Transitions Exam 2: Delegation Questions
Which situation requires intervention by the nurse who is caring for a terminally ill client in a hospital? A. The case manager notifies the family that the critical pathway requires transfer to a hospice facility. B. The case manager notifies the social worker of the client's financial needs related to hospice care. C. The social worker describes the client's feelings of grief to the spiritual counselor. D. The social worker provides information about long-term care facilities to the client.
A - no critical pathway requires transfer
You are acting as preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients? Select all that apply. A. A 38-year-old with moderate persistent asthma awaiting discharge B. A 63-year-old with a tracheostomy needing tracheostomy care every shift. C. A 50-year-old who is 1 day post op right lobectomy D. A 49-year-old just admitted with a new diagnosis of esophageal cancer
A - the patient is leaving and B - requires minimal care. C requires heavy care and D has high emotional needs.
You, the nurse, just received report on four patients. Which patient should you as the nurse see first? A. A patient who underwent a thyroidectomy and has new onset hoarseness. B. A patient who has Cushing's syndrome who has been noted to have a blood sugar of 140mg/dl. C. A client who is in renal failure and a laboratory report noting the creatinine of 3.2 mg/dl. D. A patient who was diagnosed with ulcerative colitis and recently passed 100 ml of loose bloody stools.
A indicates encroachment on airway. B,C, & D are expected symptoms
The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? A. Have the patient perform pursed-lip breathing B. Plan a nursing care regimen that gradually increases activity intolerance C. Assist the patient with basic activities of daily living D. Consult with the physical therapy department about reconditioning exercises
A is appropriately within the LPN's scope. C can be delegated to a UAP and A&D fall under the RN's scope.
Because the census is currently low in the Obstetrics (OB) unit, one of the nurses is sent to work on a medical-surgical unit for the day, or until the OB unit becomes busy. Which client assessment is best for the charge nurse to assign to the OB nurse? a.An adult who had a colon resection yesterday and has an IV b. An older adult who has a fever of unknown origin c. A woman who has had a CVA six hours ago d. A teenager with a femoral fracture who is in traction
A requires the skills most similar to OB nursing (post-operative care). C&D are not withing the skill set.
Which of the following clients would be most appropriate for the nurse to assign to the unlicensed assistant for morning care? a. An elderly client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy for mild dyspnea b. A middle-aged client who had a laryngectomy 2 days earlier c. A young client receiving chemotherapy for Hodgkin's disease d. An elderly client experiencing chest pain due to suspected pulmonary embolus
A- the patient is stable. B is in recovery, C requires advanced care, and D is unstable.
A 55-year-old male patient arrives at the ER with anterior epistaxis that has not resolved after an hour of applying pressure. Which of the following instructions, if given to the UAP by the nurse, would be considered CORRECT? a. "Please have the patient lean forward while sitting upright." b. "Have the patient apply direct vertical pressure." c. "Have the patient blow their nose firmly." d. "Give the patient a heat pack to use for comfort."
A. B - should be horizontal pressure. C&D would increase bleeding and blood flow.
While working the 3 - 11 P.M. shift the new UAP is assigned to your medical-surgical unit. He has been in class for 1 week and this is his first evening on the unit other than a brief orientation tour. Which client would you assign him first? a) A woman with Multiple Sclerosis who requires frequent turning and assistance with feeds. b) A newly admitted 64 year old who had a stroke leaving him paralyzed on the left side, aphasic, and dysphasic. c) A client with a gastrostomy tube who will be started on enteral feeds today d) A patient returning from an EGD that shift.
A. B is at risk for aspiration with feeding and, along with D, requires careful handling. C is beyond the scope of practice.
Effective principles of delegation of authority emphasize which of the following statements? a. The amount of authority granted in the delegation of a task should be somewhat greater than that needed for completion of the task b. Responsibility for doing a task can be assigned to others, thereby relieving the delegator of final accountability to his superiors. c. Assignment and accountability for action can be given without the awareness of the delegate. d. In formal organizations, delegation of tasks is needed because of the divisions of labor.
