The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require immediate intervention?

A) Unilateral upper extremity weakness:
Guillain-Barré Syndrome (GBS) typically presents with bilateral weakness, not unilateral. The weakness in GBS typically begins symmetrically in the lower extremities and ascends upward toward the upper body, including the arms, face, and respiratory muscles. Therefore, unilateral weakness is not characteristic of GBS, and its presence should prompt further investigation into other possible causes.

B) Bilateral ascending weakness:
One of the hallmark signs of Guillain-Barré Syndrome is ascending weakness, which means that the weakness usually starts in the lower extremities (legs) and progresses upwards to the upper extremities, face, and potentially the respiratory muscles. This bilateral ascending paralysis is a classic feature of GBS and occurs due to the immune system attacking the myelin sheath of peripheral nerves. The nurse should be vigilant for signs of progressive weakness, as GBS can quickly lead to respiratory failure and requires prompt intervention.

C) Mask-like facial expressions:
Mask-like facial expressions are more commonly associated with Parkinson's disease, not Guillain-Barré Syndrome. Parkinson’s disease is characterized by a reduction in facial expressiveness due to the loss of dopaminergic neurons, leading to a fixed, unblinking, or "masked" appearance. While facial involvement can occur in GBS as the weakness ascends, it is not typically described as a "mask-like" expression.

D) Pill rolling actions made by the client's fingers:
Pill-rolling is a characteristic tremor often associated with Parkinson's disease and involves the repetitive motion of the fingers, as if rolling a pill. It is a resting tremor seen in Parkinson's disease and not in Guillain-Barré Syndrome. GBS primarily presents as weakness and loss of motor function, rather than tremors or other involuntary movements.

A) Administering oral antibiotics to a client with UTI:
Administering oral antibiotics is an appropriate task to delegate to a licensed practical nurse (LPN). LPNs are trained to administer medications, including oral antibiotics, and to monitor for common side effects or adverse reactions. Since the task is routine and does not require advanced clinical judgment, it can be delegated to the LPN under the nurse’s supervision.

B) Teaching a client with a new order for a renal angiogram:
Teaching a client about a new diagnostic procedure, such as a renal angiogram, requires advanced knowledge and clinical judgment to explain the procedure, its risks, and the necessary pre- and post-procedure care. This task is best performed by a registered nurse (RN) because it involves providing detailed patient education and addressing the patient’s concerns.

C) Evaluate the outflow of peritoneal dialysate:
Evaluating the outflow of peritoneal dialysate is a more complex task that involves assessing the effectiveness of the dialysis process and identifying any potential complications (e.g., infection, leakage). This task requires clinical expertise in dialysis and the ability to interpret changes in the output. Although LPNs may assist in monitoring the process, it is ultimately the RN’s responsibility to evaluate the outcome, interpret any changes, and intervene if necessary.

D) Assess a client with flank pain due to glomerulonephritis:
Assessment of a client with flank pain related to glomerulonephritis requires a thorough evaluation of the client's condition, including understanding the potential causes of pain and monitoring for complications such as renal failure or infection. This type of assessment requires critical thinking and clinical judgment, making it the responsibility of the RN.