Which task would the nurse delegate to an unlicensed health care worker quizlet?

Recommended textbook solutions

Technical Writing for Success

3rd EditionDarlene Smith-Worthington, Sue Jefferson

468 solutions

Edge Reading, Writing and Language: Level C

David W. Moore, Deborah Short, Michael W. Smith

304 solutions

Technical Writing for Success

3rd EditionDarlene Smith-Worthington, Sue Jefferson

468 solutions

The Language of Composition: Reading, Writing, Rhetoric

2nd EditionLawrence Scanlon, Renee H. Shea, Robin Dissin Aufses

661 solutions

3. A 68-year-old client with multiple sclerosis, 2 days postoperative open cholecystectomy with recurrent mucous plugs, who is scheduled for a bronchoscopy this morning

To prepare a client for a bronchoscopy, the nurse must be able to perform basic assessment skills, such as assessing vital signs, lung sounds, ability to swallow, and gag reflex; maintain nothing-by-mouth status; prepare a checklist before the procedure; and monitor for respiratory difficulty after the procedure. Because these are skills a graduate nurse possesses, this is an appropriate assignment.(Option 1) Initiating a heparin infusion according to institution protocol involves collecting baseline serum specimens (eg, partial thromboplastin time [aPTT], International Normalized Ratio [INR], prothrombin time, platelets, hemoglobin, hematocrit), calculating weight-based dosages, (eg, bolus dose, infusion rate in units/hr), and calculating intravenous infusion pump hourly rate. Serum aPTT and INR levels are monitored every 6 hours or according to protocol. Frequent changes in rate or dose based on these levels may be necessary to maintain a therapeutic level of heparin. For these reasons, this is not an appropriate assignment for a new graduate nurse.(Option 2) A client with newly diagnosed cancer who is refusing radical surgery that will result in the loss of speech and inability to communicate normally is demonstrating fear and anxiety. This client needs preoperative teaching about the surgical procedure, what to expect immediately after surgery, methods for speech restoration, and general preoperative teaching (eg, deep breathing, suctioning, pain management). Emotional support, education, and advanced therapeutic communication skills are necessary to help allay fear and anxiety. For these reasons, this is not an appropriate assignment for a new graduate nurse.(Option 4) The elderly client with new-onset confusion is at risk for developing hospital-induced delirium related to advanced age, surgery, hypoxia, fluid and electrolyte disturbances, immobility, pain, and/or drugs. The nurse must perform neurological assessments to determine the cause and intervene appropriately. For these reasons, it is not an appropriate assignment for a new graduate nurse.
Educational objective:When assigning clients to the appropriate staff member, the RN must consider the individual client needs and the skills of the staff member. The more experienced RN is assigned to the client with the more complex physiologic and psychologic needs, who requires a more advanced level of nursing skill. The new graduate nurse is assigned to the client with less complex needs, who requires basic nursing skills, such as measurement of vital signs and basic physical assessment.

1. Correct: A hiatal hernia occurs when a portion of the stomach pushes up through the esophageal ring (hiatus) of the diaphragm. Surgical intervention is generally a last resort and only when there is evidence of serious complications. Although chest pain could be the result of reflux within the esophagus, it could also indicate a strangulated hiatal hernia. The nurse needs to assess this client immediately.

2. Incorrect: A torn rotator cuff is generally only repaired when other treatment options have been ineffective, such as rest, ice, NSAIDs and even steroid injections. This client has been ordered a surgical repair, indicating other therapies have failed. Shoulder pain on the affected side is to be expected and not an urgent need.

3. Incorrect: An inguinal hernia is the protrusion of intestine through abdominal muscles, creating a painful bulge which worsens with lifting, bending, or straining. Skin irritation usually results from wearing a supportive garment known as a truss. The purpose of this belted device is to apply pressure and provide support to the area of the hernia until surgical repair. Skin irritation is not the nurse's priority.

4. Incorrect: Large or engorged rectal hemorrhoids may require surgical repair because of excessive bleeding, pain, or prolapse. This type of bleeding is not unexpected nor does it present any major concerns about shock. This client would not need to be seen first.

