A nurse on a medical surgical unit has received report on four clients. There is an LVN, RN, and UAP working. Which of the following clients would best to assign to the RN?

Reinforcing teaching with a patient who is learning to walk with a quad cane

A new admission to the unit complaining of chest pain

Inserting an NGT for a client who is unable to eat

Calculating intake and output for the unit

Answer and Explanation

The Correct Answer is B

A. Reinforcing teaching with a patient who is learning to walk with a quad cane: Reinforcing teaching can be done by an LVN, as it involves stable, predictable outcomes.
B. A new admission to the unit complaining of chest pain: A new admission with chest pain requires a comprehensive assessment and potential critical thinking and intervention, which are within the scope of an RN.
C. Inserting an NGT for a client who is unable to eat: Inserting an NGT can be done by an RN or LVN, but it does not require the comprehensive assessment and critical thinking that managing a new admission with chest pain does.
D. Calculating intake and output for the unit: Calculating intake and output is a task that can be delegated to a UAP.

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Correct Answer is B

Explanation

A. Speak loudly and use simple words: Speaking loudly may be perceived as shouting and can increase agitation. Using simple words is appropriate, but volume should be normal and calm.
B. Address the client by name and reorient client: Addressing the client by name and reorienting him is effective because it respects his dignity and helps him understand his current situation, reducing confusion and agitation. This approach is clear, respectful, and supportive.
C. Challenge the client to refocus his attention when he becomes agitated: Challenging the client can be confrontational and may escalate agitation. It is better to use a calm, reassuring approach.
D. Ask the client a series of questions without allowing time for the client to answer: This can overwhelm and frustrate the client, leading to increased agitation.

A. “I am calling about Mrs. Smith’s recent development of dyspnea." B. "The client is post op day 1 following a lung resection" C. "Could you provide an order for an incentive spirometer?” D. "The client's respirations are 24 even and bilateral. Afebrile.”

Correct Answer is B

Explanation

A. “I am calling about Mrs. Smith’s recent development of dyspnea." This statement is part of the Situation (S) step, describing why the nurse is calling.
B. "The client is post-op day 1 following a lung resection." This statement provides Background (B) information, giving context about the patient’s medical history and recent events.
C. "Could you provide an order for an incentive spirometer?" This statement is part of the Recommendation (R) step, where the nurse suggests a specific action or order.
D. "The client's respirations are 24, even and bilateral. Afebrile." This statement is part of the Assessment (A) step, describing the current clinical findings or assessment of the patient’s condition.

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A nurse on a medical surgical unit has received report on four clients. There is an LVN, RN, and UAP working. Which of the following clients would best to assign to the RN?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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