A nurse on a medical-surgical unit is delegating client care. Which of the following tasks should the nurse delegate to an assistive personnel?

Using a pain rating scale to monitor a client's pain level

Instructing a client on self-administration of a tap water enema

Performing a dressing change on a client's peripherally inserted central catheter

Suctioning a client's long-term tracheostomy

Answer and Explanation

The Correct Answer is A

Choice A reason: Using a pain rating scale to monitor a client's pain level is a task that the nurse can delegate to an assistive personnel, as it does not require clinical judgment or specialized skills. The assistive personnel can report the pain score to the nurse, who can then adjust the pain management plan accordingly.

Choice B reason: Instructing a client on self-administration of a tap water enema is a task that the nurse cannot delegate to an assistive personnel, as it requires teaching and evaluation skills. The nurse should instruct the client on the procedure, the rationale, and the expected outcomes, and assess the client's understanding and ability to perform the task.

Choice C reason: Performing a dressing change on a client's peripherally inserted central catheter is a task that the nurse cannot delegate to an assistive personnel, as it requires sterile technique and infection control skills. The nurse should perform the dressing change according to the facility protocol, and monitor the site for any signs of complications.

Choice D reason: Suctioning a client's long-term tracheostomy is a task that the nurse cannot delegate to an assistive personnel, as it requires advanced airway management skills. The nurse should suction the client's tracheostomy as needed, and observe the client for any signs of respiratory distress.

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Correct Answer is B

Explanation

Choice A reason: The client's vital signs are not part of the background information, but rather the assessment information. The background information should include relevant and concise data about the client's history, diagnosis, and treatment.

Choice B reason: The client's name is part of the background information, as it identifies the client and establishes rapport. The name should be the first thing the nurse says when initiating the SBAR communication.

Choice C reason: The client's code status is not part of the background information, but rather the recommendation information. The code status should be communicated at the end of the SBAR communication, along with any other suggestions or requests for the receiving nurse.

Choice D reason: A prescribed consultation is not part of the background information, but rather the situation information. The situation information should describe the current problem or reason for the transfer.

A. Social worker B. Physical therapist C. Occupational therapist D. Dietitian

Correct Answer is B

Explanation

Choice A reason: A social worker is not the best choice for a referral for a client who is having difficulty walking following a stroke. A social worker can help the client with psychosocial issues, such as coping, support, and resources, but not with physical rehabilitation.

Choice B reason: A physical therapist is the best choice for a referral for a client who is having difficulty walking following a stroke. A physical therapist can assess the client's mobility, strength, balance, and coordination, and provide exercises and interventions to improve the client's gait and function.

Choice C reason: An occupational therapist is not the best choice for a referral for a client who is having difficulty walking following a stroke. An occupational therapist can help the client with activities of daily living, such as dressing, bathing, and eating, but not with walking.

Choice D reason: A dietitian is not the best choice for a referral for a client who is having difficulty walking following a stroke. A dietitian can help the client with nutritional needs, such as calorie intake, fluid balance, and dietary restrictions, but not with walking.

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A nurse on a medical-surgical unit is delegating client care. Which of the following tasks should the nurse delegate to an assistive personnel?

Nursing Test Bank

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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