The practical nurse (PN) is observing a newly hired PN who is preparing to administer a liquid medication via a client's feeding tube system using the wrong procedure. What action should the PN take?

Demonstrate how to administer medication via a feeding tube.

Confirm that the medication is only administered once daily.

Determine if the medication is compatible with the solution.

Oﬀer to assist in calculating the rate of ﬂow for the mixture.

Answer and Explanation

The Correct Answer is A

The picture shows that the newly hired PN is about to make a serious error by adding the medication directly to the feeding bag, which can cause clogging, contamination, or inaccurate dosing of the medication. The PN should demonstrate how to administer medication via a feeding tube correctly, which involves stopping the feeding, ﬂushing the tube with water, instilling the medication, ﬂushing again, and resuming the feeding.

The other options are not correct because:

B. Confirming that the medication is only administered once daily is not relevant or helpful, as it does not address the error or teach the correct technique of administering medication via a feeding tube.

C. Determining if the medication is compatible with the solution is not necessary or appropriate, as the medication should not be mixed with the solution in the first place, but given separately through the feeding tube.

D. Oﬀering to assist in calculating the rate of ﬂow for the mixture is not relevant or helpful, as there should be no mixture of medication and solution in the feeding bag, but separate administration of each through the feeding tube.

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Correct Answer is ["B","C","D"]

Explanation

A. Irrigate an indwelling urinary catheter for a client with bladder suspension. - This procedure requires specialized skills and should be performed by a licensed nurse.
B. Empty bedside drainage unit for a client with an indwelling urinary catheter. - UAP can safely perform this task by following established protocols to maintain catheter hygiene.
C. Transport a urine culture sample to the laboratory. - This task involves safely transporting a specimen and does not require specialized medical knowledge.
D. Obtain a post-voided residual (PVR) volume. - This task can be performed by UAP under supervision or with appropriate training, using a bladder scanner or assisting the client to measure remaining urine.
E. Teach the client with fluid restrictions how to measure urine output. - Teaching tasks generally fall under the responsibility of licensed nursing staff and may require specific medical knowledge.

A. Ask about pain. B. Provide mouth care. C. Offer fluids. D. Administer oxygen.

Correct Answer is D

Explanation

A. Ask about pain. This is not the most important action because pain is not the primary problem in this situation. Pain may or may not be present, but it does not address the underlying cause of cyanosis.

B. Provide mouth care. This is not the most important action because mouth care does not improve oxygenation. Mouth care may be helpful to prevent infection and promote comfort, but it is not a priority in this case.

C. Offer fluids. This is not the most important action because fluids do not increase oxygen levels in the blood. Fluids may be beneficial to prevent dehydration and maintain circulation, but they are not urgent in this scenario.

D. Administer oxygen. This is the most important action because oxygen is essential for cellular function and survival. Oxygen therapy can reverse hypoxia and improve the client's condition.

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The practical nurse (PN) is observing a newly hired PN who is preparing to administer a liquid medication via a client's feeding tube system using the wrong procedure. What action should the PN take?

Nursing Test Bank

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