2. Correct: Preschool children, ages 3 to 5, are in the Erikson stage of "initiative versus guilt" where the learning goals involve exploration and manipulation of the environment. Motor skills are developing, and playing is used to increase self-esteem through imagination and creativity. Stacking small blocks to build structures or create creatures is definitely appropriate for this age group and can easily be done on the bedside table.

1. Incorrect: A preschool child may not have the patience to sit through an entire television show. Additionally, this would not address the developmental needs of this age group, which focuses on creative activities such as coloring, painting, playdough, or building blocks. Even hospitalized children must have their developmental needs addressed. Television may appeal more to adolescents.

3. Incorrect: Table games like checkers are more appropriate for school age children, who tend to like group activities, particularly with peers of the same age and sex. Playing checkers is too tedious and inactive for a young preschooler.

4. Incorrect: Card games, even those designed for children, are generally too boring for youngsters. Preschool children prefer activities which require imagination and activity with others. Dressing up in clothing, riding bikes, or other physical games are good for engaging this age group. In the hospital, creativity can be encouraged with drawing, chalk, or playdough.

3 & 5. Correct: Positive outcomes are more likely when staff feels appreciated, receiving constructive and encouraging feedback on a regular basis. Evaluations can be very stressful when staff are uncertain of expectations or are perceived in a negative framework. Seeking clarification on how staff organize assignments indicates awareness and may help in developing new protocols. Also, showing interest in individual goals will help develop learning opportunities for all staff.

1. Incorrect The tone of this question is derogatory, implying the individual is not able to complete daily assignments in a timely manner without assistance.

2. Incorrect: This inquiry is worded in a negative manner, implying the individual may not have the ability to learn new skills.

4. Incorrect: Although this might present information the nurse manager might use to develop more learning opportunities, the negative approach may intimidate staff, preventing complete honesty.

All facilities provide periodic evaluations of staff to improve performance and enhance productivity. Many staff personnel dread these evaluations which often focus on negative issues that point out only personal short-comings. However, a well worded evaluation can help an employee improve skills while providing positive feedback and encouragement. Did you also notice that among the options for the new staff evaluation form, several areas are close-ended while others are open-ended statements? Therapeutic techniques should always be worded in such a way that allows or encourages a client to verbalize feelings. This brings up another issue. Who is the actual client in this question? The client is the staff for whom the nurse manager is developing a new evaluation form! Therefore, the wording on that form should be professional, positive, and open-ended in order to obtain accurate information.

2., 3. & 4. Correct: Developing a single response plan, educating individuals to the specifics of the response plan, and practicing the plan and evaluating the facility's level of preparedness are effective means of implementing emergency preparedness. The basic principles of emergency preparedness are the same for all types of disasters. Only the response interventions vary to address the specific needs of the situation.

1. Incorrect: One good response plan, not multiple plans, should be developed. This will ensure adequate understanding of the plan and decrease confusion of roles that could occur with multiple plans. Different types of disasters have been identified such as natural disasters, severe weather, recent outbreaks, radiation emergencies, chemical emergencies, and bioterrorism. There is no feasible way for the hospital to have a response plan for every potential disaster. The overall disaster plan can be modified for specific intervention for different types of disasters.

5. Incorrect: All client care duties cannot safely be assigned to one caregiver. The nursing supervisor needs the help of other staff to carry out nursing care for the clients in the hospital.

3. & 5. CORRECT: A UAP can perform any activities of daily living (ADL), including feeding, transfers in or out of bed and ambulation. Feeding a child whose hands are bandaged is an appropriate task. Also, ambulating the adolescent is definitely within the scope of duties for the UAP.

The RN cannot delegate assessment, evaluation, plan of care development, or teaching to an LPN or UAP. When contemplating the options in this question, consider whether the action would require any type of assessment or advanced training in order to complete.

1. INCORRECT: Obtaining a urine sample from an infant is too complex for a UAP. The two methods used for collecting this urine sample is either straight catheterization of the infant or use a "wee bag". Neither of these methods can be performed by a UAP.

