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A nurse in an acute care setting is planning care for a group of clients at the beginning of the shift. Which of the following tasks should the nurse assign to the assistive personnel (AP)?

A.

Removal of the nasogastric tube of a client who has been receiving enteral feedings

B.

Monitoring vital signs of a client who had an appendectomy 12 hr ago

C.

Application of antibiotic ointment to the arm of a client who has dermatitis

D.

Obtaining medical history information from a stable client who is being admitted

Answer and Explanation

The Correct Answer is B

Rationale:

 

A. Removal of the nasogastric tube is a more complex task that typically requires the nurse’s assessment and judgment.

 

B. Monitoring vital signs is within the scope of tasks that can be assigned to assistive personnel. This task involves routine observation and does not require complex decision-making.

 

C. Application of antibiotic ointment requires specific knowledge about the condition and treatment, which is generally performed by a nurse.

 

D. Obtaining medical history information is a task that requires clinical judgment and interaction, and should be done by a nurse rather than an assistive personnel.


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View Related questions

Correct Answer is A

Explanation

Rationale:

A. Assessment includes the current status and vital signs of the client, which are part of the information the nurse provides to assess the client’s condition.

B. Situation describes the problem or concern that prompted the communication, not detailed vital signs.

C. Background provides context or history relevant to the situation but does not include current vital signs.

D. Recommendation involves suggesting actions or solutions but does not include the current condition details.

Correct Answer is C

Explanation

Rationale:

A. "What do you have against me? It must be something or you wouldn't be criticizing my care." is defensive and confrontational, which is not appropriate for assertive communication.

B. "You shouldn't make accusations. Your nursing care doesn't always set a good example." is also defensive and shifts the focus away from addressing the concern directly.

C. "I feel as though I met the standard of care. Would you tell me more about your concerns?" is an assertive response that acknowledges the concern and seeks constructive feedback.

D. "I am at a loss for words. I always do my best to give good care to my clients." is not assertive as it does not address the concern directly or invite constructive discussion.

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