A nurse is coordinating the care of a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse not assign to the AP?
Measure the intake and output of a client who has received furosemide.
Check a client’s peripheral IV site for redness or swelling.
Assess the pain level of a client who has received acetaminophen.
Reinforcing teaching with a client about crutch-gait walking
None
None
The Correct Answer is C
- When coordinating the care of a group of clients with assistive personnel (AP), it's important to delegate tasks appropriately based on the AP's scope of practice and training. Here are the tasks that can be assigned to the AP:
Measure the intake and output of a client who has received furosemide: This task involves recording fluid intake and output, which is typically within the scope of practice for an AP, as long as they have been trained in the proper procedure and documentation.
Check a client’s peripheral IV site for redness or swelling: This task involves basic assessment and can be assigned to an AP, as long as they are familiar with the signs of potential complications related to IV sites and have been trained in the facility's protocol for reporting any issues.
Reinforcing teaching with a client about crutch-gait walking: Education and reinforcement of information provided by healthcare professionals can often be delegated to APs, especially if they have received training on the specific topic. However, it's important to ensure that the AP is knowledgeable about crutch-gait walking and the information they are reinforcing.
The task related to assessing pain (e.g., assessing the pain level of a client who has received acetaminophen) should generally be performed by a licensed healthcare provider, such as a nurse. Assessment of pain requires a deeper understanding of the client's pain experience and may involve making clinical decisions related to pain management.
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Related Questions
Correct Answer is A
Explanation
This is because the nurse should first assess the client’s baseline knowledge and readiness to learn before providing any teaching.
The nurse should also tailor the teaching to the client’s individual needs and preferences.
Choice B is wrong because showing the client a video demonstration of peak flow meter use may not be the most effective way of teaching if the client has different learning styles or needs.
The nurse should also involve the client in the learning process and not just rely on passive methods.
Choice C is wrong because observing the client using the peak flow meter is an evaluation step that should be done after teaching and reinforcing the correct technique.
The nurse should not assume that the client knows how to use the peak flow meter without assessing their knowledge first.
Choice D is wrong because emphasizing the importance of the daily use of the peak flow meter is a motivational strategy that should be done after assessing the client’s knowledge and providing teaching.
The nurse should also explain the rationale and benefits of using the peak flow meter, not just tell the client to do it.
A peak flow meter is a small device that measures how fast a person can forcefully blow air out of their lungs in one fast breath.
It is one indicator of airways changes that may occur in people with asthma or COPD.
To get a peak flow meter, speak to a doctor.
Correct Answer is B
Explanation
This action can help to reduce environmental stressors for clients in an acute care unit by limiting noise, crowding, and potential sources of infection.
Visitors should be allowed according to the client’s preference and condition, but excessive or inappropriate visitors should be discouraged.
Choice A is wrong because offering the clients many choices regarding care can increase their stress and anxiety, especially if they are confused, overwhelmed, or unable to make decisions.
The nurse should respect the client’s autonomy and preferences, but also provide guidance and education to help them make informed choices.
Choice C is wrong because assigning different nurses to provide care for clients each day can reduce the continuity and quality of care, as well as the trust and rapport between the client and the nurse.
The nurse should strive to provide consistent and individualized care for each client and establish a therapeutic relationship.
Choice D is wrong because turning on loud music in client care areas can increase environmental stressors for clients in an acute care unit by creating noise pollution, disrupting sleep, and interfering with communication.
The nurse should maintain a quiet and calm environment for the clients and use music only if it is soothing and requested by the client.
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