A nurse is assisting with the care of a group of pediatric clients. Which of the following actions should the nurse take first?
Deliver a breakfast tray to a child who has been administered regular insulin.
Complete pin site care for a child who is in skeletal traction.
Provide clear liquids to a child who is 4 hr postoperative following a laparoscopic appendectomy.
Administer acetaminophen to a child who has a temperature of 101.2°F (38.4°C).
The Correct Answer is A
If a nurse is assisting with the care of a group of pediatric clients, the first action the nurse should take is to deliver a breakfast tray to a child who has been administered regular insulin. This is because regular insulin is a fast-acting insulin that begins to lower blood sugar levels within 15 minutes of administration. It is important for the child to eat shortly after receiving regular insulin to prevent hypoglycemia.
Option B is incorrect because completing pin site care for a child who is in skeletal traction is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option C is incorrect because providing clear liquids to a child who is 4 hr postoperative following a laparoscopic appendectomy is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
Option D is incorrect because administering acetaminophen to a child who has a temperature of 101.2°F (38.4°C) is not as time-sensitive as delivering a breakfast tray to a child who has been administered regular insulin.
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Correct Answer is B
Explanation
The State Board of Nursing is responsible for regulating the practice of nursing within a specific state. It establishes the scope of practice for LPNs and sets the standards for their education, licensure, and practice. Therefore, the State Board of Nursing would be the best source of information regarding the roles of an LPN in a med-surg setting.
The other options may provide some information about the roles of an LPN in a med-surg setting, but they are not the primary source. The facility Human Resources Department [a] may have information about job descriptions and responsibilities specific to that facility. Nursing textbooks [c] may provide general information about the roles of LPNs. Coworkers on your unit [d] may have personal experience and knowledge about the roles of LPNs in that specific unit, but their information may not be comprehensive or up-to-date.
Correct Answer is D
Explanation
The nurse should prioritize the client who requests pain medication as their need is likely the most urgent. Pain management is an important aspect of nursing care and addressing the client's pain should be a priority.
The other clients have needs that are important but not as urgent as the client in pain. The client who wants a bath can wait until the nurse has addressed more pressing needs. The client who asks to review instructions about their new prescription can also wait, as long as they are not in immediate danger. The client who needs a referral for home health services can also wait until the nurse has addressed more urgent needs.
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