In providing care for a client with a nasogastric tube (NGT) connected to intermittent suction, which task can be assigned to the unlicensed assistive personnel (UAP)?
Maintain low intermittent suction.
Secure the tube to the client's nose.
Ensure correct placement of the tube.
Replace the canister when full.
The Correct Answer is B
A. Maintaining low intermittent suction requires assessing the appropriate suction settings and monitoring for complications, which are responsibilities beyond the UAP’s scope of practice. This task involves clinical judgment and knowledge of suction settings.
B. Securing the tube to the client’s nose is a task that UAPs can perform. It is a straightforward task that helps ensure the tube stays in place, which is a supportive care measure within the UAP's scope of practice.
C. Ensuring correct placement of the tube involves assessing for proper tube position through methods such as aspirating gastric contents or using imaging, which are tasks that require clinical judgment and are outside the UAP's scope of practice.
D. Replacing the canister when full involves handling medical equipment and requires understanding of suction mechanics and infection control practices, which are tasks that the PN or RN should perform.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This activity addresses both physical and social needs. It provides a gentle physical activity that can be enjoyed by people with limited mobility. It also encourages social interaction and teamwork, promoting a sense of belonging and camaraderie.
B. An open-air concert is enjoyable but may not fully engage residents in both physical and social aspects. While it offers entertainment, it lacks interactive elements that foster social engagement and physical involvement.
C. This activity requires more mobility than wheelchair-bound residents may have, especially if it involves walking on uneven terrain or sitting on the ground.
D. A tea party in the courtyard is a social activity but does not offer as much physical engagement or variety as a picnic in the park. While it is a pleasant option, it may not provide the same level of physical stimulation and change of scenery.
Correct Answer is A,B,C,D
Explanation
A. Exposing the left side of the chest is the first step to access the area where the apical pulse is assessed. This step ensures that the nurse has clear access to the chest for auscultation.
B. Locating the point of maximal impulse (PMI) is the next step once the chest is exposed. The PMI, typically located at the 5th intercostal space at the midclavicular line, is where the heart’s apex is closest to the chest wall.
C. Positioning the diaphragm of the stethoscope on the PMI is the step where the actual auscultation begins. The diaphragm is used to listen for heart sounds.
D. Listening for heart sounds at the PMI is the final step to assess the apical heart rate. This step completes the assessment by allowing the PN to count the heart rate and evaluate the rhythm.
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