Which assignment is best for the practical nurse to assign to the unlicensed assistive personnel (UAP)?
Evaluate the client's understanding of discharge instructions following a colonoscopy.
Encourage an elderly client who was admitted for dehydration to increase intake of oral fluids.
Measure the urinary output of a client who is receiving diuretics for congestive heart failure.
Check a client's femoral dressing for signs of bleeding after a cardiac catheterization.
The Correct Answer is C
A. Evaluating a client's understanding of discharge instructions typically requires a nursing assessment and explanation, more suitable for a licensed nurse.
B. Encouraging fluid intake might involve assessing the client's condition and providing specific advice, which aligns more with the responsibilities of a licensed nurse.
C. Measuring urinary output is a task that falls within the scope of practice for unlicensed assistive personnel (UAP), as it involves routine data collection and does not require clinical judgment.
D. Checking a client's femoral dressing after a cardiac catheterization requires observation for signs of bleeding, which involves assessment and potential interventions beyond the UAP's scope of practice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Checking for kinks in the drainage tubing might be a part of troubleshooting, but the observed clots and thick red fluid require immediate attention, so informing the charge nurse is the priority.
B. Delaying assessment for another hour could potentially exacerbate the issue if there's a problem with the irrigation or if the client's condition worsens.
C. Reporting the finding to the charge nurse is crucial as it indicates potential complications such as bleeding or clot formation that need immediate intervention.
D. Immediately stopping the irrigation solution without proper assessment and guidance could lead to complications and isn't the initial action warranted in this situation.
Correct Answer is B
Explanation
A. Sodium level of 130 mEq/L is slightly below the lower limit of the reference range but might not have as immediate an impact on safety as a critically low hemoglobin level.
B. Hemoglobin of 8.9 grams/dL is significantly below the normal range and indicates a substantial drop in red blood cells, which can lead to impaired oxygen transport and potentially severe postoperative complications like inadequate tissue perfusion and oxygenation.
C. Potassium level of 3.4 mEq/L is slightly below the lower limit of the reference range but might not pose an immediate threat compared to a critically low hemoglobin level.
D. Blood urea nitrogen (BUN) of 20 mg/dL is at the upper limit of the reference range but might not have an immediate implication for client safety compared to a critically low hemoglobin level.
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