Practice Question
The nurse is delegating tasks to an unlicensed assistive personal (UAP). Which statement by the UAP indicates the need for further education?
Answer Choices:
Correct Answer:
"I will remove the traction equipment only when needed for repositioning."
Rationale:
🧑⚕️ Traction is applied to maintain bone alignment and reduce muscle spasm, and it must be continuous unless specifically ordered otherwise.
🧑⚕️ Removing traction, even “only for repositioning,” can disrupt alignment, delay healing, and increase risk of neurovascular compromise.
🧑⚕️ Only the nurse and provider should decide if and when traction can be interrupted, often with a specific prescription (e.g., for skin care or repositioning).
🧑⚕️ A UAP should not adjust or remove traction equipment, as this exceeds their scope of practice and compromises patient safety.
🧑⚕️ This statement indicates the UAP needs further education about the importance of maintaining continuous traction and role limitations.
“I will ambulate the patient in the hallway using a gait belt.”
🧑⚕️ Ambulation with a gait belt is an appropriate delegated task when the nurse has assessed the patient’s mobility and deemed it safe.
🧑⚕️ Using a gait belt helps prevent falls and allows the UAP to support the patient’s center of gravity effectively.
🧑⚕️ It reflects understanding of safe patient handling techniques and supports mobility, which reduces risk of immobility-related complications.
🧑⚕️ The UAP remains within their scope, following instructions from the nurse regarding frequency and distance of ambulation.
🧑⚕️ This statement demonstrates appropriate practice, not a need for further education.
“I will have the patient dangle their legs over the side of the bed while sitting before I ambulate with them.”
🧑⚕️ Dangling the legs before ambulation helps prevent orthostatic hypotension by allowing the cardiovascular system to adjust gradually.
🧑⚕️ This practice can reduce dizziness, fainting, and falls in patients who have been lying down or are weak.
🧑⚕️ When the nurse has instructed this, the UAP is correctly using a safe progression of mobility (bed → sitting → standing → walking).
🧑⚕️ It shows awareness of the need to monitor tolerance to activity and report symptoms like lightheadedness.
🧑⚕️ This statement reflects safe, appropriate delegation and does not indicate a knowledge deficit.
“I will make sure there are no wrinkles in the linens after changing the incontinence brief.”
🧑⚕️ Smooth linens help prevent skin friction and pressure points, which reduces the risk of pressure injuries in vulnerable patients.
🧑⚕️ UAPs play a key role in skin care, including keeping the patient clean, dry, and on wrinkle-free sheets.
🧑⚕️ Removing wrinkles is part of good basic nursing care and supports patient comfort and integrity of the skin.
🧑⚕️ This behavior is clearly within the UAP scope and demonstrates understanding of pressure injury prevention.
🧑⚕️ Therefore, this statement does not require further education.
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This question is from ☑️NUR 1130 EXAM 4 EXAMPLIFY which contains 48 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Fundamentals
- Answer Choices: 4