The nurse observes a practical nurse (PN) placing a client on the right side with the left leg bent in preparation for a lumbar puncture. Which action should the nurse implement?

Assume care of the client and assign the PN to the care of a different client.

Acknowledge that the PN has positioned the client safely and correctly.

Arrange for an unlicensed assistive personnel to assist the PN during the procedure.

Demonstrate to the PN how to position the client more effectively for the procedure.

Answer and Explanation

The Correct Answer is D

Choice A reason: Assuming care of the client and assigning the PN to the care of a different client is not the best action the nurse should take. This may undermine the PN's confidence and competence and create resentment and conflict.

Choice B reason: Acknowledging that the PN has positioned the client safely and correctly is not the best action the nurse should take. This may reinforce the incorrect positioning and lead to complications during the lumbar puncture.

Choice C reason: Arranging for an unlicensed assistive personnel to assist the PN during the procedure is not the best action the nurse should take. This may not address the root cause of the incorrect positioning and may not improve the PN's skills and knowledge.

Choice D reason: Demonstrating to the PN how to position the client more effectively for the procedure is the best action the nurse should take. This will correct the error and provide the PN with feedback and guidance on how to perform the task correctly in the future.

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Correct Answer is B

Explanation

Choice A reason: Ensuring transfer of the client's electronic chart code is a necessary action, but it is not the most important. The nurse should make sure that the client's records are updated and accessible to the palliative care team, but this can be done after the client is settled in the new room.

Choice B reason: Giving a detailed report to the accepting nurse is the most important action, as it ensures continuity and quality of care for the client. The nurse should provide information about the client's diagnosis, prognosis, preferences, goals, medications, interventions, and family situation.

Choice C reason: Giving client written information about end-of-life care is a helpful action, but it is not the most important. The nurse should provide the client with educational materials and resources about palliative care, hospice care, advance directives, and bereavement support, but this can be done later or by the palliative care team.

Choice D reason: Taking the family to the client's new room is a supportive action, but it is not the most important. The nurse should assist the family with the transition and offer emotional support, but this can be done after the report is given to the accepting nurse.

A. Obtain the client's legal records for power of attorney. B. Ask the palliative care team to speak with the client. C. Give analgesic medications as needed (PRN). D. Discontinue the intravenous infusion.

Correct Answer is B

Explanation

Choice A reason: Obtaining the client's legal records for power of attorney is not the best action for the nurse to take. This may not be relevant or appropriate for the client's situation and may not address the client's wishes or needs.

Choice B reason: Asking the palliative care team to speak with the client is the best action for the nurse to take. This can help the client and the family understand the goals and options of palliative care, which focus on relieving symptoms and improving quality of life for clients with life-limiting illnesses.

Choice C reason: Giving analgesic medications as needed (PRN) is not the best action for the nurse to take. This may not be sufficient or effective for the client's pain and discomfort, and may not respect the client's preference to avoid machines or interventions.

Choice D reason: Discontinuing the intravenous infusion is not the best action for the nurse to take. This may not be in the best interest of the client's health and hydration, and may not be consistent with the client's wishes or needs.

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The nurse observes a practical nurse (PN) placing a client on the right side with the left leg bent in preparation for a lumbar puncture. Which action should the nurse implement?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

Correct Answer is B

Explanation

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