can impair circulation or cause skin damage. If pressure points are noticed, adjustments should be made to ensure proper fit and comfort.
● Follow manufacturer's instructions: The nurse should provide specific instructions regarding how to correctly don the compression stockings, including any specific guidelines provided by the manufacturer. This may include recommendations for the time of day to apply the stockings or any specific donning techniques.
The other options mentioned in the question are not essential information for the teaching plan:
The need to take anticoagulants concurrent with using compression stockings: While some individuals with venous insufficiency may require anticoagulant therapy, it is not directly related to the use of compression stockings. Anticoagulant therapy is typically prescribed for other reasons, such as prevention or treatment of blood clots.
The need to wear the stockings on a one day on, one day off schedule: Wearing compression stockings on a specific schedule of one day on, one day off is not a standard recommendation. The frequency and duration of wearing compression stockings may vary based on individual needs and healthcare provider's recommendations.
The importance of wearing the stockings around the clock to ensure maximum benefit: While consistent and regular use of compression stockings is important, it is not necessary to wear them around the clock. Healthcare providers typically provide specific guidelines on how long the stockings should be worn each day, which may vary based on the severity of venous insufficiency and individual factors.
Correct Answer is A
Explanation
The information that the nurse should include in the teaching plan for a client with hypertension who is on alpha blockers and at risk for postural hypotension is: Change positions slowly.
Alpha blockers are a class of medications commonly prescribed for hypertension. One potential side effect of alpha blockers is postural hypotension, which is a sudden drop in blood pressure when changing positions, such as from sitting to standing. To minimize the risk of postural hypotension, it is important for the client to change positions slowly. The nurse should advise the client to take their time when transitioning from lying down, sitting, or standing, allowing their body to adjust and stabilize their blood pressure.
The other options are not appropriate or helpful in managing postural hypotension:
Check blood pressure every day for signs of rebound hypertension: Rebound hypertension refers to a sudden increase in blood pressure that can occur when discontinuing certain antihypertensive medications. It is not directly related to postural hypotension. Regular blood pressure monitoring is important for managing hypertension, but it is not specifically related to postural hypotension or alpha blockers.
Do not become dependent on canes, walkers, or handrails: Assistive devices like canes, walkers, or handrails can provide support and stability for individuals who experience balance issues or are at risk of falls. It is not necessary to discourage their use unless there are specific contraindications or safety concerns.
Eat plenty of salty food to prevent hypotension: Increasing salt intake is generally not recommended for individuals with hypertension or those at risk of postural hypotension. A high-sodium diet can contribute to elevated blood pressure and is generally discouraged. The nurse should instead encourage a balanced diet that includes appropriate sodium intake based on the client's healthcare provider's recommendations.
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