a charge nurse on a long term care unit is preparing to delegate tasks to a licensed practical nurse lpn and an assistive personnel ap which of the fo
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1. A charge nurse on a long-term care unit is preparing to delegate tasks to a licensed practical nurse (LPN) and an assistive personnel (AP). Which of the following tasks should the charge nurse delegate to the LPN?

Correct answer: B

Rationale: The correct task to delegate to the LPN is administering initial NG tube feeding. LPNs are trained to carry out this task as it falls within their scope of practice. Inserting an IV catheter (Choice A) is typically performed by registered nurses. Administering insulin (Choice C) and giving medications for diabetes (Choice D) involve assessing the patient's condition and adjusting medication dosage, which are responsibilities of registered nurses or higher-level healthcare providers.

2. A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the following should the nurse recognize as a positive response to the therapy?

Correct answer: C

Rationale: Increased urine output is a positive sign that the IV fluids are effectively treating dehydration. Tachycardia (choice A) and hypotension (choice B) are signs of dehydration and would not be considered positive responses to therapy. Diarrhea (choice D) can worsen dehydration and is not a positive response to IV fluid therapy.

3. A client has a history of oliguria, hypertension, and peripheral edema. Current lab values are: BUN - 25, K+ - 4.0 mEq/L. Which nutrient should be restricted in the client's diet?

Correct answer: A

Rationale: In clients with oliguria, hypertension, and peripheral edema, protein should be restricted in the diet to reduce the workload on the kidneys. Excessive protein intake can lead to increased BUN levels, which can further stress the kidneys. Restricting protein can help prevent further kidney damage. Fats, carbohydrates, and magnesium do not directly impact kidney function in the same way as protein does, making them incorrect choices in this scenario.

4. A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following places the client at risk for aspiration?

Correct answer: A

Rationale: The correct answer is A: A history of gastroesophageal reflux disease. Clients with gastroesophageal reflux disease have a higher risk of aspiration during tube feeding due to the potential for reflux of stomach contents into the lungs. This increases the risk of aspiration pneumonia. Choices B, C, and D are incorrect. High osmolarity formulas may cause diarrhea but do not directly increase the risk of aspiration. Sitting in a high-Fowler's position actually reduces the risk of aspiration by promoting proper digestion and reducing the chance of regurgitation. A residual of 65 mL 1 hour postprandial is within an acceptable range and does not directly indicate a risk for aspiration.

5. Which of the following situations can be identified as an ethical dilemma?

Correct answer: B

Rationale: The correct answer is B. Ethical dilemmas involve conflicting values or feelings. In this situation, the family is conflicted about tube feeding for their terminally ill father, which presents a moral and ethical challenge. Choices A, C, and D do not represent ethical dilemmas. Choice A involves a nurse's impairment, which is a different issue. Choice C involves a nurse's observation of a colleague's threat, which is a patient safety concern. Choice D involves a client's hesitation in naming a spouse as power of attorney, which is a legal and decision-making issue, not necessarily an ethical dilemma.

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