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The RN is delegating tasks to the unlicensed assistive personnel (UAP). Which tasks can the nurse delegate? (Select all that apply.)
- A. Teaching the patient about breast care
- B. Assessment of a patient’s lochia and perineal area
- C. Assisting a patient to the bathroom for the first time after birth
- D. Vital signs on a postpartum patient who delivered the night before
Correct Answer: C
Rationale: A. Teaching the patient about breast care typically requires specialized knowledge and is best performed by the nurse.
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The nurse is caring for a patient receiving chemotherapy. What nursing intervention would they provide?
- A. Administer antibiotics.
- B. Administer antiemetics.
- C. Encourage physical activity after infusion.
- D. Encourage eating a large meal.
Correct Answer: B
Rationale: Patients receiving chemotherapy often experience nausea and vomiting as common side effects. Antiemetics are medications specifically designed to help manage and prevent these symptoms. By administering antiemetics, the nurse can help the patient feel more comfortable and reduce the risk of dehydration and other complications associated with nausea and vomiting. This intervention is crucial in supporting the patient's overall well-being and enhancing their quality of life during chemotherapy treatment.
A Vietnamese patient who speaks little English is admitted to the labor and birth unit in early labor. The nurse plans to use an interpreter during an initial assessment. Which should the nurse plan to implement with regard to using an interpreter? (Select all that apply.)
- A. Face the interpreter when speaking.
- B. Listen carefully to what the patient says.
- C. Speak slowly and smile when appropriate.
- D. Plan to use a male interpreter, even if a female interpreter is available.
Correct Answer: A
Rationale: A. Face the interpreter when speaking: By facing the interpreter when speaking, the nurse ensures clear communication and demonstrates respect for the interpreter's role in facilitating understanding between the patient and healthcare provider.
A medical-surgical nurse is asked to float to a women’s health unit to care for patients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and the nurse is familiar with caring for postoperative patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?
- A. The staff nurse has the reNspoRnsibIilityG of Bac.ceCptinMg any assignment that is made U S N T O while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment.
- B. Because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to patients who need care.
- C. The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
- D. The nursing supervisor should emphasize that this assignment requires care of a surgical patient for which the staff nurse is adequately trained and should therefore enforce the assignment.
Correct Answer: C
Rationale: In this situation, the nurse's refusal to accept the assignment is based on personal beliefs that conflict with the nature of the medical practice (therapeutic abortions). According to the American Nurses Association (ANA) Code of Ethics, nurses have the right to refuse assignments that go against their personal, cultural, or religious beliefs. The nurse in this scenario has expressed a legitimate concern, and the nursing supervisor should respect the nurse's autonomy and should not enforce the assignment. It is essential to balance respecting the nurse's beliefs while also ensuring patient safety and adequate staffing levels.
The clinic nurse often cares for patients who are considering an abortion. Which responsibilities does this nurse have in regard to this issue? (Select all that apply.)
- A. Informing the patient about pro-life options
- B. Informing the patient about pro-choice support groups
- C. Being informed about abortion from a legal standpoint
- D. Being informed about abortion from an ethical standpoint
Correct Answer: B
Rationale: B. Informing the patient about pro-choice support groups: It is important for the clinic nurse to provide patients with information about different support resources available, including pro-choice support groups, to ensure they have access to a variety of perspectives and guidance.
What nursing intervention would the nurse include in the preoperative care plan for a patient scheduled for an outpatient lumpectomy of a fibroadenoma?
- A. Administer pain and antiemetic medications.
- B. Help the patient arrange for a cab home after the procedure.
- C. Advise the patient to avoid food or drink for 2 hours before surgery.
- D. Review discharge instructions.
Correct Answer: C
Rationale: It is essential to advise the patient to avoid food or drink for at least 2 hours before surgery to reduce the risk of aspiration during the procedure. An empty stomach helps prevent vomiting and aspiration of stomach contents that could potentially lead to respiratory complications during the surgical procedure. This is a crucial preoperative nursing intervention to ensure patient safety and preparation for the lumpectomy surgery. Administering pain and antiemetic medications, arranging for transportation home, and reviewing discharge instructions are important aspects of care but do not directly impact the patient's safety during the procedure like fasting before surgery does.