A nurse is reviewing the provider's prescriptions for a client who has a positive sputum culture for tuberculosis. Which of the following tasks should the nurse delegate to an assistive personnel (AP)?

Collect the client's urine output every 24 hours

Administer the client's scheduled antitubercular medications

Assist the client with speech therapy exercises

Place the client on airborne precautions

Answer and Explanation

The Correct Answer is A

Choice A reason: Collecting the client's urine output every 24 hours is a task that the nurse can delegate to an AP. This task is within the AP's scope of practice and does not require clinical judgment or assessment. The nurse should provide clear instructions and expectations to the AP, and monitor and evaluate the client's fluid status and renal function.

Choice B reason: Administering the client's scheduled antitubercular medications is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires clinical judgment and assessment. The nurse should follow the five rights of medication administration and monitor the client for adverse effects and therapeutic outcomes.

Choice C reason: Assisting the client with speech therapy exercises is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires specialized knowledge and skills. The nurse should collaborate with the speech therapist and follow the prescribed plan of care for the client.

Choice D reason: Placing the client on airborne precautions is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires clinical judgment and assessment. The nurse should implement the infection control measures and educate the client and the AP about the rationale and the procedures.

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Correct Answer is A

Explanation

Choice A reason: The charge nurse should address the situation of the emergency department nurse waiting to give report on a new admission first. This is the most urgent and time-sensitive issue that affects the client's safety and continuity of care. The charge nurse should assign a staff nurse to receive the report and prepare for the admission.

Choice B reason: The charge nurse should address the situation of a nurse on the previous shift writing an incident report about a medication error second. This is an important and serious issue that requires follow-up and corrective actions. The charge nurse should review the incident report, talk to the nurse involved, and implement measures to prevent future errors.

Choice C reason: The charge nurse should address the situation of two staff members calling to say they will be absent third. This is a significant and challenging issue that affects the staffing and workload of the unit. The charge nurse should contact the staffing office, request replacements, and adjust the assignments accordingly.

Choice D reason: The charge nurse should address the situation of transport assistance being unavailable to take a client to occupational therapy last. This is a minor and temporary issue that does not compromise the client's health or well-being. The charge nurse should contact the transport department, reschedule the therapy session, and inform the client and the therapist.

A. Documenting a client's refusal to take a prescribed medication. B. Providing written information to a client regarding palliative care. C. Implementing a client's plan of care based on nursing goals. D. Obtaining an interpreter for a client who speaks a different language than the nurse. E. Initiating IV access on a client who has dementia while he is sleeping.

Correct Answer is ["A","B","D"]

Explanation

Choice A reason: Documenting a client's refusal to take a prescribed medication is an example of client advocacy because it respects the client's right to make informed decisions about their health care. The nurse should also explain the risks and benefits of the medication and offer alternatives if possible.

Choice B reason: Providing written information to a client regarding palliative care is an example of client advocacy because it educates the client about their options and supports their quality of life. The nurse should also discuss the information with the client and answer any questions they may have.

Choice C reason: Implementing a client's plan of care based on nursing goals is not an example of client advocacy because it does not reflect the client's preferences and values. The nurse should collaborate with the client and the health care team to develop a plan of care that meets the client's needs and goals.

Choice D reason: Obtaining an interpreter for a client who speaks a different language than the nurse is an example of client advocacy because it facilitates effective communication and understanding between the nurse and the client. The nurse should use a professional interpreter or a translation device if available and avoid using family members or friends as interpreters.

Choice E reason: Initiating IV access on a client who has dementia while he is sleeping is not an example of client advocacy because it violates the client's autonomy and consent. The nurse should obtain informed consent from the client or their legal representative before performing any invasive procedure and explain the purpose and risks of the procedure.

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A nurse is reviewing the provider's prescriptions for a client who has a positive sputum culture for tuberculosis. Which of the following tasks should the nurse delegate to an assistive personnel (AP)?

Nursing Test Bank

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Correct Answer is ["A","B","D"]

Explanation

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