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An LPN, serving as team leader to a team consisting of LPNs and nursing assistants, is making client assignments. Which client situation should prompt the team leader to use acuity measures to reduce an LPN's assignment?
- A. A client who demonstrates oxygen desaturation with minimal exertion
- B. A client with dementia who is combative during medication administration
- C. A client who requires the assistance of two for ambulation
- D. A client who requires several intravenous antibiotics to treat a septic infection
Correct Answer: A
Rationale: Acuity refers to the severity of the illness and the rapidity of change in the client, and thus the intensity of medical and nursing care and other therapies required. A client who desaturates with minimal exertion is at risk for respiratory compromise and respiratory arrest. This will require careful and frequent assessment that will limit the time the nurse will have for other client interactions. Dementia is a chronic condition making daily activities such as medication administration, but it does not require the frequent assessment that the client who demonstrates oxygen desaturation requires. The client who requires assistance with ambulation also is not at risk for severe complications like the client with oxygen desaturation. A client with multiple intravenous antibiotics should improve as treatment progresses and does not require the level of assessment and care that the client with oxygen desaturation will require.
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A nurse in the health care provider's office must provide care to the following clients. From first to last, in what order should the nurse provide needed care to the clients?
- A. A client in an examination room who reports flulike symptoms
- B. A client seated in the office reception area who reports chest heaviness
- C. A client on the phone inquiring about doubling a dose of medication because of a missed dose the day before
- D. A client requires a call back by the nurse for advice on a medication dosage change
- E. A client who stopped into the office to pick up sample medications
Correct Answer: B,A,C,D,E
Rationale: All nurses must manage multiple client needs in a timely manner. Nurses must prioritize to determine the proper order of response. Nurses should address issues critical to maintaining life first (airway, breathing, circulation). A client with chest heaviness potentially could be having a life-threatening condition requiring immediate attention. Next, the client in the exam room needs vital signs and a history of present illness before the health care provider enters. To maintain the flow of the office, this client is a priority. Next, the nurse would answer the question of the client on the phone who may otherwise incorrectly ingest a double dose of medication. Next, a client needs to be called with a medication dosage change. Last, the client in the office who has come to obtain sample medication needs medication instruction on dosage and side effects.
A new client charting system is in the education phase at a healthcare facility. Much discussion has been prompted regarding the new system. With which statement does the nurse best exhibit the integrated leader/manager traits?
- A. Let's look at the daily benefits of using the new technology on the clinical unit.'
- B. I am not used to the new technology, but if it better serves the client and enables easy sharing of client authorized records, I see a benefit.'
- C. New technology may be costly up front but will serve us well in the future.'
- D. I do not believe that this technology will be helpful in caring for a client because it often is down during peak use times and is difficult to train for.'
Correct Answer: B
Rationale: The traits of an integrated leader/manager combine understanding the daily operations on a clinical unit while seeing the big picture, thinking in the long term, and embracing change. Better serving the client and sharing records as needed demonstrates the willingness to think positively and take risks on improvement for the future. Focusing only on the daily benefits or only on the future impact of using the new technology each only look at one aspect of leadership and management. Stating that the new technology will not be helpful in client care is a negative statement and does not show that the manager is able to embrace change.
Which of the following would not be considered one of the five rights of delegation?
- A. Educational level
- B. Task
- C. Circumstances
- D. Person
Correct Answer: A
Rationale: The NCSBN (2019) identified the five rights of delegation: right task, right circumstances, right person, right direction/communication, and right supervision/evaluation. Educational level is not one of the five rights of delegation.
The LPN is caring for a full nursing assignment and delegates specific duties to the unlicensed assistive personnel (UAP). Which nursing action would best assess the competency of the UAP to complete the assignment?
- A. Ask the client if the assignments were completed.
- B. Review the documentation that the assignment was completed.
- C. Ask the UAP exactly how the assignment was completed.
- D. Observe the UAP during completion of the assignment.
Correct Answer: D
Rationale: Observing the UAP is the best way for the LPN/LVN to assess the competency of the UAP. All delegates must demonstrate knowledge and competency on how to perform a delegated responsibility. Reviewing the documentation or asking the UAP to explain how the assignment was completed will not demonstrate the UAP's competency. Asking the client if the assignment was completed may confirm its completion but does not address the UAP's competency.
The LPN is assigning clients on a rehabilitation unit. Which of the following nursing actions should the LPN complete prior to assigning any delegated task?
- A. Complete nursing report
- B. Review physician notes
- C. Assess the clients
- D. Obtain feedback from the CAN
Correct Answer: C
Rationale: Assessing the client prior to delegation assures the right person, task, and circumstance. The licensed nurse should assess the appropriateness of assignment to meet the skills of the person being delegated to. Completing nursing report provides information about the client, which the assessment phase confirms. Reviewing physician notes provides updated information regarding medical prescriptions. Obtaining feedback on the assignment from CNA provides information on skill level.