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A nurse is planning client care for herself and an assistive personnel (AP) working with her. Which of the following tasks should the nurse plan to perform?

Assisting a client to cough and deep breathe

Application of antiembolic stockings

Administration of an enema

Assessing a client's sacrum for edema

Answer and Explanation

The Correct Answer is D

Rationale:

A. Assisting a client to cough and deep breathe is a task that can be performed by an AP under supervision.

B. Application of antiembolic stockings is within the scope of APs, though it may be monitored by an RN.

C. Administration of an enema typically requires nursing judgment and assessment, making it more appropriate for the RN.

D. Assessing a client’s sacrum for edema requires clinical assessment skills and nursing judgment, which should be performed by an RN.

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Correct Answer is A

Explanation

Rationale:

A. The client should sign the informed consent if they are alert, oriented, and capable of making decisions. The client's ability to understand the procedure and its implications is key to valid informed consent.

B. The client's son, who has a durable power of attorney would only sign the consent if the client were not competent or unable to understand the procedure, which is not the case here.

C. The client's partner may be involved in the decision-making process but does not have the legal authority to sign the consent unless designated as a legal representative.

D. The client's daughter, who is the primary caregiver would also not have the legal authority to sign the consent unless she holds a durable power of attorney or the client is deemed incapable of giving consent.

A. Insist the client take prescribed medications. B. Inform the client that the medication is the same as taken at home. C. Tell the client that refusal of the medication is considered noncompliance. D. Encourage the client to verbalize questions.

Correct Answer is D

Explanation

Rationale:

A. Insisting the client take medications does not respect the client’s autonomy and is not an advocacy action.

B. Informing the client that the medication is the same as taken at home does not necessarily address the client’s concerns or questions.

C. Telling the client that refusal is noncompliance does not support client autonomy and does not address their concerns.

D. Encouraging the client to verbalize questions supports their right to be informed and make decisions about their care, demonstrating advocacy.

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A nurse is planning client care for herself and an assistive personnel (AP) working with her. Which of the following tasks should the nurse plan to perform?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a history of dementia. The client is alert and oriented to person, place, and time, and has advance directives. The client is scheduled for a procedure that requires informed consent. Which of the following persons should sign the informed consent?

Correct Answer is A

Explanation

A nurse is preparing to administer a prescribed medication to a client. Which of the following actions should the nurse plan to take to demonstrate client advocacy?

Correct Answer is D

Explanation

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