When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

Correct Answer: C

Rationale: The correct answer is C: Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. Rationale: 1. Administering insulin falls under the scope of practice for an LPN/LVN. 2. Administering lispro insulin before surgery helps maintain the patient's blood glucose within a safe range during the procedure. 3. LPN/LVNs are trained to administer medications safely and accurately. Summary: A: Communication with the circulating nurse requires critical thinking and interpretation, which may be beyond the scope of an LPN/LVN. B: Discussing the reason for insulin therapy involves patient education and interpretation, which are typically responsibilities of a registered nurse. D: Planning strategies to prevent hypoglycemia or hyperglycemia requires higher-level critical thinking and assessment skills, usually performed by a registered nurse.

Correct Answer: B

Rationale: The correct answer is B: Wipe the top of the formula can with alcohol. This is the first action the nurse should take because it ensures the cleanliness and sterility of the formula before administering it to the client through the NG tube, reducing the risk of contamination and infection. A: Making sure the enteral formula is at room temperature is important but not the first action to take. C: Rinsing the feeding bag with water between feedings is not necessary for every feeding and does not address the immediate need to ensure the cleanliness of the formula. D: Instructing the client to keep the head of the bed elevated is important for preventing aspiration but is not the first action to take in this scenario.

Correct Answer: A

Rationale: The correct answer is A: Hydrocolloid dressing. For a stage 2 pressure injury, a hydrocolloid dressing is ideal as it maintains a moist environment to promote healing, absorbs excess exudate, and provides a barrier against bacteria. Transparent dressings (B) are more suitable for superficial wounds. Gauze dressings (C) may adhere to the wound bed and cause trauma upon removal. Alginate dressings (D) are better for wounds with heavy exudate, not typically seen in stage 2 pressure injuries.

Correct Answer: A

Rationale: Rationale: Choice A is correct because the pneumococcal vaccine is recommended for adults aged 65 and older to prevent pneumonia and other pneumococcal diseases. This recommendation aligns with the age group of the older adults at the senior living center. A shingles vaccine is actually recommended at age 50, not 70 (B). Tetanus boosters are recommended every 10 years, not 5 (C). Eye examinations are typically recommended annually, not every 2 years (D). Therefore, choice A is the most appropriate recommendation for the nurse to include in the educational program.

Correct Answer: A

Rationale: The correct answer is A: The client reports relief of nausea. This is because when an NG tube is correctly placed in the stomach, it can help decompress the stomach and relieve nausea. Choice B is incorrect because pH less than 5 indicates gastric placement, but it does not confirm correct placement. Choice C is incorrect as bowel sounds can be present even if the tube is incorrectly placed. Choice D is incorrect because an x-ray showing the tube above the pylorus only confirms tube position, not necessarily correct placement.