2. INCORRECT: Emptying containers can be within the realm of duties for a UAP. However, that does not include a NG canister. A nurse must assess the color, consistency, and amount of drainage in the canister in addition to location and position of the NG tube. This particular action should be completed by a nurse.

4. INCORRECT: Changing an ostomy appliance is a complex task. A nurse needs to assess the skin for evidence of skin breakdown or excoriation that needs treated before another flange is applied. The nurse must also assess the condition of the stoma. This is not a task appropriate for a UAP, although emptying the ostomy bag would be appropriate.

1. Corect: When moving a client, the most important safety action for the staff doing the lifting is to spread their feet apart to shoulder width, with knees slightly bent, to prevent back injury. The feet should never be placed together. The most stable part of the body is at the hips, and moving feet apart stabilizes the lifter. The nurse would intervene in this scenario before the UAPs are injured.

2. Incorrect: The UAPs are aware when sliding a client up in bed, if the client does not lift their head, the sudden movement could hyperextend the client's neck, causing severe trauma. The client must lift head off bed just before the staff moves the draw sheet to prevent neck injury. This is a correct action.

3. Incorrect: When moving an obese client, there should be at least two staff members on each side of the bed, grasping the draw sheet with both hands. With a firm grasp on the draw sheet, the staff then slides the client upward in the bed. The UAPs completed this action correctly.

4. Incorrect: Before moving the client upward, all staff should turn slightly toward the head of the bed, feet planted shoulder width apart and firmly grasp the draw sheet with both hands. This position is correct for both client and staff safety.

3. & 5. Correct: The nurse should follow the procedure to return the narcotic, and then the nurse should report the observation to the supervisor. The nurse must serve as client advocate by reporting a nurse who may be impaired.

1. Incorrect: This may be the first observation; however, it is unlikely that it is the first incidence. The impaired nurse must be reported. You are responsible to the clients on the unit, not to the staff member.

2. Incorrect: The supervisor is the one to provide information on obtaining help. The hospital or long term care facility will have a policy for the supervisor to follow and usually this policy also includes rehabilitation. The nurse may say okay to you if you tell them to get help, but then never seek help. The person caught will generally do or say anything to keep the authorities from finding out. As a colleague you can offer support, but don't go there alone.

4. Incorrect: The nurse should leave if she is taking narcotics. The supervisor will be the one to send the nurse home. The supervisor needs to determine if the degree of impairment would interfere with the ability to drive home safely.

Note on impaired nurses: Impaired nurses can become dysfunctional in their ability to provide safe, appropriate client care. Addiction is considered a disease, but the addicted nurse remains responsible for actions when working. Nurses should be aware of the signs and symptoms of substance abuse and know when to report a coworker suspected of substance abuse to management. While it may be very difficult to suspect a co-worker of substance abuse, and the fear of reprisal may keep some nurses from action, it's important to take the steps necessary to confront or notify the nurse manager of your suspicions. Educate yourself on the organization's policy and procedures for employee substance abuse and employee assistance programs. Careful documentation of any changes in the suspected impaired nurses' behaviors is important. Legal aspects to report a substance-abusing nurse vary among individual states, but nurses have an ethical and moral duty to clients, colleagues, the profession of nursing, and the community to take action. Documents such as the American Nurses Association Code of Ethics for Nurses provide a framework for client safety. Consider the following: Do not ignore poor performance; Do not lighten or change the nurses' patient assignment.; Do not accept excuses; Do not allow yourself to be manipulated or fear confronting a nurse if patient safety is in jeopardy.

There are several clues in this question which present important information. First, note this LPN is newly hired, which would indicate either orientation or learning is still in progress. Secondly, the charge nurse is to make an actual client assignment.

2. Correct: The general scope of practice for a licensed practical nurse (LPN) includes the completion of tasks with predictable outcomes. Completing perineal care is definitely within the LPN's scope of practice. If any irregularities are noted, such as amount or color of drainage, the LPN would report this to the RN for further assessment.

