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A nurse is planning to delegate tasks to a licensed practical nurse (LPN). Which of the following entities is important for the nurse to understand when delegating tasks to the LPN?
- A. The National Council of State Boards of Nursing Decision Tree
- B. The state Nurse Practice Act
- C. The Omnibus Budget Reconciliation Act of 1987
- D. The National Association for Practical Nurse Education and Services
Correct Answer: B
Rationale: The correct answer is B: The state Nurse Practice Act. The Nurse Practice Act outlines the scope of practice and legal responsibilities for nurses in each state. When delegating tasks to an LPN, the nurse must adhere to the regulations and guidelines set forth in the Nurse Practice Act to ensure safe and appropriate delegation. Understanding this act is crucial to prevent legal and ethical violations.
Incorrect Choices:
A: The National Council of State Boards of Nursing Decision Tree - While this resource provides guidance on delegation, the Nurse Practice Act holds legal authority.
C: The Omnibus Budget Reconciliation Act of 1987 - This act relates to healthcare financing and does not specifically address the delegation of tasks to LPNs.
D: The National Association for Practical Nurse Education and Services - This organization focuses on education and services for LPNs but does not dictate legal guidelines for delegation.
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A nurse is planning to assign tasks for a group of clients. Which of the following tasks should the nurse plan to assign to an assistive personnel (AP)? (Select all that apply.)
- A. Ambulate an older adult client who has hypertension.
- B. Provide discharge instructions for a client who has a new skin graft.
- C. Check a blood product with another nurse prior to administration.
- D. Weigh a client who has heart failure.
- E. Perform an admission assessment on a client.
Correct Answer: A,D
Rationale: The correct tasks to assign to an assistive personnel (AP) are A and D. APs are trained to assist with basic care activities. Ambulating an older adult client with hypertension and weighing a client with heart failure are within the scope of practice for APs as they do not involve complex assessments or critical decision-making. Providing discharge instructions (B) requires specialized knowledge and education, which is beyond the scope of an AP. Checking a blood product (C) and performing an admission assessment (E) require specific training and expertise that only licensed nurses should perform.
A nurse has received change-of-shift report and is delegating tasks to the assistive personnel (AP). The nurse should tell the AP to complete which of the following tasks first?
- A. Perform blood glucose monitoring of a client who has a prescription for short-acting insulin prior to breakfast.
- B. Apply a condom catheter to a client who is incontinent.
- C. Deliver a clean voided urine specimen to the laboratory.
- D. Feed a client who has bilateral casts due to upper arm fractures.
Correct Answer: A
Rationale: The correct answer is A: Perform blood glucose monitoring of a client who has a prescription for short-acting insulin prior to breakfast. This task should be completed first because it involves monitoring a client's blood glucose level to ensure safe administration of insulin. Insulin administration is time-sensitive and should be based on current blood glucose levels to prevent hypoglycemia or hyperglycemia. This task directly impacts the client's immediate health and safety, making it the priority.
Summary of other choices:
B: Applying a condom catheter can be important but is not as time-sensitive or critical as monitoring blood glucose levels for insulin administration.
C: Delivering a clean voided urine specimen is important but can often wait until after more urgent tasks are completed.
D: Feeding a client with bilateral casts is important, but it is not as time-sensitive as monitoring blood glucose levels for insulin administration.
A nurse is participating in a disaster drill for a chemical spill. Which of the following actions should the nurse take first when caring for exposed clients?
- A. Administer antidotes for the chemical agent.
- B. Decontaminate clients by removing contaminated clothing.
- C. Assess clients for respiratory distress.
- D. Document the number of affected clients.
Correct Answer: B
Rationale: Decontaminating clients by removing contaminated clothing is the first step to prevent further exposure and harm, aligning with disaster response protocols for chemical spills.
A nurse suspects that a coworker is diverting opioid analgesics. Which of the following is an adverse effect of opioid medications?
- A. Dilated pupils
- B. Euphoria
- C. Rhinorrhea
- D. Hallucinations
Correct Answer: B
Rationale: The correct answer is B: Euphoria. Opioid medications can cause euphoria as they act on the brain's reward system, leading to feelings of pleasure and well-being. This can contribute to their potential for misuse and diversion. Dilated pupils (A) are a common side effect of opioid use, not an adverse effect. Rhinorrhea (C) refers to a runny nose and is not typically associated with opioid use. Hallucinations (D) are rare but possible with high doses or in susceptible individuals. In summary, euphoria is a known adverse effect of opioid medications, making it the correct choice.
An RN is delegating care activities to a licensed practical nurse (LPN). Which of the following is the priority criterion the RN should consider when delegating?
- A. Agency policies for the LPN
- B. The documented experience level of the LPN
- C. The documented skill level of the LPN
- D. State Nurse Practice Act for the LPN
Correct Answer: D
Rationale: The correct answer is D: State Nurse Practice Act for the LPN. This is the priority criterion because the Nurse Practice Act outlines the scope of practice for LPNs in a specific state, ensuring that the tasks delegated are within their legal scope. This helps to protect patient safety and ensures legal compliance.
A: Agency policies for the LPN - Agency policies are important but do not take precedence over legal requirements outlined in the Nurse Practice Act.
B: The documented experience level of the LPN - Experience level is important but does not guarantee legal authority to perform certain tasks.
C: The documented skill level of the LPN - Skill level is important but does not override legal limitations set by the Nurse Practice Act.