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A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to:
- A. supplement the staffing pattern when an RN is not available.
- B. aid the RN by performing appropriately delegated care tasks.
- C. replace the RN when the health care facility provides long-term care.
- D. provide patient teaching, allowing more direct care to be provided by the RN.
Correct Answer: B
Rationale: The correct answer is B: aid the RN by performing appropriately delegated care tasks. UAP and LPN/LVNs are crucial in supporting the RN by carrying out tasks within their scope of practice under the RN's supervision. This is essential to ensure efficient patient care delivery and allow the RN to focus on more complex nursing assessments and interventions.
A: Supplementing the staffing pattern when an RN is not available is incorrect because UAP and LPN/LVNs work alongside RNs, not as substitutes for them.
C: Replacing the RN in long-term care settings is incorrect as UAP and LPN/LVNs provide valuable assistance but do not replace the RN's role.
D: Providing patient teaching to allow more direct care by the RN is incorrect as UAP and LPN/LVNs focus on task-based care rather than patient education, which is typically within the RN's scope of practice.
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An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to:
- A. check the patient's drug packages to ensure that the correct drugs were given.
- B. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner.
- C. contact the nurse manager and ask that the LPN/LVN's license be suspended.
- D. call the pharmacy and ask for replacement medications for the patients.
Correct Answer: B
Rationale: The correct answer is B: stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. This is the priority intervention because it addresses the immediate issue of potentially incorrect documentation and allows for clarity and understanding between the RN and LPN/LVN. It promotes open communication and a chance to correct any errors that may have occurred.
Choice A is incorrect because checking the drug packages after the fact does not address the issue of potentially incorrect documentation and missed medications.
Choice C is incorrect as it is an extreme response that does not promote a collaborative and educational approach to resolving the situation.
Choice D is incorrect as calling the pharmacy for replacement medications is not necessary at this stage and does not address the immediate concern of potentially incorrect documentation.
The practice of public health nursing and the Henry Street Settlement are credited to:
- A. Mary Breckenridge.
- B. Mary Seacole.
- C. Clara Barton.
- D. Lillian Wald.
Correct Answer: D
Rationale: The correct answer is D: Lillian Wald. Lillian Wald is credited with founding the Henry Street Settlement in New York City in 1893, which pioneered the practice of public health nursing in the United States. She emphasized the importance of providing healthcare services to underserved populations in their own communities. Mary Breckenridge, known for establishing the Frontier Nursing Service, is not associated with the Henry Street Settlement. Mary Seacole was a British-Jamaican nurse known for her work during the Crimean War, not for public health nursing in the US. Clara Barton is known for founding the American Red Cross, not the Henry Street Settlement. Therefore, the correct answer is D, Lillian Wald.
A hospital refused to purchase a better grade of utility gloves, even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the pre-election phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (select all that apply)
- A. Scheduling a meeting in the agency's cafeteria to determine employees' interest in unionization
- B. Distributing nondocumented information that female nurses receive lower annual performance evaluations than do male nurses
- C. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital
- D. Suggesting to workers the likelihood of job loss should the union not win the election
Correct Answer: B
Rationale: The correct answer is B because distributing nondocumented information about gender-based performance evaluations violates the National Labor Relations Act, which prohibits making false statements about an employer. This action could potentially mislead employees and interfere with the election process. Choices A, C, and D are not prohibited actions by the National Labor Relations Board. Choice A involves a legal and common method of gauging interest in unionization. Choice C involves providing information about union benefits and grievances, which is a protected activity. Choice D is permissible as long as it does not contain false or coercive statements.
A nurse who is teaching a class to introduce telehealth to the staff would include which example?
- A. A robot performs menial housekeeping chores for an invalid patient.
- B. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler.
- C. A physician speaks into a computer, and the admission history is recorded and saved in the patient file.
- D. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly.
Correct Answer: D
Rationale: The correct answer is D because it demonstrates the use of telehealth in monitoring and providing remote care to a patient. In this scenario, a nurse is able to supervise and ensure the correct execution of peritoneal dialysis by observing the patient from a different location. This exemplifies the practical application of telehealth in enhancing patient care and safety.
Choice A is incorrect because it describes a robot performing housekeeping chores, which is not directly related to telehealth or patient care. Choice B is incorrect as it focuses on computer software alerting about drug interactions, but it does not involve remote patient care or monitoring. Choice C is incorrect as it describes a physician dictating an admission history, which is not a direct example of telehealth involving remote patient monitoring or care.
Which statement made by an RN regarding delegation indicates the need for additional teaching? (select all that apply)
- A. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely.
- B. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD.
- C. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion.
- D. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency.
Correct Answer: A
Rationale: The correct answer is A. Delegating the assessment of vital signs during the first 5 minutes of a blood transfusion to UAPs is not appropriate. This is because a reaction can occur within the first few minutes of a blood transfusion, making it crucial for a registered nurse to assess the patient during this critical period. UAPs do not have the education or training to recognize and manage potential adverse reactions promptly.
Choice B is incorrect because an LPN/LVN can indeed administer a PPD if there is no history of a positive result. Choice C is incorrect because LPN/LVNs should not administer medications that have a high potential for adverse effects, such as dopamine. Choice D is incorrect as transferring a patient who is being discharged home requires skilled nursing assessment and intervention, not just training in transferring techniques.