a charge nurse is making client care assignments
The nurse who made the medication error should take which of the following actions first? 4. Which pediatric client care assignment is most appropriate for the charge nurse to delegate to the LPN/LVN? b. Client to receive dietary education. Select all that apply. A charge nurse is making client care assignments. 3. a. What was the rationale for this plan? d. Social conversation, a. A charge nurse is reviewing the list of tasks that have been delegated to the assistive personnel (AP) by the staff nurse. The option does not say the client is terminal, in a vegetative state, or in a coma. Sudden attacks of sleep What information should the nurse include? 3. Pick up the tray and tell the UAP that they didn't do a good job. 4. Have a pen and paper handy This could indicate a worsening of this client's condition. 2. 3. A nurse is caring for a client who has a wound infection. Allow the UAP to work without supervision. Client with ureterolithiasis who requires frequent PRN pain medication. e. an open perineal wound, 92. 4. In planning care for the post-operative client, the nurse has decided to retain the task of vital sign assessment. 3. 4., & 5. A client receiving a blood transfusion that requires monitoring. Provide positive feedback to the UAP. 2. 3. 55. Incorrect: This prescription is written correctly. Which of the following actions should the nurse take? A nurse has just finished a wound irrigation for a client who requires contact precautions. The charge nurse is developing patient care assignments for the evening shift and needs to assign clients to a licensed practical nurse/licensed vocational nurse (LPN/LVN) and a certified nursing assistant (CNA). To focus on effective learning with this client, which of the following interventions should the nurse use? The nurse has just completed a 12 hour shift. Accept assignment, documenting personal concerns regarding work conditions. c. They tend to use more verbal communication c. Decreased sodium excretion 1. 4. Refuse the delegated intervention. Incorrect: This is a nursing responsibility and the best practice committee is the best place to begin. c. Provide the client with a diet high in protein b. 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. b. I'm so sorry to hear about this d. When asking if the client took his medications this morning, 82. b. The charge nurse needs additional information to make a decision. The first client who needs treatment is the one with multiple injuries from a motor vehicle accident. Select all that apply The expected standard of care was strict bed rest), 96. a. Hypotension 3. d. Perception Hormone replacement does not affect the immune system and, therefore, this nurse is not at risk for infection from CMV exposure. 4. Only a plain enema or soap enema can be given by the UAP. d. Wait to discuss the behavior in the presence of others, a. An experienced nurse would be assigned to this unstable client due to the possibility of a reoccurring hemorrhagic stroke resulting from the client's hypertension. Which client would be appropriate for the RN to assign to the LPN? 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. 1. The report should contain consequences. c. Contact Changing the subject The second client the nurse needs to see is the client diagnosed with gastroenteritis who had two 300 mL diarrhea stools in one hour. A. nurse is caring for a client who is not cooperating with his care and demonstrates defiant behavior. During report, the nurse notes that the float nurse appears disheveled, flushed, and is trembling slightly while drinking coffee. c. Hand-off technique c. Shivering (shivering is a systemic response to cold therapy as the body attempts to promote heat production), 77. 3. Monitor for behavioral changes. Assist a client to ambulate using a gait belt Notify clients that the disaster plan has been put into effect. 4. Which of the following actions should the nurse take prior to administering the tube feeding? 3. A nurse is preparing to obtain a blood specimen from a client by venipuncture. 1. Which of the following statements should the nurse identify as an indication that the client understands the discharge information? A nurse is caring for a client who is immobile. 2. 1. e. Suctioning a client's new tracheostomy tube, 93. Incorrect: This is doing research, which requires the research process be implemented, including appropriate approval. The nurse received a client following surgery 8 hours ago. An LPN/VN has been floated to the emergency room following a chemical plant explosion. c. imaginary Correct: It would be best to explore the reason the RN thinks the assignment is too heavy. Which of the following actions by the nurse is considered an indirect nursing care activity? d. Question the charge nurses about the care deficits that might have contributed to the ulcer's development, b. 1., 2., 3., & 4. c. Hold an object away from her body as she lifts it A nurse is caring for a client who has emphysema and has difficulty with mobility. A nurse is creating a discharge plan. a. Auscultate breath should at least ever 2 hr Feed a client that had a stroke 3 months ago. a. I will keep my walker at the end of my bed Which of the following tasks should the nurse delegate to assistive personncl ( AP) ? the nurse responds: "It must be very frustrating to encounter this kind of attitude." The client is considered unstable until assessed by the nurse. 1. 2. 3. 2) Assist a client to ambulate using a gait belt. The charge nurse must triage and assign clients to appropriate staff. Elderly client admitted 30 minutes ago with reports of constipation for four days. 3. 