Extract:

Question 1 of 5

A charge nurse is making client care assignments. Which of the following tasks should the nurse delegate to assistive personnel (AP)? (Select all that apply.)

A. Bathe a client who had an amputation 2 days ago.B. Review a low-sodium diet for a client who has hypertension.C. Feed a client who had a stroke 3 months ago.D. Explain oral hygiene to a client receiving chemotherapy.E. Assist a client to ambulate using a gait belt.

Correct Answer: A,C,E

Rationale: Bathe a client who had an amputation 2 days ago: This task can be delegated to assistive personnel (AP). Feed a client who had a stroke 3 months ago: This task can be delegated to APs, provided that the client is stable. Assist a client to ambulate using a gait belt: This task can be delegated to APs.

Question 2 of 5

The nurse assesses patients to determine their risk for healthcare acquired infections. Which hospitalized patient would the nurse consider most at risk for developing this type of infection?

A. A 60 year old patient who is on a mechanical ventilatorB. A 65 year old patient who is vegetarian and obeseC. A 45 year old patient who smokes a pack of cigarettes a dayD. A 70 year old patient who has a normal WBC count

Correct Answer: A

Rationale: A 60 year old patient who is on a mechanical ventilator: This patient is at the highest risk for healthcare-acquired infections (HAIs) due to the use of mechanical ventilation.

Question 3 of 5

A nurse is teaching an assistive personnel (AP) about using personal protective equipment while caring for clients. Which of the following statements should the nurse identify as an indication that the AP understands the instructions?

A. I will wear gloves and a gown when bathing a client who has open skin lesions.B. I will wear gloves when measuring a client's blood pressure.C. I will wear gloves whenever I am in contact with clients.D. I will wear gloves to minimize the number of times I have to wash my hands.

Correct Answer: A

Rationale: I will wear gloves and a gown when bathing a client who has open skin lesions: This statement indicates an understanding of the appropriate use of personal protective equipment (PPE) in a situation where there is a risk of exposure to blood or bodily fluids.

Question 4 of 5

A nurse is teaching a newly licensed nurse about ethical principles. Which of the following is an example of justice?

A. A nurse gives a client the choice to take a pain medication via intramuscular or oral route.B. A nurse administers scheduled pain medication for a client who is having pain.C. A nurse fulfills a promise to a client that they will return with their pain medication.D. A nurse provides nonpharmacological pain interventions to each client equally.

Correct Answer: D

Rationale: A nurse provides nonpharmacological pain interventions to each client equally: This action represents the principle of justice, which emphasizes fairness and equality in the distribution of resources and treatment among clients.

Question 5 of 5

A nurse caring for a client who has an infected wound removes a dressing saturated with blood and purulent drainage. How should the nurse dispose of the dressing material?

A. Discard the dressing in the bedside trash receptacle.B. Enclose the dressing in a single clear plastic bag and discard in the bedside trash receptacle.C. Double-bag the dressing in clear bags and label it 'biohazard'.D. Dispose of the dressing in a biohazardous waste container.

Correct Answer: D

Rationale: Dispose of the dressing in a biohazardous waste container: This is the correct action. Biohazardous waste containers are specifically designed to safely dispose of materials that may be contaminated with blood, body fluids, or infectious agents. Proper disposal helps to prevent the spread of infection and ensures compliance with safety regulations in healthcare settings.