Nursing Elites

1. Which task could the nurse safely delegate to the UAP?

• A. Oral feeding of a two-year-old child after application of a hip spica cast
• B. Assessment of the placement and patency of an NG tube
• C. Participation in staff rounds to record notes regarding client goals
• D. Evaluation of a client's incisional pain following narcotic administration

Correct answer: A

Rationale: The correct answer is A because oral feeding of a stable child is a task that can be safely delegated to a UAP. This task does not require nursing assessment or clinical judgment. Choice B involves assessment, which requires the nurse's clinical judgment. Choice C involves recording client goals during staff rounds, which may require interpretation and understanding of the goals set. Choice D involves evaluating a client's pain following medication administration, which requires assessment and clinical judgment by a nurse.

2. The nurse observes a UAP performing oral hygiene on an unconscious client who is lying in a flat side-lying position with an emesis basin on a towel under the chin. Which action should the nurse take?

• A. Stop the procedure and tell the UAP to place the client in a Fowler's position
• B. Praise the UAP for doing the oral hygiene but encourage family participation
• C. Tell the UAP to continue because the unconscious client is positioned safely
• D. Enroll the UAP in a hospital education class on conducting safe client care

Correct answer: C

Rationale: The correct answer is to tell the UAP to continue because the unconscious client is positioned safely for oral care. Placing an unconscious client in a side-lying position helps prevent aspiration, and having an emesis basin under the chin is appropriate to catch any fluids. Therefore, the nurse should acknowledge that the UAP is performing the procedure correctly. Choices A, B, and D are incorrect. Placing the client in a Fowler's position is not necessary for this procedure as the client is already positioned safely. Praise and encouragement for family participation are important aspects but not the immediate action needed in this scenario. Enrolling the UAP in a hospital education class is not warranted as the current procedure is being performed correctly.

3. At 1200, the practical nurse learns that a client's 0900 dose of an anticonvulsant was not given. The next scheduled dose is at 2100. Which action should the PN take?

• A. Administer half of the missed dose immediately
• B. Administer the missed dose as soon as possible
• C. Give the missed dose with the next scheduled dose
• D. Withhold the missed dose unless seizure activity occurs

Correct answer: B

Rationale: Administering the missed dose as soon as possible is crucial in this situation. Missing an anticonvulsant dose can lead to breakthrough seizures, which are harmful to the client. Administering the missed dose promptly helps maintain the therapeutic level of the medication and reduces the risk of seizure activity. Giving half the dose may not provide adequate protection against seizures. Delaying the dose until the next scheduled time increases the time the client is without the medication, potentially increasing the risk of seizures. Withholding the missed dose unless seizure activity occurs is not recommended, as prevention is key in managing anticonvulsant therapy.

4. A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful?

• A. I don't need to buy a special type of thermometer.
• B. I need to wait 5 minutes after smoking a cigarette before I take my temperature.
• C. I need to take my temperature before I get out of bed in the morning.
• D. I need to take my temperature at least once every day.

Correct answer: C

Rationale: The correct answer is C. Basal body temperature must be taken before getting out of bed in the morning to get an accurate reading, as even slight activity can raise body temperature and affect the results. Choice A is incorrect because a special type of thermometer is not required for basal body temperature measurement. Choice B is incorrect because smoking can affect body temperature, but the timing mentioned is not relevant to basal body temperature measurement. Choice D is incorrect because while it is essential to take the temperature consistently each day, the duration of temperature measurement is not specified, making this choice less specific compared to the correct answer.

5. What is the primary function of hemoglobin in red blood cells?

• A. To transport oxygen from the lungs to body tissues
• B. To protect the body from infections
• C. To help in blood clotting
• D. To regulate body temperature

Correct answer: A

Rationale: The primary function of hemoglobin in red blood cells is to transport oxygen from the lungs to body tissues and return carbon dioxide from the tissues to the lungs. Hemoglobin binds to oxygen in the lungs and releases it in the body's tissues. Choice B is incorrect because hemoglobin is not involved in protecting the body from infections. Choice C is incorrect because blood clotting is mainly facilitated by platelets and clotting factors, not hemoglobin. Choice D is incorrect because the regulation of body temperature is mainly controlled by processes like sweating and shivering, not by hemoglobin.

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