A nurse is delegating care to an assistive personnel. Which of the following assignments should the nurse make?

Taking the vital signs of a client who is experiencing acute angina

Collecting a urine specimen from a client who is experiencing dysuria

Answering a telephone inquiry about NPO status from a client who is scheduled for a procedure

Reinforcing teaching with a client about stool specimen collection

Answer and Explanation

The Correct Answer is B

A.   Taking the vital signs of a client who is experiencing acute angina. Acute angina is a potentially unstable condition requiring assessment by a nurse.
B.   Collecting a urine specimen from a client who is experiencing dysuria. APs can perform routine specimen collection tasks.
C.   Answering a telephone inquiry about NPO status from a client who is scheduled for a procedure. Only licensed nurses should provide pre-procedure instructions.
D.   Reinforcing teaching with a client about stool specimen collection. Reinforcement of teaching involves assessment and evaluation, which are the nurse’s responsibilities.

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Correct Answer is ["B","E"]

Explanation

A. Client 5 (Streptococcal pharyngitis): Proper isolation and precautions were implemented, including a private room and surgical mask during transport. No follow-up is needed.
B. Client 4 (Mycobacterium tuberculosis): Requires follow-up. Tuberculosis requires a negative pressure room, not a positive airflow room. Positive airflow rooms are used for clients who need protection from outside pathogens, such as those who are immunocompromised.
C. Client 3 (Herpes simplex): Correct precautions were implemented. Herpes simplex (when involving open lesions) requires contact precautions, including gown and gloves. No follow-up is necessary.
D. Client 2 (Clostridium difficile): Appropriate precautions were taken, including a private room and the use of gown and gloves for direct care. No follow-up is needed.
E. Client 1 (Pertussis): Requires follow-up. Pertussis is transmitted via respiratory droplets, but placing the client in a negative pressure room is unnecessary. Droplet precautions (standard private room and surgical mask use within 3 feet) are sufficient. Negative pressure rooms are reserved for airborne infections such as tuberculosis.

A. Tell the client's partner the charge nurse can provide the results. B. Tell the client's partner the results of the laboratory tests. C. Tell the client's partner not to worry about the results. D. Tell the client's partner to ask the client about the results.

Correct Answer is D

Explanation

A. Tell the client's partner the charge nurse can provide the results: The charge nurse would still be bound by HIPAA regulations and cannot share the client's information without consent.
B. Tell the client's partner the results of the laboratory tests: Sharing health information without the client’s permission violates HIPAA regulations.
C. Tell the client's partner not to worry about the results: This response dismisses the partner's concerns and does not address the privacy issue.
D. Tell the client's partner to ask the client about the results: This is the appropriate action, as the client has the right to choose whom to share their health information with.

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A nurse is delegating care to an assistive personnel. Which of the following assignments should the nurse make?

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Naxlex Comprehensive Predictor Exams

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Explanation

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