A nurse is assigned to care for the following patients who all need vital signs taken right now. Which patient is most appropriate for the nurse to delegate vital sign measurement to the nursing assistive personnel (NAP)?
a. Patient scheduled for a procedure in the nuclear medicine department
b. Patient transferring from the intensive care unit (ICU)
c. Patient returning from a cardiac catheterization
d. Patient returning from hip replacement surgery
ANS: A
The nurse does not assign vital sign measurement or other tasks to NAP when patients are experiencing a change in level of care. The patient awaiting the procedure in nuclear medicine is the only patient who has not experienced a change in level of care. According to the rights of delegation, tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have minimal risk can be delegated to assistive personnel. The patient in this question with the most predictable condition is the patient awaiting the nuclear medicine procedure. Once the nurse determines that the other patients are stable, the nurse could delegate their future vital sign measurement to the NAP. However, it is important for the nurse to assess patients coming from the ICU, the cardiac cath lab, and surgery when they first arrive on the unit.
You might also like to view...
The nurse is going to perform light palpation. Which statement regarding light palpation is true?
1. It is a gentle downward movement of the hand in a circular fashion. 2. It is done by using two hands to apply pressure. 3. It is only done by the health care provider. 4. It should cause the client pain.
A nurse is providing information on the medication Pancrease (lipase, protease, amylase) to a patient diagnosed with pancreatitis. Which important instruction should the nurse be sure to in-clude?
a. Taken before meals b. Sprinkled on warm food c. Mixed with juice d. Taken 1 hour after eating
Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:
1. Autoantibodies to two tyrosine phosphatases 2. Mutation of the hepatic transcription factor on chromosome 12 3. A defective glucokinase molecule due to a defective gene on chromosome 7p 4. Mutation of the insulin promoter factor
The nurse is caring for a pt after a nephrectomy. the nurse notes the urine flow was 50 mL/hr at the beginning of the shift, but several ours later has dropped to 30 mL/ what would the nurse do first?
a. notify the HCP for an order for an IV fluid bolus b. document the finding and continue to monitor for downward trend c. check the drainage system for kicks or obstructions to flow d. obtain the pt's weight and compare it to baseline