A 73-year-old male patient has been admitted to an inpatient unit from the emergency room. He has been coughing severely for the past two days, has a headache, and a sore throat.
His COVID test is positive and he has Type II Diabetes. He denies any history of smoking.
His vital signs are as follows: Temperature - 101.0, Pulse - 84, Respiration - 24, Blood Pressure - 152/84, Pulse oximetry - 92%. The registered nurse (RN) delegates the collection of a urine specimen and Fasting Blood Sugar (FSBS) from the client to the nurse aide II. What are the responsibilities of the RN in regard to this delegated task?
Select all that apply.
Ensure the nurse aide has the required training to perform these tasks.
Maintain accountability for ensuring the delegated tasks are conducted correctly and completely.
Ensure policies cover the delegation.
Perform an assessment of the patient prior to delegation.
Observe all tasks performed by the nurse aide II.
Correct Answer : A,B,C,D
Choice A rationale
The RN must ensure that the nurse aide has the required training to perform these tasks. This is because the RN is responsible for determining client needs and when to delegate. The RN must also ensure that the delegate is competent to perform the activity.
Choice B rationale
The RN must maintain accountability for ensuring the delegated tasks are conducted correctly and completely. This is because the RN is answerable for their own choices, decisions, and actions as measured against a standard.
Choice C rationale
The RN must ensure policies cover the delegation. This is because the RN must understand the delegation process and the state nurse practice act (NPA) to ensure that it is safely, ethically, and effectively carried out.
Choice D rationale
The RN must perform an assessment of the patient prior to delegation. This is because the RN’s decision of whether or not to delegate is based upon their judgement concerning the condition of the patient.
Choice E rationale
While observing all tasks performed by the nurse aide II is a good practice, it is not a requirement for the RN in regard to this delegated task.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While auscultating the lung fields can provide valuable information about the patient’s respiratory status, it is not the most immediate action needed for a COPD patient with an oxygen saturation of 89%4.
Choice B rationale
Administering oxygen is the most appropriate action for a COPD patient with an oxygen saturation of 89%. This will help increase the patient’s oxygen saturation and alleviate their shortness of breath.
Choice C rationale
Elevating the head of the bed can help improve lung expansion and ease breathing, but it is not as immediately effective as administering oxygen.
Choice D rationale
Assisting the patient to get up to the chair is not the most immediate action needed for a COPD patient with an oxygen saturation of 89%4.
Correct Answer is A
Explanation
Choice A rationale
Explaining interventions prior to performing them is a key aspect of patient autonomy. It allows patients to understand what is happening to them and gives them the opportunity to ask questions or refuse treatment if they wish.
Choice B rationale
While keeping patient information private is important and is part of the ethical principle of confidentiality, it does not directly support patient autonomy.
Choice C rationale
Bringing back medication at the stated time supports the principle of beneficence (doing good) and reliability but does not directly support patient autonomy.
Choice D rationale
Providing equal care to all patients is part of the ethical principle of justice, not autonomy.
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