Which of the following tasks should the nurse delegate to assistive personnel (AP)? Temporary urinary retention Now, in Option #2, we see a dangerous prescription. A nurse is caring for an older client who is at risk for skin breakdown. c. Hand-off technique Reporting laboratory findings to a member of the client's family (the only people allowed to receive info are those that the client has given permission and those that are working with the client and their case), 29. Pernicious Anemia Society A nurse is rehearsing assertive communication approaches to use when declining leadership of a nursing department committee. The provider must renew a restraint prescription every 8 hr. Client who requires teaching about the use of a patient-controlled analgesia (PCA) pump. Stand directly in front of the client This client could be transferred with traction still maintained. The nurse on a large surgical unit needs to evaluate several clients returning from procedures. c. Foot b. I'll use the cleansing wipes from the front to back A nurse in a clinic is teaching a group of clients about preventing low back pain and injury. b. I should call my doctor if I find it harder to concentrate INCORRECT: Although the vascular status of the foot will need to be assessed, there is no indication if the debridement has been completed yet. The area surrounding the insertion site feels warm to the touch, 61. The word or phrase that you choose must express roughly the same meaning as the italicized word in the passage. Ask client if they are eating small, frequent meals. d. Talk with others who have info about the client, b. I can detect the presence of carbon monoxide by a metallic odor, 58. 1. Correct: A long term care facility is considered a client's "home environment", and families are encouraged to visit often. 4., & 5. Cleanse the wound with 0.9% sodium chloride saline irrigation before obtaining the specimen (nurse should remove all wound exudate and any residual antimicrobial ointment or cream to avoid altering the culture results), 56. Accept the client's behavior as confrontational. 3. Family cannot withdraw the Advance Directive and make decisions that go against the client's wishes made within the document. The client will need to be assessed, but there is no specific indication the respiratory status is presently compromised. The nurse should base her pain management interventions primarily on which of the following methods of determining intensity of the client's pain? Incorrect: This would unnecessarily alarm the clients. Correct: Nurses must immediately report all client care issues, concerns or problems to the supervising nurse, the primary healthcare provider and/or the performance improvement or risk management department. d. The nature and invasiveness of the surgical procedure, d. The nurse has already considered alternatives to restraints, 89. A nurse is developing a plan of care for a client who does not speak the same language as the nurse. c. Nonfat milk Incorrect: The client does need to have food; however, there is another action that should be performed first. c. Hallucinations at the onset of sleep Pain The charge nurse is planning the staff assignments for the clients on a neurological unit. b. Summarization c. The chances of a malpractice suit are minimal as long as you follow our policies and procedures 1. The cleint's family asks the nurse for info about this type of care. C-section planning discharge, postpartum infection, mastectomy. The LPN/LVN can reinforce teaching. a. d. Talk with the client's partner, b. So, this client who is receiving PRN pain medication is certainly someone that the LPN could be assigned to. Incorrect: This client is post cardiac catheterization and remains on bedrest; therefore, the affected leg must be kept straight to prevent femoral hemorrhaging. Which of the following statements should the preceptor make? As part of an annual physical examination a nurse is preparing a client to undergo a chest x-ray. Incorrect: The nurse may trust the UAP; however, the nurse has not been able to determine the competency of the new staff member. The nurse is evaluating care provided by an unlicensed assistive personnel (UAP). c. Behaving defensively 3. 4. Discussing a client's surgical procedure with the nurse manager Send a day's worth of medications with the client to the receiving facility. 1. c. Surgeon (the health care provider who will perform the treatment or procedure is responsible for obtaining informed consent from the client). 3. 2. The assignment process requires constant evaluation and reevaluation of information and priorities. Client diagnosed with a hemorrhagic stroke 1 week ago, who currently has a blood pressure of 170/96. The nurse cannot assign assessment and evaluation of the nursing process to the UAP. A nurse has just finished a wound irrigation for a client who requires contact precautions. Incorrect: The charge nurse should first obtained the needed information and then decide whether to notify the nursing supervisor. The nurse who made the medication error should take which of the following actions first? 1., 2., 3., & 4. Notify the nursing supervisor of the situation. d. Voided 30 mL frequently, 48. d. Routine acquisition of a urine specimen Reach around the pack and open the top flap away from the body A nurse is adhering to standard precautions while caring for a group of clients. Additionally, off-duty personnel may be needed and should be alerted to stand by; however, the command center alone makes the determination whether extra personnel should be called in, or if it would put more individuals in jeopardy. b. Incorrect: The charge nurse cannot change the scope of practice for the LPN by evaluating the intervention. Accept assignment, documenting personal concerns regarding work conditions. Following a passenger train derailment, local hospitals are notified to activate disaster protocols on all floors. Client #3 is receiving heparin sub-q for deep-vein thrombosis, and sub-q injections are within the LPN's scope of practice. 