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The nurse is caring for an elderly male client, who will be discharged from the hospital with new medications.
The nurse begins discharge teaching about the new medications.
The patient seems to be disinterested and states, "Please share this information with my wife.
She knows all my medications.”. What action would the nurse take?

Remind the patient that he needs to be in charge of knowing about his own medications as it is not his wife's responsibility.

Document the patient stated "Please share all this information with my wife.

Continue to teach the patient as he is the one being discharged and avoid teaching the wife.

Ask the patient, "Why does your wife know about your medications instead of you?".

Answer and Explanation

The Correct Answer is C

Choice C rationale:

In this situation, the nurse should continue to teach the patient about his medications despite his disinterest. It is essential for the patient to be knowledgeable about his own medications, as he will be responsible for taking them once discharged. While involving family members in the teaching process can be beneficial, the primary responsibility lies with the patient. Documenting the patient's request is also important for the record, but it does not replace the need for the patient to be informed about his medications.

Choice A rationale:

Reminding the patient of his responsibility is a good initial approach, but it should be followed by continued teaching to ensure the patient understands his medications thoroughly.

Choice B rationale:

Documenting the patient's request is important, but it does not address the patient's lack of interest in learning about his medications. The nurse should still provide education to the patient.

Choice D rationale:

Asking the patient why his wife knows about his medications is confrontational and may not be well-received by the patient. It does not address the primary issue, which is the patient's disinterest in learning about his medications.

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Correct Answer is A

Explanation

Choice A rationale:

When a nurse delegates a specific intervention to unlicensed assistive personnel (UAP), the nurse transfers the responsibility for completing the task to the UAP. However, the nurse remains accountable for the outcome. Delegation does not absolve the nurse of their accountability; instead, it means that the nurse trusts the UAP to perform the task safely and effectively under their supervision. This approach allows healthcare teams to work collaboratively, improving efficiency and patient care outcomes.

Choice B rationale:

Nurses do have the authority to delegate interventions to UAP, but they must do so responsibly and within the scope of practice. Improper delegation or delegating tasks that UAP are not trained to perform can lead to adverse outcomes and legal consequences.

Choice C rationale:

While the UAP is responsible for their own actions, the nurse remains accountable for the overall patient care. Nurses must ensure that tasks are delegated to competent individuals and provide adequate supervision and guidance. The nurse cannot completely transfer all responsibility to the UAP without being accountable for the outcome.

A. "Move your wrist in a circular motion 5 times every hour.”. B. "Squeeze your gluteal muscles tightly 3 times every hour.”. C. "Lift a 5-pound weight to increase your arm strength.”. D. "Bend your knee up to your chest 4 times each day.”. .

Correct Answer is B

Explanation

Choice B rationale:

Isometric exercises involve contracting muscles without changing the length of the muscle or joint angle. In this case, squeezing the gluteal muscles tightly constitutes an isometric exercise. Isometric exercises are often used in rehabilitation settings to strengthen specific muscle groups without putting too much strain on the joints.

Choice A rationale:

Option A describes a range of motion exercise involving the wrist, which is not an isometric exercise. Isometric exercises focus on static muscle contractions, not dynamic movements like circular motions.

Choice C rationale:

Lifting a 5-pound weight to increase arm strength involves isotonic exercise, not isometric exercise. Isotonic exercises involve muscle contractions with movement and changing muscle length, unlike isometric exercises, where muscle length remains constant.

Choice D rationale:

Bending the knee up to the chest is an example of a range of motion exercise and does not constitute an isometric exercise. Range of motion exercises involve moving joints through their full extent, but isometric exercises involve static muscle contractions without joint movement.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse delegates a specific intervention to unlicensed assistive personnel (UAP). What implications does this have for the nurse?

Correct Answer is A

Explanation

The nurse explains isometric exercises to the patient on the rehabilitation unit.Which explanation provided by the nurse is accurate?

Correct Answer is B

Explanation

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