You are working on a busy unit and need to delegate tasks to the LPN and M

Asking the LPN to administer an intramuscular injection to a patient.

Asking the LPN to assess a post-operative patient’s wound for signs of infection.

Asking the MA to complete a follow-up call with a patient about test results.

Asking the MA to insert a nasogastric tube in a patient who requires nutritional support.

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering an intramuscular injection is within the LPN’s scope of practice, ensuring safe delegation. This aligns with nursing delegation guidelines, making it the correct example of appropriate task assignment for the nurse to delegate to the LPN on a busy unit.

Choice B reason: Assessing a wound for infection requires RN judgment, exceeding the LPN’s scope. Administering an injection is appropriate, making this incorrect, as it’s an improper delegation compared to the nurse’s choice of a task within the LPN’s role.

Choice C reason: MAs cannot discuss test results, as this requires clinical judgment beyond their scope. LPN injection administration is correct, making this incorrect, as it’s an inappropriate task for the MA compared to the nurse’s proper delegation choice.

Choice D reason: Inserting a nasogastric tube is an RN task, not within the MA’s scope. LPN injection administration is appropriate, making this incorrect, as it’s unsafe delegation compared to the nurse’s selection of a task suitable for the LPN.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

Choice A reason: Referring to the ethics committee is premature without discussing the patient’s wishes with the family. Asking about the patient’s preferences respects autonomy, making this incorrect, as it bypasses the family’s role in decision-making for the unresponsive patient.

Choice B reason: Asking what the family wants is vague and may pressure them without context. Inquiring about the patient’s wishes guides ethical decisions, making this incorrect, as it’s less focused than the nurse’s approach to honor the patient’s likely preferences.

Choice C reason: Stating the doctor’s recommendation may bias the family and doesn’t explore the patient’s wishes. Asking what the patient would want is more patient-centered, making this incorrect, as it’s less collaborative in discussing ongoing care options.

Choice D reason: Asking what the patient would want respects autonomy and guides family decision-making in the absence of an advance directive. This aligns with ethical principles, making it the correct approach for the nurse to discuss ongoing care with the family.

A. “I need to increase the fiber in my diet.” B. “I will need to avoid caffeinated beverages.” C. “I’m going to learn some stress-reduction techniques.” D. “I can have exacerbations and remissions with Crohn’s disease.”

Correct Answer is A

Explanation

Choice A reason: Increasing fiber during Crohn’s exacerbation worsens diarrhea and inflammation, indicating a misunderstanding. A low-fiber diet is recommended, making this the correct statement needing further instruction, as it contradicts the nurse’s teaching on managing dietary needs during Crohn’s disease flare-ups.

Choice B reason: Avoiding caffeinated beverages is correct, as they stimulate the gut and worsen Crohn’s symptoms. This aligns with dietary teaching, making it incorrect, as it shows understanding, unlike the incorrect fiber statement requiring further instruction from the nurse.

Choice C reason: Learning stress-reduction techniques is appropriate, as stress can trigger Crohn’s exacerbations. This reflects understanding of self-management, making it incorrect, as it aligns with the nurse’s teaching, unlike the fiber statement indicating a need for further dietary instruction.

Choice D reason: Recognizing exacerbations and remissions is accurate for Crohn’s disease, showing disease knowledge. This aligns with the nurse’s education, making it incorrect, as it demonstrates understanding, unlike the fiber statement that requires further instruction to correct the client’s misconception.

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You are working on a busy unit and need to delegate tasks to the LPN and M

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction?

Correct Answer is A

Explanation

Which situations are early signs of an ethical dilemma? (Select all that apply)

You are working on a busy unit and need to delegate tasks to the LPN and M

A nurse has just received report on 4 clients who all have chest tubes in place. Which client is the priority to see first?

A nurse is assessing a client. Which of the following manifestations would indicate that the client is in cardiogenic shock? (Select all that apply)

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?

A client diagnosed with viral hepatitis is complaining of “no appetite” and “losing my taste for food.” What instruction would the nurse give the client to provide adequate nutrition?

Which action will the nurse perform first to prevent harm for a client suspected to have fluid overload?

A client suspected of having a duodenal ulcer has undergone esophagogastroduodenoscopy. The nurse would place the highest priority on which item as part of the client’s care plan?