4. b. 5. Changing the subject The third client that should be sent back for treatment is the female client stating she has been raped. 1. Which of the following tasks should the nurse delegate to assistive personncl ( AP) ? Which of the following activities should the nurse perform in this zone? b. Pointing to the two glasses partially filled with water, the magician asked, "Which glass contains the least water?". 5. a. Make referrals to community services. a. Although this will require assessment, this client is not the priority at this time. Incorrect: A client scheduled for surgery after a mastectomy is still able to make decisions. Which of the following actions should the nurse take to assist the client with feeding? is a new graduate in orientation. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes? This service began with the client's admission to the hospital, 18. c. Complete an incident report Incorrect: This response overlooks a potentially severe problem. Incorrect: The RN is responsible for developing the plan of care which would include necessary referrals. A nurse is working with an AP while caring for a surgical client who is 1 day postoperative. Teach caregivers memory enhancement aids. The last client that should be sent back for care is the client experiencing epigastric pain and nausea after eating. What is the most appropriate action by the charge nurse? Most of the following sentences contain errors in the use of modifiers and comparisons. 3. Fundamentals Practice Flashcards | Quizlet This perceived lack of control can create distrust and frustration among personnel, ultimately impacting client care. Which tasks would be appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)? Correct: The client who has a cast and requires pain medication is a stable and predictable client. Four clients arrive for their appointment at a diabetic clinic. Which actions should be instituted by each unit's charge nurse? The nurse has been assigned four clients. 4. Which of the following pieces of PPE should the nurse remove first? Provides day to day direction and supervision to assigned direct patient care staff. Have a pen and paper handy What client should the nurse assess first? 3. Documentation of what occurred, and the client's assessment is required in the nurse's notes. Where on the body is each type of skin found? c. Gender Elizabeth Young BSN, RN-OCN - Registered Nurse - PIEDMONT CANCER Which of the following statements should the nurse identify as an indication the client needs further teaching? 1. c. Lock the medication in a room and finish preparing it after returning from the emergency The nurse is planning care for a client admitted with Alzheimer's Disease. 4. This situation needs advanced monitoring and care, so this nurse with very little postpartum experience would not be the most appropriate to assign to this client. A nurse is preparing an education presentation about organ donation for a group of newly licensed nurses. Practice Leadership Exam for Nursing - A charge nurse in an - StuDocu After making initial assessment rounds on assigned clients in the morning, the RN tells the charge nurse that the clients are too difficult. 3. 3. Which of the following findings should the nurse expect? It is an inherited form of anemia, a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout the body. d. I have a set of my brothers' crutches in the basement I can also use, a. Remember airway, breathing and circulation (ABCs). b. 1. b. Emptying a urinary drainage bag for a client who has pneumonia d. Move to the opposite side of the pack and open the fourth flap, 54. Estimate the number of Calories in two tablespoons of peanut 1, 3 & 5. b. I will call the doctor and get the prescription Charge Nurse - RN | Fresenius Karriere Encourage the client to use self-exploration The responsibility of the nurse manager is to implement change in a positive manner, while assisting staff adaptation even to unpopular modifications. 1. Correct: The client must have lost decision-making capacity because of a condition that is not reversible or must be in a condition that is specified under state law, such as a terminal, persistent vegetative state, irreversible coma, or as specified in the Advanced Directive. 2. A client post pacemaker insertion, awaiting discharge instructions. Making Client Care Assignment NUR 211: Module 4 Assignment Rationale: The patient is stable, she will need to teaching on self-care after a pacer insertion. 5. Correct: Talking to the nurses about client concerns and completing the client assignment sheet for oncoming staff will provide for a thorough shift change report. 4. b. Well, do you see the q.d.? Who should the nurse see first? d. Resistance is evident as subgroups form in this stage, c. Discard the tablet and obtain another dose of medication, 35. (Select all that apply.). The nurse should perform which of the following activities in this space? A nurse is caring for a client who is about to have a colonoscopy. c. Consensus evolves in this stage 3. 4. b. 3. Schedule visiting times in two-hour increments so clients are not overwhelmed. Correct: The nurse should recognize that this child has a very low absolute neutrophil count (ANC), which is referred to a neutropenia. This situation is considered an external disaster which means the hospital will be expecting multiple victims. Client reporting epigastric pain and nausea after eating. Which region of the tRNA pairs with mRNA? 1., 2., 3., & 4. What task would be best to assign to the LPN/LVN? Correct: Advance directives do consist of two types of legal documents: Power of Attorney and a Living Will. The charge nurse on the postpartum unit is making assignments. Document current functional status assessment Convenience for the nursing staff or the client's family Incorrect: The charge nurse does not have to assess every client. 