An experienced charge nurse is providing mentoring to a new charge nurse. The new charge nurse is making the shift assignment for a licensed practical nurse (LPN). Which assignment requires intervention by the experienced nurse?

Providing nasopharyngeal suctioning for a client with pneumonia

Assisting a client who is 24 hours post-operative to use an incentive spirometer

Teaching a new client who has asthma to use a metered-dose inhaler

Collecting a clean catch urine from an ambulatory client with a wound

Answer and Explanation

The Correct Answer is C

Choice A reason: Providing nasopharyngeal suctioning for a client with pneumonia is within the scope of practice for an LPN. This task involves performing a procedure to clear the airway, which is a common responsibility for LPNs.

Choice B reason: Assisting a client who is 24 hours post-operative to use an incentive spirometer is appropriate for an LPN. This task involves helping a client with breathing exercises to prevent post-operative complications, which is a standard part of post-operative care.

Choice C reason: Teaching a new client who has asthma to use a metered-dose inhaler requires educational and assessment skills that typically fall within the scope of practice for a registered nurse (RN). While LPNs can reinforce education, the initial teaching and assessment of a client's understanding should be done by an RN.

Choice D reason: Collecting a clean catch urine from an ambulatory client with a wound is within the scope of practice for an LPN. This task involves obtaining a urine sample, which is a routine procedure that LPNs are trained to perform.

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Correct Answer is D

Explanation

Choice A reason: The person granted power of attorney for healthcare would be responsible for signing the informed consent only if the client is unable to make decisions for themselves due to incompetence or incapacity. Since the client in this scenario is competent and neurologically intact, the power of attorney is not applicable.

Choice B reason: The client's emergency contact is not authorized to sign informed consent unless they hold legal power of attorney or the client is incapacitated and unable to make decisions. The emergency contact's primary role is to be contacted in emergency situations, not to make medical decisions on behalf of the client.

Choice C reason: The legal next of kin would only be responsible for signing the informed consent if the client is not capable of doing so themselves. In this case, the client is competent and neurologically intact, so the next of kin's consent is not needed.

Choice D reason: The client is responsible for signing the informed consent because they are competent and capable of making their own medical decisions. Informed consent must be obtained from the client directly when they have the capacity to understand and agree to the proposed treatment or procedure.

A. Heart rate of 104 bpm B. Tympanic temperature of 102.6°F (39.2°C) C. Blood pressure of 158/90 mmHg D. Respiratory rate of 24 breaths/min

Correct Answer is B

Explanation

Choice A reason: A heart rate of 104 bpm can be expected in a client with pneumonia and after suctioning. Tachycardia (elevated heart rate) can occur as a response to infection, stress, or the suctioning procedure itself. While it should be monitored, it is not the most critical finding.

Choice B reason: A tympanic temperature of 102.6°F (39.2°C) is unexpected and indicates a significant fever, which may suggest a worsening infection or sepsis. This finding requires immediate attention as it could indicate that the current treatment for pneumonia is not effective, and the client's condition may be deteriorating.

Choice C reason: A blood pressure of 158/90 mmHg, though elevated, may be less critical in the context of this client's condition. Hypertension can occur due to various factors, including stress and illness, and should be monitored but is not the most urgent priority compared to a high fever.

Choice D reason: A respiratory rate of 24 breaths/min is slightly elevated but can be expected in a client with pneumonia and after suctioning. This rate indicates mild tachypnea, which should be monitored but is not as immediately concerning as a high fever.

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An experienced charge nurse is providing mentoring to a new charge nurse. The new charge nurse is making the shift assignment for a licensed practical nurse (LPN). Which assignment requires intervention by the experienced nurse?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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