Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel on a pediatric unit?
Weigh the diaper of an infant for output.
Assess the dressing of the infant that is two days post-operative.
Calculate the Morse Fall Scale for the preschool child.
Perform assessment of a child's developmental milestones.
The Correct Answer is A
Choice A rationale
Weighing an infant's diaper for output is a task suitable for unlicensed assistive personnel (UAP) because it involves data collection rather than clinical judgment or critical thinking. The results can be recorded and reported to the nurse for further assessment and interpretation.
Choice B rationale
Assessing a post-operative dressing requires clinical judgment to identify signs of infection, dehiscence, or other complications. This task is within the scope of a licensed nurse and should not be delegated to UAP to ensure patient safety.
Choice C rationale
Calculating the Morse Fall Scale involves understanding and interpreting risk factors, which requires critical thinking and clinical judgment. It is inappropriate for delegation to UAP, as they are not trained to analyze or interpret clinical data.
Choice D rationale
Performing an assessment of a child's developmental milestones requires knowledge of growth and development patterns, as well as clinical judgment to interpret findings. This task is outside the scope of UAP and must be performed by a licensed nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["75"]
Explanation
Step 1 is (50 mg × 6 kg) ÷ 24 hours. The total daily dose calculates to 300 mg/day.
Step 2 is 300 mg ÷ 4 doses/day. Each dose calculates to 75 mg of Amoxicillin.
Final calculated dose per administration is 75 mg.
Correct Answer is B
Explanation
Choice A rationale
Elevated AFP levels are not typically associated with Down syndrome. In fact, pregnancies with Down syndrome often show decreased levels of AFP in maternal serum screening. AFP is a protein produced by the fetal liver, and its levels vary depending on developmental abnormalities like neural tube defects, not chromosomal disorders like Down syndrome.
Choice B rationale
Elevated AFP levels in a pregnant patient indicate potential neural tube defects such as spina bifida. Spina bifida results from incomplete closure of the fetal neural tube during early pregnancy, leading to exposure of neural tissues. AFP leaks into the maternal serum through this defect, thus raising its concentration significantly, which serves as a marker.
Choice C rationale
AFP levels are generally low in cases of Down syndrome due to chromosomal anomalies. Trisomy 21 pregnancies display distinctive serum markers, including decreased AFP. Elevated AFP does not signify Down syndrome because the pathology involves a different spectrum of physiological abnormalities.
Choice D rationale
While spina bifida is indeed a condition associated with elevated AFP, this statement is less accurate due to the phrasing. AFP elevations serve as an indicator rather than definitive confirmation of spina bifida. Further diagnostic tests like ultrasonography or amniocentesis are needed to confirm the condition.
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