A nurse is delegating oral care for a client who is unconscious to an assistive personnel (AP). The AP tells the nurse that APs are not allowed to perform the delegated task. Which of the following actions should the nurse take?

Ask the nurse manager who should perform the task.

Perform the oral care.

Ask a licensed practical nurse to perform the task.

Check the AP job description.

Answer and Explanation

The Correct Answer is D

A.   While consulting with the nurse manager is appropriate in some cases, it's important to first verify the AP's scope of practice.
B.   If the AP is not qualified to perform the task, the nurse may need to perform it themselves or delegate it to someone who is qualified. However, it's important to first verify the AP's scope of practice to avoid unnecessary delegation.
C.   This may be a viable option if the AP is not qualified to perform the task and the nurse is unable to do it themselves. However, it's important to ensure that the licensed practical nurse has the necessary training and competence to perform the task safely and effectively.
D.   The AP job description outlines the specific tasks and responsibilities that the AP is authorized to perform. By checking the job description, the nurse can determine if the AP is indeed qualified to perform oral care for an unconscious client.

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Correct Answer is C

Explanation

A. Closing fire doors and doors to clients' rooms is a good practice to contain smoke and fire. However, this action alone does not address the immediate needs of dealing with the fire or alerting others. It is an important step in the overall fire response, but it should follow other more immediate actions.
B. Extinguishing the fire is a critical step, but it comes after ensuring the safety of all individuals. If the nurse has already removed the client from the room, the next priority is to alert others and ensure that the fire is managed properly.
C. Activating the fire alarm is crucial because it alerts everyone in the building to the danger and initiates the building’s fire response protocols. This action should be taken as soon as possible to ensure that everyone in the building is aware of the emergency and can begin evacuating if necessary. It also ensures that emergency services are notified.
D. While removing all clients from the unit is extremely important, it is usually done as part of a coordinated response that includes alerting others and ensuring the safety of everyone in the building. The nurse should first activate the fire alarm and then work on evacuating all clients if it’s safe to do so.

A. Serve on a quality improvement committee. B. Conduct a root cause analysis. C. Develop preventative measures. D. Review current evidence-based practice.

Correct Answer is B

Explanation

A. While serving on a quality improvement committee is beneficial for long-term strategies and systemic changes, it is not the immediate action needed to address the specific increase in medication errors. The committee may work on broader issues and improvements over time, but addressing the current problem starts with understanding its root causes.
B. Conducting a root cause analysis (RCA) should be the first action. RCA is a systematic process for identifying the underlying causes of problems or events. By conducting an RCA, the nurse manager can determine the specific factors contributing to the increase in medication errors, whether they are related to processes, training, equipment, or other issues.
C. Developing preventative measures is essential for reducing future medication errors, but it should follow the root cause analysis. Without a clear understanding of the underlying causes, any preventative measures may not address the real issues or may be misdirected.
D. Reviewing current evidence-based practices is important for ensuring that care protocols align with the latest standards and guidelines. However, this should come after identifying the specific problems causing the medication errors.

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A nurse is delegating oral care for a client who is unconscious to an assistive personnel (AP). The AP tells the nurse that APs are not allowed to perform the delegated task. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse enters a client's room and notices a small fire in the bathroom trash can. The nurse removes the client from the room. Which of the following actions should the nurse take next?

Correct Answer is C

Explanation

A nurse manager notes that the number of medication administration errors has increased on the unit. Which of the following actions should the nurse take first?

Correct Answer is B

Explanation

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