A nurse is coordinating care of a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse assign to the AP?

A. Assess the pain level of a client who has received acetaminophen.

Check a client's peripheral IV site for redness or swelling.

Measure the intake and output of a client who has received furosemide.

Reinforce teaching with a client about crutch-gait walking.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Assessing pain levels is a nursing task requiring clinical judgment, which is beyond the scope of an assistive personnel's duties.

Choice B rationale

Checking an IV site for redness or swelling also requires clinical assessment skills, which are tasks for the nurse.

Choice C rationale

Measuring intake and output is a routine task that can be safely delegated to an assistive personnel. It involves straightforward measurement and recording.

Choice D rationale

Reinforcing teaching about crutch-gait walking requires specific patient education, which falls under the nurse's responsibilities.

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Correct Answer is C

Explanation

Choice A rationale

Administering a sedative medication to the client without their consent is unethical and can constitute medical malpractice.

Choice B rationale

Explaining to the client that they cannot leave until the surgeon discharges them is not effective if the client insists on leaving against medical advice.

Choice C rationale

Having the client sign an against medical advice form is the appropriate action to document that the client understands the risks of leaving and is choosing to do so against the medical team's recommendations.

Choice D rationale

Telling the client that the surgeon will prescribe restraints if they try to leave is coercive and not an appropriate method to manage a client's desire to leave the hospital.

A. He appears anxious about the transfer. B. His partner has been visiting. C. He is voiding adequately. D. He is allergic to sulfa.

Correct Answer is D

Explanation

Choice A rationale

He appears anxious about the transfer provides subjective information about the client's emotional state. While important, it's not essential for the transfer report which typically focuses on objective, actionable data.

Choice B rationale

His partner has been visiting is valuable for understanding the client's support system, but it does not directly affect the client's clinical care during transfer.

Choice C rationale

He is voiding adequately offers relevant information about the client's bodily function, important for ongoing care but not as critical as allergy information.

Choice D rationale

He is allergic to sulfa provides essential medical information that can affect the client's treatment plan. Knowing allergies is crucial to prevent adverse reactions to medications.

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A nurse is coordinating care of a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse assign to the AP?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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