A nurse is caring for residents at a long-term care facility following a tornado. Which of the following tasks should the nurse delegate to an assistive personnel?
Determine which clients need priority medical treatment.
Answer questions from area residents who have health concerns.
Perform CPR for a client who is not breathing.
Complete distal capillary refill checks for a client who has an open leg wound.
The Correct Answer is C
A) Determine which clients need priority medical treatment: This task requires clinical judgment and assessment skills beyond the scope of practice for assistive personnel. Nurses are responsible for assessing clients' needs during emergencies and determining priority for medical treatment based on the severity of their conditions.
B) Answer questions from area residents who have health concerns: While it's important to provide information and support to those affected by the tornado, answering questions about health concerns requires knowledge and expertise in healthcare that is typically within the nurse's scope of practice. Nurses should address inquiries and provide education to ensure the well-being of the community.
C) Perform CPR for a client who is not breathing: This task can be delegated to assistive personnel if they are trained and competent in CPR. In emergencies such as cardiac arrest, prompt initiation of CPR can be life-saving. However, it's crucial to ensure that the assistive personnel are properly trained and certified in CPR before delegating this task.
D) Complete distal capillary refill checks for a client who has an open leg wound: While assessing capillary refill is an important aspect of wound care, performing this task for a client with an open leg wound requires specialized knowledge and skills in wound assessment and management. It falls within the scope of nursing practice and should not be delegated to assistive personnel.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Incorporate the process change into daily practice within the facility: While incorporating process changes is an essential step in quality improvement, it should not be the first action taken. Before implementing changes, it is crucial to gather data and identify areas for improvement to ensure that interventions are targeted and effective.
B) Determine if the implemented change has lowered the current infection rate: Assessing the effectiveness of interventions is an important aspect of quality improvement, but it should occur after identifying baseline data and implementing interventions. Without baseline data, it is challenging to determine the impact of changes accurately.
C) Select a potential intervention to lower the current infection rate: While selecting interventions is a necessary step in quality improvement, it should follow the identification of current infection rates and areas for improvement. Without data on current infection rates, it is difficult to select appropriate interventions.
D) Identify current infection rates from facility data: This is the correct first action when initiating a quality improvement program to address healthcare-associated infections. Gathering data on current infection rates provides a baseline for assessing the problem's magnitude and identifying areas for improvement. It allows healthcare providers to target interventions effectively and evaluate their impact over time.
Correct Answer is B
Explanation
A) Contact the nurse from the previous shift to report the doubled dose:
While it may be appropriate to communicate with the nurse from the previous shift to gather information about the medication administration, contacting them solely to report the doubled dose may not be the most effective action. The priority is to ensure appropriate documentation of the incident and take necessary steps to address it.
B) Document the doubled dose in the client's medical record:
Documenting the doubled dose in the client's medical record is essential for accurate and transparent documentation of the incident. This documentation should include details such as the medication, dosage, time of administration, and any actions taken in response to the error. It ensures that all members of the healthcare team are aware of what occurred and facilitates appropriate follow-up and monitoring.
C) Place a copy of the incident report in the client's record:
While completing an incident report is necessary to formally document the medication error and initiate an investigation, simply placing a copy of the report in the client's record may not be sufficient. The incident report typically serves as an internal document used for quality improvement purposes and may not be part of the client's official medical record.
D) Report the incident to the manager of the pharmacy:
Reporting the incident to the manager of the pharmacy may be appropriate for addressing potential medication dispensing errors or system issues but may not be the immediate action required when a medication error occurs at the administration stage. The first priority is to ensure accurate documentation of the error in the client's medical record.
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