A charge nurse is making shift assignments on a medical-surgical unit. Which of the following tasks should the nurse assign to the AP?

Measuring oxygen saturation for a client who has dyspnea

Performing nasal hygiene for a client who has an NG tube

Pouching a client's ostomy bag for a new colostomy

Inserting a rectal suppository for a client who is vomiting

Answer and Explanation

The Correct Answer is C

a.   Measuring oxygen saturation requires nursing judgment and assessment skills, which are beyond the scope of practice for an assistive personnel (AP).
b.   Nasal hygiene for a client with an NG tube involves specific skills and requires nursing assessment to ensure proper technique and patient comfort.
c.   Pouching a client's ostomy bag involves routine care that can be safely performed by assistive personnel under the direction and supervision of a nurse.
d.   Inserting a rectal suppository requires nursing judgment and assessment to determine appropriateness based on the client's condition, which is beyond the scope of practice for an AP.

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Correct Answer is C

Explanation

54) A nurse is preparing to delegate bathing and turning of a newly admitted client who has end-stage bone cancer to experienced assistive personnel. Which of the following assessments should the nurse make before delegating care?
a. Is the client’s family present so the AP can show them how to turn the client
b. Does the AP have time to change the client’s central IV-line dressing after turning her?
c. Has data been collected about specific client needs related to turning?
d. Has the AP checked the client’s pain level prior to turning her?

A. The AP wears a surgical mask when caring for a client who has respiratory tuberculosis B. The AP uses alcohol-based hand sanitizer after emptying the bedpan of a client who has Clostridium difficile C. The AP bundles the clean side of linen inward when changing the sheets for a client who has an infected surgical wound D. The AP removes her gloves before leaving the room of a client who has MRSA

Correct Answer is D

Explanation

A. A surgical mask is insufficient for caring for a client with respiratory tuberculosis; an N95 respirator should be worn to protect against airborne transmission.

B. Alcohol-based hand sanitizer is ineffective against Clostridium difficile spores. Handwashing with soap and water is essential to eliminate the spores and prevent transmission.

C. While bundling linens correctly helps minimize contamination, the action does not pertain to infection control precautions relevant to the scenario.

D. Removing gloves before leaving the room of a client with MRSA is appropriate as it helps prevent cross-contamination and the spread of infection to other areas of the facility. Proper disposal and hygiene practices should always be followed after contact with potentially infected surfaces.

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A charge nurse is making shift assignments on a medical-surgical unit. Which of the following tasks should the nurse assign to the AP?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to delegate bathing and turning of a newly admitted client who has end-stage bone cancer to experienced assistive personnel. Which of the following assessments should the nurse make before delegating care?

Correct Answer is C

Explanation

A nurse on a medical-surgical unit is evaluating an assistive personnel’s (AP) use of infection control precautions. Which of the following actions by the AP indicates correct use of the precautions?

Correct Answer is D

Explanation

A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?

A nurse is providing discharge teaching to the parent of a toddler who has a new diagnosis of asthma. The parent states she is unable to afford the nebulizer prescribed for the child. Which of the following referrals should the nurse recommend?

A nurse is providing change-of-shift report for an oncoming nurse. Which of the following information should the nurse include in the report?

A nurse enters the hallway and discovers a visitor looking at a client’s medical information on a computer. Which of the following actions should the nurse take first?

A nurse is working on a medical-surgical unit and is managing the care of four clients. The nurse should schedule an interdisciplinary conference for which of the following clients?

A nurse enters a client’s room to obtain informed consent for a gastroscopy. The client states he does not understand the procedure. Which of the following actions should the nurse take?

A nurse is delegating care for a group of clients. Which of the following clients should the nurse assign to the LPN?

A nurse is caring for a client who has anorexia nervosa. Which of the following interdisciplinary team members should be consulted in regard to this client's care?