A nurse observes an assistive personnel (AP) empty an indwelling urinary catheter drainage bag while not wearing gloves. Which of the following interventions should the nurse take first?

Provide the AP with a copy of the unit's policy.

Notify the charge nurse about the incident.

Talk with the AP about the technique used.

Conduct an in-service on standard precautions.

Answer and Explanation

The Correct Answer is C

A.   Providing the AP with a copy of the unit's policy may be done but is not the first step. Direct communication is important for immediate feedback.
B.   Notifying the charge nurse is appropriate but may not be the first action when direct communication with the AP can address the issue.
C.   Talking with the AP about the technique used is the first and immediate action to address the observed lapse in infection control practices.
D.   Conducting an in-service on standard precautions is a broader intervention and may be considered after addressing the immediate concern with the AP.

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Correct Answer is A

Explanation

A. Giving oral care to a client who cannot take oral fluids is a task that can be safely delegated to an assistive personnel.
B. Checking intravenous insertion sites for signs of infiltration requires nursing judgment and assessment skills and should be performed by a licensed nurse.
C. Assessing a client's ability to ambulate involves clinical judgment and should be performed by a licensed nurse.
D. Demonstrating how to use a glucometer to a client with diabetes requires nursing knowledge and education skills and should be performed by a licensed nurse.

A. Ciprofloxacin 200 mg IV q12h x 7 days B. Dx pyelonephritis C. Hourly 180 D. Acetaminophen 1000 mg PO QD

Correct Answer is B

Explanation

A. Ciprofloxacin 200 mg IV q12h x 7 days is a clear and acceptable prescription.
B. "Dx" is an unaccepted abbreviation; it is not appropriate for documentation and may lead to confusion.
C. "Hourly 180" is unclear and may need clarification; it could refer to an hourly measurement or a specific order, but it lacks clarity.
D. Acetaminophen 1000 mg PO QD is a clear and acceptable prescription.

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A nurse observes an assistive personnel (AP) empty an indwelling urinary catheter drainage bag while not wearing gloves. Which of the following interventions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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