1. Incorrect: Although bottle feeding may sound like a simple task, there are multiple on-going assessments involved with newborns. A nurse must evaluate whether the infant can latch on, has an appropriate sucking reflex, or if the newborn displays any allergic reactions to the milk. This task should be designated to an experienced nurse rather than the LPN.

3. Incorrect: While it is not inappropriate for a newly hired LPN to observe this unique surgery, it would not help orient or prepare the individual for working on the unit. The LPN should be preparing for other duties or working with a preceptor to learn the floor routine.

4. Incorrect: A number of staff members could ambulate clients to the bathroom, including the LPN or unlicensed assistive personnel (UAP). This task could easily be designated to the UAP, allowing the charge nurse to better utilize the LPN's abilities within the scope of practice.

1., 4., 5., & 6. Correct: Federal and state laws require that certain individuals, particularly those who work in health care with the elderly, with children, and other vulnerable populations, have an affirmative duty to report to a specified state agency when violence occurs against those populations. This includes physical, mental, and financial abuse. Gunshots and knife injuries are reportable to law enforcement. Certain communicable diseases such as gonorrhea and West Nile virus are reportable to the CDC.

2. Incorrect: Suspected negligence of a colleague is not in the realm of mandatory reporting to authorities, but the nurse should discuss with the supervisor.

3. Incorrect: A spouse is not considered a vulnerable person so it is not required by law to report. You should encourage the spouse to report the abuse but you, as the nurse, are not bound by law to do so.

4. Correct: The nurse has not been able to determine the skill of vital sign assessment for this new UAP. When the licensed person cannot determine this, the task should not be delegated. This determination is needed to assure client safety is being considered.

1. Incorrect: The nurse may trust the UAP; however, the nurse has not been able to determine the competency of the new staff member. Since this is a postoperative client, It is important that the vital sign measurement is accurate to detect any changes or possible complications.

2. Incorrect: When a unit is very busy, the nurse should rely on the UAP if the person is competent to perform the tasks. In this situation, it is not a matter of the nurse preferring to take all the vital signs, but the nurse needs to know the competency level of the UAP before delegating this task.

3. Incorrect: The nurse can measure vital signs; however, agency policy usually states that UAP can perform this task also. If the client is unstable, the nurse would retain the role of measuring the vital signs. Once the client is stable, the UAP could perform this task. However, since the new UAP's competency level is not known, the nurse does not delegate this task for the safety of the client.

3. Correct: First, the nurse will want to determine that the interventions were performed. If they were not carried out, the goal could not be achieved. In addition, the nurse should determine if the nursing interventions were carried out appropriately and completely. Evaluation of the effectiveness of the nursing interventions would follow.

1. Incorrect: New goals may need to be identified; however, in this case it is not yet known if the interventions were carried out appropriately. Until it is determined that the current nursing interventions were implemented and performed appropriately, there is no way to accurately explore if new goals are needed. The original goals may be the most appropriate for the client.

2. Incorrect: New interventions may be appropriate, but until the nurse determines if these were carried out appropriately, it would be premature to establish new nursing interventions.

4. Incorrect: Additional time for goal attainment may be appropriate; however, other actions should be performed first. Before extending time for achieving the goal, the nurse should determine if the nursing interventions have been carried out appropriately. If these have been performed, extending the time for goal attainment may delay making changes that are needed.

Options that imply everything will be all right, deny clients' feelings, change the subject raised by the client, encourage the client to be cheerful, or transfer nursing responsibility to other members of the healthcare team usually are distractions and can be eliminated from consideration.

3. Correct:The nurse manager should utilize therapeutic techniques with staff as well as clients. The introduction of new equipment, particularly with no staff input, can cause frustration, job dissatisfaction, or even anger. Open-ended statements and questions allow staff to verbalize emotions in a situation which has led to feelings of powerlessness. This approach by the nurse manager will help staff adapt more successfully to this situation.

1. Incorrect: This closed, antagonistic remark is accusatory and provides no opportunity for staff interaction. The nurse manager has responded by placing blame on the staff instead of encouraging the expression of feelings and frustrations.

2. Incorrect: Such a comment focuses on training or lack of staff knowledge regarding the new equipment. This is a closed-ended comment which focuses on the issue of staff learning rather than lack of input for the equipment.

