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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. This statement demonstrates an understanding of the importance of protecting personal health information by encrypting it when transmitting electronically, ensuring confidentiality.
b. Using another nurse's password violates client confidentiality and compromises security protocols.
c. Discarding personal health information documents in the trash without proper disposal methods can lead to unauthorized access and breach of confidentiality.
d. Posting a client's vital signs in their room could potentially compromise their privacy, as it may be viewed by unauthorized individuals.
Correct Answer is A
Explanation
a. An asymmetrical thorax could indicate chest trauma which could compromise oxygen delivery.
b. An open fracture of the femur without vessel inury is a lesser priority than chest trauma.
c. Preorbital edema (swelling around the eyes) may indicate facial trauma but is not as immediately lifethreatening as an open fracture.
d. A deep-partial thickness burn on the lower extremities is serious but does not pose an immediate threat to life compared to other injuries such as an open fracture with potential bleeding and risk of infection.
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