Reproductive- Lippincott Management of Care

Managing Care Quality and Safety 117. The nurse is assigning tasks to the unlicensed assistive personnel (UAP) for a client with an abdominal hysterectomy on the first postoperative day. Which of the following can not be delegated to the UAP? 1. Taking vital signs. 2. Recording intake and output. 3. Giving perineal care. 4. Assessing the incision site.

117. 4. The registered nurse is responsible for monitoring the surgical site for condition of the dressing, status of the incision, and signs and symptoms of complications. Unlicensed assistive personnel who have been trained to report abnormalities to the registered nurse supervising the care may take vital signs, record intake and output, and give perineal care.

118. The nurse-manager on a gynecologic surgical unit is addressing reports from clients that they have to wait too long on the night shift for their pain medication. Which course of action should the nurse-manager take first? 1. Change the staffing schedule on nights to include a medication nurse. 2. Consult the nursing supervisor. 3. Consult the nurses on the evening shift about their evaluation of the night nurses regarding these reports from the clients. 4. Complete a quality improvement study with the night nurses to document the waiting times for pain medication and other data, including staffing and client acuity

118. 4. To determine the cause of this problem, a quality improvement study should be conducted. Before implementing solutions to a problem, the precise issues in the hospital system must be observed and documented. Consulting with the evening nurses may result in biased observations because the evening nurses are not conducting care under the same environment as the night nurses. Including a medication nurse is not the first step in understanding the problem and may be an unrealistic or expensive solution. The supervisor is not directly involved with the problem and should only be consulted if the problem cannot be solved by those involved.

119. A nurse is reviewing the physician's admitting prescriptions for a 52-year-old client scheduled for a dilatation and curettage. The nurse is unable to decipher the handwriting and determines the medication prescription reads either metoprolol succinate (Toprol) or topiramate (Topamax). What should the nurse do next? 1. Ask the client if she has hypertension. 2. Ask the client if she has migraines. 3. Call the physician to clarify the prescription. 4. Ask the pharmacist to interpret the prescription.

119. 3. The nurse must clarify this prescription with the admitting physician to ensure medication accuracy and client safety. In health care settings without computerized medical records or computer prescribing, misinterpretation of handwriting remains a leading cause of medication errors. It is not safe practice to question the client regarding a diagnosis and assume the medication is correctly prescribed. The pharmacist will need clarification of the prescription as well. It is not the role of the pharmacist to interpret the prescription.

120. The unlicensed assistive personnel (UAP) reports to the nurse that the client with an abdominal hysterectomy who returned from the recovery room 1 hour earlier has saturated the blue pad with bright red blood. The nurse should: 1. Call the surgeon to report the bleeding. 2. Ask the UAP to obtain vital signs while the nurse calls the surgeon. 3. Ask the UAP to increase the flow of IV fluids to prevent shock. 4. Assess the client again in 15 minutes before the nurse takes any further action.

120. 2. The surgeon should be notified when a client who has had an abdominal hysterectomy develops vaginal bleeding that saturates a blue pad in 1 hour, and care should be managed so that other personnel can obtain vital signs while the nurse contacts the surgeon. The client may need to have IV fluids increased, but the surgeon needs to be notified first. Waiting 15 minutes while the client is having bright-red bleeding is an unsafe nursing action; the client may lose a large amount of blood.

121. A nurse on the gynecologic surgery unit observes a respiratory therapist (RT) take a medication cup with pills that was sitting in the medication room. What course of action should the nurse take? 1. Report the situation to the supervisor of respiratory therapy. 2. Tell the RT that you saw her take the pills from the medication room. 3. Report the situation to the nursing supervisor. 4. Tell the nurse who was administering medications not to leave pills out.

121. 3. The nurse should follow the line of authority or chain of command by reporting the observation immediately to the nursing supervisor. The nurse should not confront the person or the medication nurse because the line of authority for reporting incidents should be followed. The RT supervisor may subsequently be involved in the incident, but the nursing supervisor should initiate and follow the policy and procedure.