Leadership Case: Problems in Delegation: Blood Transfusion

The registered nurse administering a blood transfusion suspects a reaction has occurred. Which signs and symptoms would the nurse expect with an allergic reaction to blood? Hypotension and tachycardia Decreased urinary output and hypertension Fever and chills Rash and hives

Rash and hives

The new charge nurse is planning assignments for a team of licensed practical nurses (LPN/LVNs) and registered nurses (RNs). Which patient assignment would be most appropriate for an LPN/LVN? An adolescent with dehydration who is taking fluids well by mouth A young adult who suffered burns in a motor vehicle accident and needs dressing changes 76-year-old client admitted with right-sided heart failure. A middle-aged diabetic client admitted for insulin readjustment

An adolescent with dehydration who is taking fluids well by mouth

An RN has delegated care of a newly postoperative client to an LPN/LVN. The LPN/LVN notifies the RN that the client's blood pressure and respirations are elevated from previous readings and that the client is complaining of pain and dyspnea. Which action should the RN take next? Call the attending surgeon to report that the client is having pain and dyspnea. Thank the LPN/LVN for update and document the information in the patient's medical record. Assess the client, check the client's surgical notes, and gather additional data before calling the surgeon. Request that the LPN/LVN offer the client an opioid analgesic, which has been ordered postoperatively.

Assess the client, check the client's surgical notes, and gather additional data before calling the surgeon.

The new graduate nurse is preparing to delegate patient care. The nurse recalls that what rights are among the five rights of delegation? (Select all that apply.) The right communication The right task The right person The right time The right circumstance

The right communication The right task The right person The right circumstance

When preparing to take the NCLEX-RN examination, the student nurse recalls which differentiated practice concept that assists with delegating care to a licensed practical nurse/licensed vocational nurse (LPN/LVN)? LPN/LVNs should be assigned to perform standard, unchanging tasks. LPN/LVNs should be assigned to patients with the highest acuity. LPN/LVNs should be assigned to stable patients with predictable outcomes. LPN/LVNs should be assigned to patients with no medication orders.

LPN/LVNs should be assigned to stable patients with predictable outcomes.

The evening charge nurse, an RN, is making patient care assignments for the next shift, which includes a licensed practical nurse/licensed vocational nurse (LPN/LVN/LVN) and a nursing assistant. Which task should be assigned to the LPN/LVN? Providing a.m. hygiene care to a patient receiving a blood transfusion Reinforcing teaching to a patient about the need for a blood transfusion Ambulating a patient to the bathroom Measuring a client's vital signs during a blood transfusion

Reinforcing teaching to a patient about the need for a blood transfusion

A registered nurse delegated the assessment of a patient's vital signs to an LPN/LVN. The LPN/LVN failed to perform this task, and the patient's health status declined until the oversight was discovered 4 hours later. What is the RN's legal responsibility in this situation? The RN may be liable for not providing adequate supervision to the LPN/LVN. Legal responsibility lies with the RN because the LPN/LVN does not have a defined scope of practice. The RN is free from legal responsibility, provided the RN documented the fact that the task was delegated. The LPN/LVN is exclusively liable because the task was appropriately delegated.

The RN may be liable for not providing adequate supervision to the LPN/LVN.

The charge nurse, who is an RN, is preparing to make assignments for a busy surgical unit. Which concept should the charge nurse consider when making patient care assignments? The charge nurse should make patient care assignments based on staff preference. The charge nurse should delegate all possible client care to other caregivers on the team, such as LPN/LVNs and UAPs. The charge nurse should assume care for those patients newly admitted to the unit. The charge nurse should retain the client care activities that only an RN can perform and delegate other activities as appropriate.

The charge nurse should retain the client care activities that only an RN can perform and delegate other activities as appropriate.

The nurse manager explains to the new charge nurse which critical guiding principle with regard to developing patient care assignments? Accommodating patient requests for care assignments will result in patient satisfaction The nurse shares accountability for delegated tasks Sharing of assigned tasks between unlicensed assistive personnel will facilitate teamwork Staff satisfaction with patient care assignments supports unit retention

The nurse shares accountability for delegated tasks