Correct Answer: A

Rationale: Giving oral care to a client who cannot take oral fluids is a task that can be safely delegated to an assistive personnel. Checking intravenous insertion sites for signs of infiltration requires nursing judgment and assessment skills and should be performed by a licensed nurse. Assessing a client's ability to ambulate involves clinical judgment and should be performed by a licensed nurse. Demonstrating how to use a glucometer to a client with diabetes requires nursing knowledge and education skills and should be performed by a licensed nurse.

Correct Answer: A

Rationale: Palliative surgery focuses on relieving symptoms and improving comfort rather than curing the underlying disease.
Therefore informing the client that they will be more comfortable after surgery is an appropriate instruction. Palliative surgery may not necessarily provide more information about the disease. Palliative surgery does not aim to restore function in the same way as corrective or restorative surgery. Palliative surgery is not performed with the expectation of curing the disease; its goal is to enhance the quality of life by alleviating symptoms.

Correct Answer: A

Rationale: Surveying the target population is the best approach to identify the specific interests and health concerns of the older adults ensuring that the programs are relevant and tailored to their needs. Determining the availability of health care providers is a logistical consideration but may not necessarily address the specific interests or needs of the older adults. Basing the programs on their developmental stage is important but surveying the population allows for a more comprehensive understanding of their diverse needs and preferences. Reviewing Healthy People 2020 Objectives is a valuable resource but may not capture the specific interests or concerns of the local population.

Correct Answer: A

Rationale: The client's belief that his needs will be met through education reflects intrinsic motivation which is likely to enhance the client's commitment to learning and self-care. Seeking family approval may be a motivator but it is an external factor and intrinsic motivation is generally more effective for sustained behavior change. While the nurse explaining the need for education is important the client's personal belief and understanding of the value of education are key for motivation. The nurse's empathy is essential for building rapport but the client's belief in the benefits of education is more directly related to motivation.

Correct Answer: A

Rationale: Obtaining apical and radial rates simultaneously allows the nurse to assess for a pulse deficit by comparing the two rates. A pulse deficit is present when the apical rate (heard with a stethoscope) is greater than the radial rate (palpated at the wrist). Palpating pulses in the lower extremities is not specific for assessing a pulse deficit and may not accurately reflect the cardiac output. Checking blood pressure in left and right arms assesses for blood pressure differences but does not specifically address a pulse deficit. Comparing the pulse strength in the upper extremities does not directly assess for a pulse deficit; simultaneous assessment of apical and radial rates is more appropriate.