The nurse is planning care for a group of patients and is deciding upon which activities to delegate to an experienced UAP. Which activities should the nurse plan to do, rather than delegate to the UAP? Select all that apply
1. Helping the patient get up in the chair at bedside.
2. Feeding a patient who had a cerebral vascular accident 3 years ago.
3. Monitoring an intravenous line for infiltration.
4. Monitoring vital signs on a newly admitted patient who is diagnosed with myocardial infarction.
5. Deciding to use an as needed order to administer an over-the-counter medication for a patient complaint of a headache.
3, 4, 5
Explanation: 1. This is a standard intervention that does not require the special skills of a nurse. It can be delegated.
2. Since this patient had a CVA several years ago and there is no indication of critical difficult swallowing, feeding does not require the advanced skills of a nurse. It can be delegated.
3. This skill requires the judgment and skills of a nurse. It cannot be delegated. The UAP can ask the nurse to assess the IV site if the UAP believes that there is a problem.
4. This patient is in a potentially risky situation. Vital signs should be monitored by a nurse.
5. Assessing a patient and deciding to use an as needed order to administer medication requires the advanced skills of a nurse.
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Mrs. Brown has an intercerebral hematoma that is being managed medically. The nurse notes that Mrs. Brown is exhibiting ataxic breathing. The nurse should
A) realize that all patients with head injuries exhibit changes in respiratory patterns, so she should not be alarmed. B) notify the physician and make sure the equipment for intubation and ventilation is accessible. C) insert a nasopharyngeal airway to suction the patient. D) realize this is an indication of improved neurologic function.
While assessing a client's respirations as abnormal, the nurse notes the following:(Select all that apply) Standard Text: Select all that apply
1. The rate of respirations 2. The depth of respirations 3. The client's normal breathing patterns 4. The relationship of respirations to cardiovascular function 5. Lack of sound when breathing
At a recent staff meeting the staff educator discussed the importance of catheter care for the prevention of urinary tract infections (UTI). What percentage of health care–associated infections result from indwelling catheter use?
a. 10% b. 60% c. 70% d. 80%
A health care organization provides care to patients that are of Hispanic, Asian, and Eastern European heritage. What will the organization do to ensure that the staff represents the demographics of the service area?Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.
A. Hire nurses that speak Spanish. B. Promote a staff member from the Asian culture. C. Provide language assistance services. D. Post signage in the languages of the different groups E. Incorporate internal audits for culturally appropriate services