A. B&C false, D is not the best answer.
A nurse is taking care of a previously healthy adult patient with a newly diagnosed serious medical condition. The patient is apprehensive and confused by all of the information, tests, test results, and the number of medical practitioners involved in the care plan. The nurse knows that it is her job to inform and educate this patient on the rights and responsibilities of those receiving healthcare as specified in the Patients' Bill of Rights. According to this document, which of the following is not included in this discussion? A. the right to choose any provider or plan for healthcare B. the responsibility to inform the healthcare staff of any previous conditions and medications C. the right to be informed about and participate in the decisions regarding medical treatment D. the right to refuse any treatment
B
The charge nurse is making client care assignments for the evening shift. One of the LPN (licensed practical nurse) is a new graduate in orientation. Which of the following clients would be an appropriate care assignment for this nurse? a) A 41-year-old client with unstable angina b) A 72-year-old client with diverticulitis c) A 32-year-old client hospitalized for chemotherapy treatment d) A 5-year-old client with Kawasaki's disease
B - common condition, so LPN appropriate. C requires special training, D is a reare disease, and A is unstable.
The nurse-manager wants to assign an agency nurse to a client who has a new tracheostomy. What action should the nurse-manager implement? a. Assign the nurse to the client with the tracheostomy and evaluate the care given b. Ask the nurse about her competency to care for a client with a tracheostomy c. Request the agency to send a nurse who is experienced in providing trach care d. Transfer the client to another nurse and assign the agency nurse to more basic responsibilities
B - ensure the delegate can do the task.
The nurse is assigning care to an unlicensed assistive personnel (UAP) for a client with a nasogastric tube with intermittent suction after gastric surgery. Which of the following interventions cannot be delegated to the UAP? a. Recording output b. Repositioning the tube c. Securing the nasal tapes d. Documenting the color of the drainage
B is not within scope. A,C, & D are.
The charge nurse in the emergency department receives a call that four patients will be arriving immediately with various injuries. Based on the following reports, order the patients from first to last to be seen. A. An adult with an obvious deformity of the left forearm, a strong radial pulse, and complaints of extreme pain. B. An adult with no obvious injuries, a heart rate of 135, and confusion. C. A child who cries loudly with a cut on her forehead and a heart rate of 105. D. A child with a break through the skin and obvious deformity of the right leg who is pale and complains he feels dizzy.
B, D, A, C
The clinic nurse is making assignments to the staff. Which assignment/delegation would be most appropriate? A. Request the LPN to escort the clients to the examination rooms. B. Ask the UAP to prepare the room for the next client. C. Instruct the RN to administer the tetanus shot to the client. D. Tell the clinic secretary to call in a new prescription for a client.
B. LPN can do C, UAP can do A, and D is outside the scope of practice.
The charge nurse is making assignments for each of 4 staff members, including an RN, LPN and 2 UAPs. Which task is best to assign to the LPN? (a) maintain a 24hr urine collection (b) wean a client from a mechanical ventilator (c) Perform sterile wound irrigation (d) Obtain scheduled vital signs
C A&D underutilize, B is beyond training
The nurse receives report in the emergency center for four clients. Which client should the nurse assess first? A. A screaming child with a compound fracture of the wrist. B. A diabetic client with a laceration on the sole of the foot. C. A client experiencing shortness of breath and dyspnea. D. A geriatric client with many new and old bruises noted.
C (airway). Next would be B (circulation and infection).
The nurse is designing a program to control nosocomial infections on a geriatric unit of an acute care hospital. What strategy should be included in this plan? A. Do not allow those with influenza to be admitted to the unit. B. Require that all clients receive a pneumonia vaccine prior to admission. C. Ensure that sterile technique is followed when changing surgical dressings. D. Encourage clients to drink water to prevent urinary tract infections.
C - the rest aren't feasible
When the charge nurse is making assignments, which tasks can be assigned to an unlicensed assistive personnel (UAP)? A. Perform a dressing change, oral suctioning, and admission of a client to the unit. B. Time contractions, determine heart fetal rate, and administer an enema to a client in early labor. C. Take vital signs, give a cleansing enema, and apply soft restraints to an older client. D. Irrigate a naso-gastric tube, collect a stool specimen, and measure intake and output.
C - within scope of practice.