5. Comatose client with end stage chronic obstructive pulmonary disease. The nurse should not assume that the UAP just did not do their job, but needs to ascertain the reason for not feeding the client. The UAP can ambulate the client and can report to the nurse if the client states that pain is occurring but cannot monitor or collect data. a. Place in priority order. c. To determine the client's electrolyte balance c. The nurse may serve as a witness to informed consent for organ donation This is an appropriate prescription. b. Correct: An LPN should be assigned clients with predictable outcomes. Nothing by mouth (NPO). c. Changing a dressing a. 76. Perform range of motion (ROM) exercises at least 2-3 times daily 1. a. 3. A newborn is admitted to the nursery with a diagnosis of rule out cytomegalovirus (CMV). a. The nurse assists the patient to the bedside commode and the client sustains an injury to the operative area. c. Review another client's similar surgical experience Two hours after other trays were picked up from the rooms, the nurse notes that the client's untouched tray is still at the bedside. Correct. Incorrect: Most adults have already been exposed to the virus and are not at risk for adverse effects of the infection. Which of the following statements should the nurse identify as an indication that the client needs further teaching? Complete blockage of the large intestine. A nurse enters an older adult client's room to insert a saline lock. The client is reporting anxiety, discomfort, and a feeling of bloating. This template is beneficial for nursing students and veteran nurses alike, and can be used in any unit. Symbolic communication Semi-formed stools are great news! A nurse caring for a client is using active listening skills. Which of the following client statements indicates an understanding of the procedure? The client faces the direction of movement when sliding an object across the floor (sliding an object across the floor rather than lifting it prevents strain on the lower back muscles and facing the direction prevents from twisting his back). d. Explain the procedure to the client if they do not understand, c. Lock the medication in a room and finish preparing it after returning from the emergency (securing them and returning later to finishing preparing and administering them decreases the risk of medication errors), 72. Which client should the nurse assess first? If you give the magnesium citrate, which is a laxative, what will happen? The nurse has received the change-of-shift report. 208 Which tasks would be appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)? Confrontation should occur in the presence of a charge nurse or supervisor. b. c. I'll clean the inside of the container with a wipe A nurse is orienting a newly licensed nurse about documentation of a client's information in the electronic health record. A nurse is admitting a client who has a partial hearing loss. A nurse is attending a social event when another guest coughs weakly once, grasps his throat with his hands, and cannot talk. Correct: The hospital nurse to client staffing ratio should reflect the complexity of nursing care for high acuity clients. 1. 1. Incorrect: First, the local news does not necessarily have the most accurate information on the disaster. a. Clients are frequently admitted to a medical unit with a diagnosis of seizures and prescribed an anti seizure medication. INCORRECT 3) Review a low-sodium diet for a client who has hypertension. Which of the following statements should the nurse make? A float nurse arrives on the unit to assist in the care of clients for the shift. Which of the following interventions should the nurse use to help maintain the integrity of the client's skin? _____The house that we lived in for nine years has been sold. Placing the traction weights on the bed to transfer the client to x-ray. This client would not be a priority to be seen before assessing the client with the cast that is too tight who may be developing compartment syndrome. The RN with 10 years' experience pulled from the ER. This is an elderly client who is a new admit. What proposal would the nurse determine to best meet the needs of families and clients in long term care? Incorrect: Is phantom pain something that is unexpected with above the knee amputations? The nurse did not trust the new UAP. Aplastic anemia is a rare but serious condition. 2. c. Leave a nightlight on in the client's room This task cannot be delegated to the LPN/LVN. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. A nurse is caring for a client who states, "I have got to get out of this hospital! A nurse is developing a plan of care for a client who does not speak the same language as the nurse. The client states, "I am so nervous about what the doctor might find during the test." b. I'll use the cleansing wipes from the front to back b. b. Which region of the tRNA pairs with mRNA? c. Open the right flap with the left hand A nurse is caring for a client who has had an allogenic hematopoietic stem-cell transplant. A nurse is performing care activities for a client in the zone of touch that requires his consent. A nurse is preparing a sterile field. This client can wait until the others are treated. b. Client diagnosed with gastroenteritis who reported 300 mL diarrhea stool x2 in the last hour. Occupational therapist C. Review a low-sodium diet for a client who has hypertension. Evaluate pain relief after narcotic administration. 2. d. Talk with the client's partner, b. The nurse should assess the client for which of the following expected outcomes after catheter removal? a charge nurse is making client care assignments for the day. Family cannot withdraw the Advance Directive and make decisions that go against the client's wishes made within the document. Prospectors are considering searching for gold on a plot of land that contains 1.31g1.31 \mathrm{~g}1.31g of gold per bucket of soil. A client post pacemaker insertion, awaiting discharge instructions. The reason for the UAP not feeding the client needs to be determined. 1. Incorrect: If alcohol or drug dependency is suspected, confrontation will result in hostility and denial. This client needs careful monitoring and specialized care. c. Visual observation for nonverbal signs of pain b. 2. A charge nurse role includes front line nurse supervisor, resource nurse, bed manager, peer reviewer, patient advocate, other charge nurse duties, and staff scheduler. Initiate oxygen and IV lines as needed. b. Find a mentor Most nurses learn to make nurse-patient assign-ments from a colleague. This situation requires an immediate neurovascular check to determine if intervention is needed to relieve the pressure and restore circulation. 2. A nurse is prioritizing care for two clients at the start of the shift. Headache following this procedure is a potential side effect and would not be the priority concern for the nurse. Client scheduled for a dressing change to foot ulcer. a. 1., 2., 3., & 4. Providing a passive response Encourage the client to be more cooperative. c. Nonfat milk A person can be designated to make medical decision in the event the client cannot. b. 2. Since the enema would clean below the obstruction, the client would be able to expel the enema and any feces in this part of the colon. A nurse is preparing a client's evening dose of risperidone when the tablet falls on the countertop. 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.
No Comments