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A charge nurse is working with an assistive personnel (AP) who provides excellent care to clients and is an effective team member. Which of the following actions should the nurse take first to recognize the AP's contributions to client care?
- A. Tell other nurses what an effective team member the AP is.
- B. Detail the AP's contributions to the nurse manager.
- C. Nominate the AP for the Employee of the Month award.
- D. Give positive feedback directly to the AP.
Correct Answer: D
Rationale: The correct answer is D: Give positive feedback directly to the AP. This is the first action the nurse should take because it directly acknowledges and reinforces the AP's contributions. Providing feedback directly shows appreciation and motivates the AP to continue their excellent work. It helps build a positive relationship and boosts morale.
Choice A is less effective as it does not directly recognize the AP's efforts and may not reach the AP. Choice B involves an intermediary and may delay recognition. Choice C is a formal recognition and may not provide immediate feedback to the AP. Thus, giving direct positive feedback to the AP is the most immediate and impactful way to recognize their contributions.
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A charge nurse is reviewing the list of tasks that have been delegated to the assistive personnel (AP) by the staff nurse. Which of the following tasks should the charge nurse reassign to a licensed nurse?
- A. Providing a back rub to a client who has right-sided paralysis
- B. Transporting a client who experienced a stroke 72 hr ago to the radiology department
- C. Performing oral hygiene for a client who is 1 day postoperative following an amputation of the right arm
- D. Removing and cleaning the cannula of a client who has a new tracheostomy
Correct Answer: D
Rationale: The correct answer is D because removing and cleaning the cannula of a client with a new tracheostomy requires specialized skills and knowledge that only a licensed nurse possesses to prevent complications and ensure safety. Providing a back rub (A) can be delegated to an AP as it is within their scope of practice. Transporting a stroke client (B) and performing oral hygiene post-amputation (C) can also be delegated as they do not involve complex nursing assessments or interventions. It is crucial to reassign the tracheostomy care task to a licensed nurse to maintain the client's airway safely.
A nurse notes a provider frequently arrives to the unit with bloodshot eyes and smells like alcohol after lunch. Which of the following actions should the nurse take?
- A. Inform the state medical board for an immediate investigation.
- B. Counsel the provider to determine the cause of the substance abuse.
- C. Notify the nursing supervisor of the concerns.
- D. Encourage clients to change to a different provider.
Correct Answer: C
Rationale: The correct answer is C: Notify the nursing supervisor of the concerns. This is the most appropriate action because it allows for immediate intervention by someone in authority to address the provider's behavior. The nursing supervisor is in a position to assess the situation, determine the appropriate course of action, and provide support to the nurse in dealing with this sensitive issue. Reporting to the state medical board (choice A) may be premature and could potentially harm the provider's career without first addressing the issue internally. Counseling the provider (choice B) may not be effective if there is a serious substance abuse problem. Encouraging clients to change providers (choice D) is not the nurse's responsibility and may not address the root cause of the issue.
A nurse is caring for a client who is postoperative and has a chest tube. The nurse notes that the chest tube is disconnected from the drainage system. Which of the following actions should the nurse take first?
- A. Reconnect the chest tube to the drainage system.
- B. Clamp the chest tube near the insertion site.
- C. Notify the provider of the disconnection.
- D. Place the end of the chest tube in sterile water.
Correct Answer: D
Rationale: Placing the end of the chest tube in sterile water prevents air from entering the pleural space, which could cause a pneumothorax, making it the priority action.
A nurse is assessing four clients on a medical-surgical unit. Which of the following clients should the nurse care for first?
- A. A client who has pneumonia and has an axillary temperature of 38° C (101° F)
- B. A client who has diarrhea and requests clear liquids for breakfast
- C. A client who has a cast on the left leg and reports numbness and paresthesia
- D. A client who has type 1 diabetes mellitus and has a fasting blood glucose level of 150
Correct Answer: C
Rationale: The correct answer is C because numbness and paresthesia in a client with a cast can indicate compartment syndrome, a medical emergency requiring immediate attention to prevent tissue damage or loss of limb. This condition can lead to permanent disability if not addressed promptly. Clients with pneumonia (choice A) and elevated temperature can be managed with antipyretics and antibiotics, while a client with diarrhea (choice B) requesting clear liquids can be managed with dietary adjustments. A client with type 1 diabetes and a blood glucose level of 150 (choice D) may require insulin adjustment but is not as urgent as addressing potential compartment syndrome.
A nurse manager is observing the care provided by a nurse who is in orientation to the unit. Which of the following actions by the nurse indicates the nurse manager should intervene?
- A. The nurse opens the top flap of a sterile tray toward the body when assisting the provider with a thoracentesis.
- B. The nurse uses clean gloves when discontinuing a client's intravenous infusion.
- C. The nurse uses the client's telephone number as one form of identification when administering medications to a client.
- D. The nurse empties a client's drainable colostomy pouch when it is one-third full.
Correct Answer: C
Rationale: The correct answer is C. Using a client's telephone number as identification is a violation of privacy and confidentiality. It is not a secure or reliable form of identification and could lead to errors in medication administration. The other choices do not indicate immediate intervention is needed. A: Opening the top flap of a sterile tray is incorrect but may not cause immediate harm. B: Using clean gloves for discontinuing an IV infusion is incorrect, but can be corrected easily. D: Emptying a colostomy pouch when it is one-third full is appropriate to prevent skin irritation and leakage.