Answer to Question 1
ANS: A
The nurse needs to assess the patient's skin. Assessment should not be delegated; it is the responsibility of the licensed professional nurse. The nurse needs to document the assessment findings objectively, not subjectively per the nursing assistant. Before requesting a consult or determining treatment, the nurse needs to assess the skin.
Answer to Question 2
ANS: C
The nurse needs to intervene if observing the technician taking an oral temperature after consuming any type of beverage because of the potential for a temperature difference in the liquid that may affect the patient's measured temperature. The other options are appropriate.
Patient receiving ultrasound treatment to the left elbow.
A patient centered care approach
A hearing-impaired patient using an interpreter.
Preparing the Patient’s Skin for Surgical Procedures
Nursing Interventions and Prochaska's Stages of Change
Pediatric Nomogram Used for Determining Body Surface Area