A 78-year-old client admitted to the hospital with chronic anemia caused by possible gastrointestinal bleeding has all of these activities included in the care plan. Which activity is best delegated to an experienced nursing assistant (NA)?

Correct Answer: A

Rationale: The correct answer is A) Use Hemoccult slides to obtain stool specimens because this task involves collecting a sample for testing, which is within the scope of practice for a nursing assistant. Nursing assistants are trained to perform basic tasks like specimen collection under the supervision of licensed healthcare professionals. Option B) Having the client sign a colonoscopy consent form requires explanation of the procedure, potential risks, and benefits, which is beyond the nursing assistant's scope of practice. Option C) Administering PEG-ES bowel preparation involves medication administration, which should be done by a licensed nurse who has the knowledge and training to assess the client's response and manage any potential side effects. Option D) Checking for allergies to contrast dye or shellfish requires knowledge of allergies, potential reactions, and appropriate interventions, which should be done by a licensed healthcare provider who can make clinical judgments. Educationally, understanding the scope of practice for different healthcare team members is crucial for effective delegation and ensuring safe and efficient patient care. Nursing assistants play a vital role in supporting the healthcare team by performing delegated tasks within their scope of practice, contributing to optimal patient outcomes.

Correct Answer: B

Rationale: In this scenario, the most concerning statement made by the client is option B, "I take one aspirin every morning because of my history of angina." This statement is of utmost concern because aspirin, being a blood thinner, can exacerbate thrombocytopenia by further reducing the number of platelets in the blood, leading to an increased risk of bleeding. Option A, soft and dark brown bowel movements, could indicate gastrointestinal bleeding but is not as immediately concerning as the aspirin use in a thrombocytopenic patient. Option C, decreased appetite, is a common side effect of chemotherapy and may not directly impact the risk of bleeding in this context. Option D, increased bruising, is a common symptom of thrombocytopenia and, though relevant, is not as concerning as the client's aspirin use. Educationally, this question highlights the importance of understanding the potential interactions between medications and a patient's condition. It emphasizes the need for healthcare providers to be vigilant in assessing and addressing all aspects of a patient's history to provide safe and effective care, especially in oncology patients with complex treatment regimens.

Correct Answer: A

Rationale: The correct answer is option A) "I have started to eat more healthy foods like green salads and fruit." This statement indicates a potential lack of understanding about warfarin therapy because consuming large amounts of green, leafy vegetables rich in vitamin K can interfere with the effectiveness of warfarin. Vitamin K is essential for normal blood clotting, and warfarin works by inhibiting vitamin K-dependent clotting factors. Therefore, a sudden increase in vitamin K intake can reduce the anticoagulant effects of warfarin. Option B) "The doctor said that it is important to avoid becoming constipated" is incorrect because constipation, while it can affect medication absorption in some cases, is not directly related to warfarin therapy. Option C) "Coumadin makes me feel a little nauseated unless I take it with food" is incorrect because taking warfarin with food to reduce nausea is a common practice and does not necessarily indicate a need for additional teaching. Option D) "I will need to have some blood testing done once or twice a week" is incorrect because regular blood testing to monitor the International Normalized Ratio (INR) levels is a standard part of warfarin therapy and does not indicate a lack of understanding. In an educational context, it is crucial to emphasize to patients on warfarin therapy the importance of maintaining a consistent intake of vitamin K-rich foods to ensure the medication's effectiveness. This case highlights the need for clear and detailed patient education regarding dietary considerations when taking warfarin to prevent complications and ensure optimal therapeutic outcomes.

Correct Answer: C

Rationale: The most appropriate response in this scenario is option C: "Tell me a little bit more about your fear of dying." This response demonstrates active listening and empathy, allowing the patient to express their emotions and concerns freely. It opens up a channel for the patient to share their feelings, which can help in addressing their fears and providing appropriate support. Option A is incorrect because it does not directly address the patient's specific fear of dying, which may require further exploration. Option B is inappropriate as it immediately jumps to suggesting medication without fully understanding the source of the patient's fear. Option D, while providing some reassurance, does not acknowledge or validate the patient's feelings of fear. In an educational context, it is crucial for healthcare providers to develop strong communication skills to effectively address the emotional needs of patients, especially in oncology settings where patients may experience significant distress. By actively listening and encouraging patients to express their emotions, healthcare providers can build trust, provide holistic care, and support patients through their treatment journey.

Correct Answer: B

Rationale: In the context of a long-term-care client with chronic lymphocytic leukemia experiencing activity intolerance due to weakness and anemia, delegating the task of checking the client's blood pressure and pulse rate after ambulation to a nursing assistant is the most appropriate choice. This task is within the scope of practice for a nursing assistant and directly relates to monitoring the client's physiological response to activity, which is crucial in assessing their tolerance levels and adjusting care plans accordingly. Option A, evaluating the client's response to normal activities of daily living, requires a higher level of clinical judgment and interpretation of findings, making it more suitable for a licensed nurse. Option C, determining self-care activities the client can do independently, involves assessing the client's functional abilities and should be done by a healthcare provider with a comprehensive understanding of the client's condition and limitations. Option D, assisting the client in choosing a diet to improve strength, involves nutritional assessment and individualized planning, which falls under the scope of a registered dietitian or a nurse with specific training in nutrition. Educationally, understanding the principles of delegation based on scope of practice and client needs is essential for effective healthcare team collaboration. By correctly delegating tasks, nurses can optimize efficiency, promote patient safety, and ensure quality care delivery tailored to each client's unique requirements. Nurses must possess a solid grasp of delegation principles to allocate responsibilities appropriately and maximize the effectiveness of the healthcare team.