Which task should the nurse delegate to an experienced unlicensed assistant personnel (UAP)? a. Evaluate the ability of a client to swallow ice one hour post endoscopy b. Assist a client with initial ambulation after a hip replacement using a walker c. Provide stoma care and apply ostomy appliance to a mature stoma. d. Change the disposable tracheostomy inner cannula when secretions become tenacious
C is safe for a mature stoma. B requires assessment before ambulation. A&D are too specialized
The charge nurse, along with two registered nurses (RN), one practical nurse (PN), and one unlicensed assistive personnel (UAP), is working in an emergency department. What activity should be assigned to the UAP? a. Monitor a client with mid sternal chest pain, nausea and vomiting b. Give instructions to the EMS about a client being transferred back to a long term care facility c. Transport a client with septicemia to a medical unit d. Obtain the history from a female client who presents in early labor
C is within the UAP's scope of practice.
The nurse has asked the unlicensed assistant to help with admitting an elderly client who has been diagnosed with bacterial pneumonia. Which of the following activities is appropriate for the nurse to ask the assistant to perform? a. Assess the client's lung sounds b. Collect a history of illness c. Obtain the height and weight d. Evaluate the oxygenation saturation level
C is within the scope of practice. A, B & D are assessments, which is the nurses scope.
The RN is planning the client assignments for the day. Which of the following is the most appropriate assignment for the nursing assistant? a) a client requiring a colostomy irrigation b) A client receiving continuous tube feedings c) A client who requires urine specimen collections d) A client with difficulty swallowing food and fluids
C. A is too advanced, B&D are high risk
Which task would b most appropriate for the clinic nurse to assign to the LPN? A. The intravenous push antiemetic to the client who is nauseated and vomiting. B. The subcutaneous epinephrine to a client who is having an asthma attack. C. The antacid to the client who is diagnosed with GERD. D. The sublingual nitroglycerin to the client who is complaining of chest pain.
C. LPNs can't do IVs (A) and B&D are too unstable
The nurse is giving change-of-shift report for four clients in the emergency center and reports the client with a terminal disease has a living will and a "Do not resuscitate" (DNR) order on file. Which client fits the criteria for a terminal illness? A. 2-year-old child with esophageal burns from drinking drain cleaner who now has a gastrostomy tube. B. 76-year-old female client with Alzheimer's disease who is pacing the halls and trying to "go home." C. 52-year-old male client who had a partial lobectomy and on a ventilator on the 2 postoperative day. D. 43-year-old male with amyotrophic lateral sclerosis who is refusing artificial nutrition or hydration.
D
A female client is receiving an enteral feeding via nasogastric feeding tube. The daughter reports to the charge nurse that her mother is coughing vigorously and sounds congested. Which staff member should the charge nurse ask to check on the client? A. Registered nurse (RN) who is admitting a new postoperative client to the unit. B. Practical nurse (PN) who is giving routine medications. C. Practical nurse (PN) who is talking with anxious family members. D. Registered nurse (RN) who is entering nursing notes at the computer.
D - assessment is for the RN. This RN is not performing active care
A registered nurse (RN) is caring for several clients on a progressive care "step-down" unit. After assessing the clients, which clerical task should the nurse delegate to a unlicensed assistive personnel (UAP)? A. Chart pulse oximeter readings and type of breath sounds auscultated in the medical record. B. Record the presence of blood-tinged urine and the hourly Foley output on the flow sheet. C. Document the type and amount of drainage on a new surgical dressing in the progress note. D. Transcribe the vital signs from a unit worksheet to the individual graphic page in the client charts.
D - data transfer is within scope. B&C require assessment. A involves assessment.
The nurse instructs the unlicensed assistant how to care for a client with chest tubes that are connected to water-seal drainage. Which of the following instructions would be appropriate for the nurse to give the unlicensed assistant? a. Milk the chest tubes every 4 hours b. Raise the collection apparatus to the height of the bed to measure the fluid level c. Attach the chest tubes to bed linen to avoid tension on the tubing d. Mark the time and amount of drainage on the collection container
D has the least potential for harm. C is a safety hazard, B is potentially hazardous, and A is beyond the scope of practice
