Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an assistive personnel (AP)?
"Take vital signs every 2 hours for the client who had a cholecystectomy in room 6122.”
"Check the urinary output at 11:00 for John Doe and report it to me immediately.”
"Report to me if the chest tube drainage is excessive for Jane Doe in room 2438.”
"Please notify me of any clients whose vital signs or blood glucose levels are significant.”
The Correct Answer is B
The answer is b. "Check the urinary output at 11:00 for John Doe and report it to me immediately.”
a. "Take vital signs every 2 hours for the client who had a cholecystectomy in room 6122.” is wrong because it does not specify which client to monitor. The AP should know the client’s name and room number for identification and safety purposes.
c. "Report to me if the chest tube drainage is excessive for Jane Doe in room 2438.” is wrong because it does not define what constitutes excessive drainage. The nurse should provide clear and measurable criteria for the AP to follow.
d. "Please notify me of any clients whose vital signs or blood glucose levels are significant.” is wrong because it is vague and does not indicate which clients to check, how often to check them, or what values are significant. The nurse should provide specific and individualized instructions for each client
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is b. Inform the assistive personnel of the client’s weight-bearing status.
Choice A: Assess the client’s incision every 8 hours for the first 48 hours. While it is important to monitor the incision site for signs of infection, the frequency of every 8 hours for the first 48 hours may not be necessary unless specified by the surgeon or the patient’s condition warrants it.
Choice B: Inform the assistive personnel of the client’s weight-bearing status. This is the correct answer. After a total hip arthroplasty, it’s crucial to communicate the client’s weight-bearing status to all members of the healthcare team, including assistive personnel. This helps ensure that everyone is aware of the client’s mobility limitations and can assist the client safely.
Choice C: Instruct the client to cross their legs at the ankles when sitting in a chair. This is not recommended. After a hip arthroplasty, patients are typically advised not to cross their legs to prevent dislocation of the new hip joint.
Choice D: Teach the client’s partner to assist the client to flex the hip at least 120° each hour. This is not recommended. After a hip arthroplasty, patients are typically advised to avoid flexing the hip more than 90 degrees to prevent dislocation of the new hip joint1. Therefore, flexing the hip at least 120° each hour could potentially harm the patient.
Correct Answer is D
Explanation
Choice A rationale:
A podiatrist specializes in foot-related issues. Osteoarthritis primarily affects joints, so referring the client to a podiatrist would not directly address their difficulty in buttoning clothes.
Choice B rationale:
A social worker typically addresses psychosocial needs, including emotional and financial concerns. While important, this role wouldn't directly address the client's physical difficulty with buttoning clothes due to osteoarthritis.
Choice C rationale:
Paramedical technologists are skilled in various diagnostic tests and procedures. However, they are not directly involved in assisting clients with activities of daily living or improving physical function.
Choice D rationale:
An occupational therapist (OT) specializes in helping clients regain and enhance their ability to perform daily activities, such as dressing, grooming, and self-care. For the client with osteoarthritis struggling to button clothes, an OT would assess their physical limitations and provide strategies or adaptive tools to improve independence in these activities.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.