A charge nurse is making assignments for a group of clients.
Which of the following clients should the nurse assign to a licensed practical nurse?
A client who has a new diagnosis of diabetes mellitus and is awaiting teaching about meal planning.
A client who has a urinary output of 30 mL in the past hour.
A client who is postoperative following a hip arthroplasty and has a respiratory rate of 10/min.
A client who is newly admitted and requires an admission assessment.
The Correct Answer is B
The correct answer is Choice B.
Choice A rationale: This client has a new diagnosis and requires initial teaching about meal planning, which is typically a responsibility of a registered nurse (RN) due to the need for specialized knowledge and teaching skills.
Choice B rationale: This client has a low urinary output, which needs to be monitored, but the care required is within the scope of practice of a licensed practical nurse (LPN). They can manage and report findings to the RN.
Choice C rationale: This client has a low respiratory rate postoperatively, which could indicate respiratory depression. This requires immediate assessment and intervention from an RN, who can make complex clinical judgments and initiate appropriate care.
Choice D rationale: This client needs an admission assessment, which includes comprehensive initial evaluation. An RN is required for this as it involves detailed assessment, care planning, and initiation of care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
The nurse should not recommend placing the diaper over the strap of the Pavlik harness. Placing the diaper over the strap can cause discomfort and may interfere with the proper function of the harness, which is designed to maintain hip joint alignment in infants with developmental hip dysplasia.
Choice B rationale:
The Pavlik harness is typically worn continuously, including during sleep. It should not be removed for sleeping each night because consistent use is essential for its effectiveness in promoting hip joint development.
Choice C rationale:
Applying lotion under the straps of the harness is not recommended. Lotions or creams can create friction and moisture, which may lead to skin irritation or discomfort for the infant. It's best to follow the healthcare provider's instructions regarding the care and maintenance of the harness.
Choice D rationale:
The correct choice is D. The nurse should include the statement that "The harness can promote hip joint development" in the teaching. This is because the Pavlik harness is used to treat developmental hip dysplasia by maintaining the hip joint in a stable position, allowing for proper development. It is important for parents to understand the purpose and benefits of the harness in order to ensure compliance and effectiveness of the treatment.
Correct Answer is B
Explanation
Choice A rationale:
Informing the client that the procedure will take 60 minutes is not a critical action before an esophagogastroduodenoscopy (EGD) The duration of the procedure may vary, but this information is not as essential as other pre-procedure considerations.
Choice B rationale:
The correct action is to "Ensure that the client gave informed consent." Before any invasive procedure like an EGD, it is crucial to confirm that the client has provided informed consent. This ensures that the client understands the procedure, its risks, and benefits, and has the opportunity to ask questions and make an informed decision.
Choice C rationale:
Administering an oral contrast solution is not typically done before an EGD. An EGD involves the insertion of a flexible scope through the mouth into the esophagus, stomach, and duodenum to visualize these structures. Contrast solutions are usually used in other imaging procedures, such as barium swallow studies.
Choice D rationale:
Ensuring that the client's bladder is full is not necessary for an EGD. This requirement may be relevant for other imaging studies, but it does not apply to this procedure. The focus should be on the client's comfort, safety, and informed consent before the EGD.
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