4. Incorrect: Though the comment may seem encouraging, the nurse manager is ignoring the staff's feelings and implying everything will be okay. This belittles staff emotions and is closed-ended, eliminating the opportunity to work through feelings. Therapeutic communication is designed to encourage sharing of feelings in an accepting and nonjudgmental environment. The nurse manager makes reference to working together, which may seem like a good idea, but the statement does not promote further discussion or foster a therapeutic atmosphere.

1., 2., 3., & 4. Correct: The nurse's level of fatigue must be considered especially under conditions of mandatory overtime. Shouldn't the nurse identify whether personal fatigue will be an issue in caring for clients? Splitting the overtime shift is an acceptable option that the nurse could suggest in order to solve the staffing problem and decrease the amount of time the nurse will be working. The nurse can accept the assignment, documenting your personal concerns regarding working conditions in which management decides the legitimacy of employee's personal concerns. This documentation should go to your manager. Refuse the assignment, being prepared for disciplinary action. If your reasons for refusal were client safety, nurse safety, or an imperative personal commitment, document this carefully including the process you used to inform the facility (nurse manager) of your concerns. Keep a personal copy of this documentation, provide a copy to the immediate supervisor, and send a copy to the Local Unit Officer.

5. Incorrect. The nurse can also accept the assignment; however, that nurse should document professional concern for client safety and the process you used to inform the facility (manager) of your concerns. Remember if you work overtime, fatigue is not a viable reason for a error and will not stand up in court.

Remember: An LPN/VN cannot assess, evaluate, create a plan of care, or do initial teaching. An LPN/VN can "re-evaluate" teaching to see if the client understands, but cannot initiate new instruction. Another important aspect to remember is that you cannot "assume" information that is not specifically provided in the question.

1, 2, 5 & 6. Correct: Thes clients are appropriate and stable enough for the LPN/VN's scope of practice. While an LPN/VN cannot be assigned a fresh post-op, the first client had an appendectomy two days ago. The LPN/VN could even delegate ambulating this client to unlicensed assistive personnel (UAP). A client with bronchitis will need a respiratory assessment by the RN at some point, but the LPN/VN is definitely qualified to administer aerosol treatments. The third client was admitted for observation following a fall a day ago, indicating no injuries serious enough for a full admission. PNs can insert and monitor NG tubes.

3. Incorrect: This client is a newly diagnosed diabetic who will require extensive teaching about selfcare at home. Additionally, discharging a client always involves teaching, which cannot be initiated by an LPN/VN. This option does not indicate that any teaching had been presented, so the client is not an appropriate assignment for the LPN/VN.

4. Incorrect: Myasthenia Gravis is a progressive weakening of the neuromuscular system placing the greatest risk on the respiratory system. Although this client is on a medical-surgical floor, there is a need for close monitoring and frequent assessment of the respiratory system, requiring an RN.

1, 4 & 5.Correct: The tasks appropriate for the unlicensed assistive personnel (UAP) focus on activities of daily living. Replacing any item of clothing, including heel protectors, is appropriate for the UAP. Ambulating a client outside is an excellent activity to delegate to the UAP, in addition to helping a client complete the diet menu. The UAP can read the selections to the client and mark the choice.

2. Incorrect: When a client reports heartburn, there are potential issues requiring assessment by the RN. The client may actually be experiencing a cardiac event which would require intervention and contacting the primary healthcare provider. Though TUMS is an over the counter product, it is still considered a medication and should be administered nursing staff.

3. Incorrect: Did you hesitate here, thinking that fingernails were acceptable? This was a difficult choice, no doubt. Ordinarily a UAP can indeed trim fingernails, as long as they are cut directly across. However, note that this client is diabetic and is also confused. Consider the potential for injury when cutting this client's nails. This risky task should be completed by a nurse.

Which task would the nurse delegate to an unlicensed health care worker?

Which task would be appropriate for the nurse to delegate to an unlicensed assistive personnel UAP )? Quizlet?

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel?

Which task may be safely delegated to unlicensed assistive personnel UAP )?