A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions?

Place the client on droplet precautions.

Place the client in a room with positive-pressure airflow.

Wear a surgical mask when taking the client out of the room.

Wear an N95 respirator mask when in the client's room.

Answer and Explanation

The Correct Answer is D

Answer is: Wear an N95 respirator mask when in the client’s room.

Explanation: Pulmonary tuberculosis (TB) is a contagious disease caused by bacteria that can spread through the air. The most common way of transmission is through respiratory droplets that are expelled when a person with active TB coughs, sneezes, or speaks1. Therefore, the charge nurse should expect the newly licensed nurse to take precautions to protect themselves and the client from exposure to TB. One of these precautions is to wear an N95 respirator mask when in the client’s room2. An N95 respirator mask is a type of personal protective equipment (PPE) that filters out at least 95% of airborne particles, including bacteria and viruses3. It can prevent the nurse from inhaling or spreading TB to others.

The other options are incorrect because:

Place the client on droplet precautions: Droplet precautions are not enough to prevent transmission of TB, as they only protect against respiratory droplets that are less than 5 micrometers in diameter1. However, TB bacteria can be found in larger droplets that can travel farther and infect people who are not in direct contact with the source1.
Place the client in a room with positive-pressure airflow: Positive-pressure airflow is not effective against TB, as it does not reduce the concentration of airborne particles or prevent them from escaping through cracks and gaps in doors and windows. Moreover, positive-pressure airflow can create negative pressure in other areas of the facility, which can increase the risk of cross-contamination.
Wear a surgical mask when taking the client out of the room: A surgical mask is not sufficient to protect against TB, as it only filters out particles that are larger than 5 micrometers in diameter3. It also does not fit properly on the face and may allow some particles to pass through3.

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Correct Answer is A

Explanation

The correct answer is choice A: "I delegate tasks to personnel based on their job descriptions."

Choice A rationale:

The response "I delegate tasks to personnel based on their job descriptions" is appropriate in this situation. Charge nurses are responsible for delegating tasks based on the scope of practice and job descriptions of the staff members. This response emphasizes the importance of adhering to established roles and responsibilities within the healthcare team.

Choice B rationale:

The statement "Everyone working here has to care for clients who are incontinent" may be true, but it does not address the specific concern raised by the assistive personnel (AP). It's important to provide a more focused response that addresses the AP's feelings and concerns.

Choice C rationale:

While discussing workflow organization to reduce the number of incontinent clients (Choice C) might be a potential solution, it doesn't directly address the AP's statement about fairness. The charge nurse's response should prioritize explaining the delegation process and addressing the AP's concerns about fairness.

Choice D rationale:

The response "Why do you not want to care for clients who are incontinent?" could be perceived as confrontational and defensive. It's essential to maintain a respectful and supportive tone when addressing staff concerns. This response does not effectively address the situation or provide a solution.

A. "Take vital signs every 2 hours for the client who had a cholecystectomy in room 6122.” B. "Check the urinary output at 11:00 for John Doe and report it to me immediately.” C. "Report to me if the chest tube drainage is excessive for Jane Doe in room 2438.” D. "Please notify me of any clients whose vital signs or blood glucose levels are significant.”

Correct Answer is B

Explanation

The answer isb. "Check the urinary output at 11:00 for John Doe and report it to me immediately.”

This instruction follows the five rights of delegation by including the requirements for right direction/communication: the data to collect, client-specific information, a timeline for data collection, and the expectation for communicating the findings back to the nurse.

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

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A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions?

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Naxlex Comprehensive Predictor Exams

An assistive personnel (AP) tells a charge nurse that it is unfair that they have to take care of all the clients who are incontinent. Which of the following responses should the charge nurse make?

Correct Answer is A

Explanation

Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an assistive personnel (AP)?

Correct Answer is B

Explanation

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