2. a. a. Bathe a client who had an amputation 2 days ago Respite care allows the primary caregiver time away from day-to-day care responsibilities, 75. b. Request a prescription for a medication to ease the client's anxiety 3. Incorrect: No, the monitoring is too specific for the med-surg nurse. Measure urine output when client voids. A nurse in a dialysis center is caring for a client who has a new diagnosis of end-stage kidney disease. d. Reduced blood viscosity, a. Auscultating heart sounds e. Assessing a mole on the client's shoulder, Latin GCSE Vocab - 1st and 2nd Declension Adj, NUR 204 ATI Psychosocial Integrity Ch. d. Discussing intake and output Notify the surgeon that the client wishes to withdraw informed consent for the procedure (the client has the right to withdraw consent therefore the surgeon should be the one notified of the request), 14. 3. Besides, a charge nurse is a leader on the floor and should possess . A nurse is caring for a client who has a wound infection. The situation should be explored before bringing the supervisor in on the situation. Incorrect: Informing is the same thing as teaching. A nurse is administering a cold therapy application to a client. Which clients should be assigned to the CNA? b. Urinary frequency for several days 1. A client who is disoriented and awaiting transfer to a long-term care facility. Reporting laboratory findings to a member of the client's family A client requesting assistance packing his belongings for discharge later today.. c. Explain the risks and benefits of the procedure b. Select all that apply A nurse accidentally sticks her hand with a syringe needle after administering an IM injection to a client. Restock pediatric patient care rooms with oral rehydration fluids using a standardized check list., The charge nurse is preparing the patient care assignments for the day shift, assigning clients to a LPN/LVN and a certified nursing assistant (CNA). Thus, the tasks involve successful management of the charge nurse's responsibilities. a. d. Anger, b. A nurse observes an adolescent client who has paraplegia sitting in a wheelchair crying. b. It involves people who are constantly changing-their conditions improve and deteriorate, they're admitted and discharged, and their nursing needs can change in an instant. 6. b. Incorrect: A colostomy client with diarrhea will have a lot of drainage requiring frequent emptying of the colostomy bag. Which of the following explanations should the nurse provide? 4. If the client is unstable, the nurse would retain the role of measuring the vital signs. D. & 3. 1. If the LPN notes any serious bleeding situations, it would need reported immediately to the RN. For Option #3, you may have recognized MgSO4 as being magnesium sulfate. d. Motor impairment, 84. It's unfortunate that I have to be in the hospital for this treatment (TENS units are portable; they can be used at home), 45. 2. Review the action of insulin therapy Additional data includes pulse 100/min, RR 24/min, BP 124/76 mm Hg, and temp 36.8C (98.2 F). A charge nurse is making client care assignments. Draining the colostomy bag on a client with diarrhea. Semi-formed stools are great news! Post-surgical pain is expected and without further parameters, no determination can be made regarding this client. A float nurse arrives on the unit to assist in the care of clients for the shift. The RN requests reassigning at least one of the clients to another nurse. (Select all that apply.) a. 3. Incorrect: This is a nursing responsibility and the best practice committee is the best place to begin. The client says, "go away, no one can help me." Teach the UAP to change surgical dressings. These areas require the expertise of an RN and would not be appropriate for an LPN/LVN. One important aspect is encouraging the flow of ideas between management and staff members. c. Hold an object away from her body as she lifts it (Select all that apply.). Removing the client's dentures This will allow the charge nurse to analyze the situation to make a better decision as to whether the assignment should be changed. b. (a) HCN(aq)+H2O(l)H3O+(aq)+CN(aq);K=4.91010\mathrm{HCN}(a q)+\mathrm{H}_2 \mathrm{O}(l) \longrightarrow \mathrm{H}_3 \mathrm{O}^{+}(a q)+\mathrm{CN}^{-}(a q); K=4.9 \times 10^{-10}HCN(aq)+H2O(l)H3O+(aq)+CN(aq);K=4.91010 4. d. I'll carry heavy objects close to my body, d. Places clean linen that touched the floor in the soiled linen bag, 25. The nurse should call for immediate help so that a safe care environment is maintained for all clients. Left upper forearm A nurse is providing discharge teaching for a client who requires home oxygen therapy. 2. -Review a low-sodium diet for a client who has HTN . 5. Which group of clients should she assign to the medical surgical nurse? b. Vital sign measurement Administering 3 g/hr IV of morphine would be extremely dangerous. 5. 5. 2. The charge nurse knows what client would be most appropriate for this LPN? Electric cords behind the furnitrure b. Lisinopril 20.0 mg PO daily The client asks the nurse, "Why do I need that? a. The charge nurse must triage and assign clients to appropriate staff. A client receives a wrong medication. Refuse the delegated intervention. Of the following barriers to learning the nurse identifies with this client, which should the nurse interpret as a need to postpone the session? Determining the client's length of stay a. 2. Taking the report from the ED could be delayed but is a courtesy to the ED and will provide information about the client that will be useful in making assignments for the next shift. Based on this information,what should the nurse do? Female client stating she has been raped. c. Do not eat or drink anything the morning of the test The nurse is using which of the following therapeutic communication techniques?
