Assignment q

The pediatric unit charge nurse is working with a newly graduated RN who has been on orientation in the unit for 2 months. Which patient should the charge nurse assign to the new RN? 1. A 2-year-old patient with a ventricular septal defect for whom digoxin 90 mcg by mouth has been prescribed 2. A 4-year-old patient who had a pulmonary artery banding and has just been transferred in from the intensive care unit 3. A 9-year-old patient with mitral valve endocarditis whose parents need teaching about IV antibiotic administration 4. A 16-year-old patient with a heart transplant who was admitted with a low-grade fever and tachycardia

1 This patient requires the least complex assessments and interventions of the four patients. Safe administration of oral medications such as digoxin would have been included in the orientation of the new RN graduate. The conditions of the other patients are more complex, and they require assessments or interventions (e.g., teaching) that should be carried out by an RN with more experience.

The charge nurse assigns the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which instructions would the RN provide for the LPN/LVN? Select all that apply. 1. Check the patient's vital signs every 15 minutes in the first hour. 2. Check the dressing for drainage and tightness. 3. Elevate the patient's hand above the heart. 4. The patient will no longer need pain medication. 5. Check the neurovascular status of the fingers every hour. 6. Instruct the patient to perform range of motion on the affected wrist.

1235 Postoperatively, patients undergoing open carpal tunnel release surgery experience pain and numbness, and their discomfort may last for weeks to months. Hand movements may be restricted for 4 to 6 weeks after surgery. All of the other directions are appropriate for the postoperative care of this patient. It is important to monitor for drainage, tightness, and neurovascular changes. Raising the hand and wrist above the heart reduces the swelling from surgery, and this is often done for several days.

Which actions should the nurse assign to the experienced LPN/LVN for the care of a patient with hypothyroidism? Select all that apply. 1. Assessing and recording the rate and depth of respirations 2. Auscultating lung sounds every 4 hours 3. Creating an individualized nursing care plan for the patient 4. Administering sedation medications every 6 hours 5. Checking blood pressure, heart rate, and respirations every 4 hours 6. Reminding the patient to report any episodes of chest pain or discomfort

1256 Assessment, auscultation, and reminding patients about information that has been taught to them are within the scope of practice of the LPN/LVN. The LPN/LVN could be assigned to check the patient's vital signs, and this is certainly within the scope of practice. Checking vital signs could also be delegated to the unlicensed assistive personnel. Creating nursing care plans falls within the scope of practice of the RN. The use of sedation is discouraged for patients with hypothyroidism because it may make respiratory problems more difficult. If sedation is used, the dosage is reduced, and it is not given around the clock.

The nurse is acting as preceptor for a newly-graduated RN during the second week of orientation. The nurse would assign and supervise the new RN to provide nursing care for which patients? Select all that apply. 1. A 38-year-old patient with moderate persistent asthma awaiting discharge 2. A 63-year-old patient with a tracheostomy needing tracheostomy care every shift 3. A 56-year-old patient with lung cancer who has just undergone left lower lobectomy 4. A 49-year-old patient just admitted with a new diagnosis of esophageal cancer 5. A 76-year-old patient newly diagnosed with type 2 diabetes 6. A 69-year-old patient with emphysema to be discharged tomorrow

126 The new RN is at an early point in orientation. The most appropriate patients to assign to the new RN are those in stable condition who require routine care. The patient with the lobectomy will require the care of an experienced nurse, who will perform frequent assessments and monitoring for postoperative complications. The patient admitted with newly diagnosed esophageal cancer will also benefit from care by an experienced nurse. This patient may have questions and needs a comprehensive admission assessment. The newly diagnosed diabetic patient will need much teaching as well as careful monitoring. As the new nurse advances through orientation, the preceptor will want to work with him or her in providing care for patients with more complex needs.

A client with a cervical spinal cord injury has been placed in fixed skeletal traction with a halo fixation device. When caring for this client, the nurse may assign which actions to the LPN/LVN? Select all that apply. 1. Checking the client's skin for pressure from the device 2. Assessing the client's neurologic status for changes 3. Observing the halo insertion sites for signs of infection 4. Cleaning the halo insertion sites with hydrogen peroxide 5. Developing the nursing plan of care for the client 6. Administering oral medications as ordered

1346 Checking and observing for signs of pressure or infection is within the scope of practice of the LPN/LVN. The LPN/LVN also has the appropriate skills for cleaning the halo insertion sites with hydrogen peroxide. Administering oral drugs is within the scope of practice for an LPN/LVN. Neurologic examination and care plan development require additional education and skill appropriate to the professional RN.

Which clients would be best to assign to the most experienced nurse in an ambulatory care center that specializes in vision problems and eye surgery? Select all that apply. 1. Client who requires postoperative instructions after cataract surgery 2. Client who needs an eye pad and a metal shield applied 3. Client who requests a home health referral for dressing changes and eyedrop instillation 4. Client who needs teaching about self-administration of eyedrops 5. Client who requires an assessment for recent and sudden loss of sight 6. Client who requires preoperative teaching for laser trabeculoplasty

1356 Providing postoperative and preoperative instructions, making home health referrals, and assessing for needs related to loss of vision should be done by an experienced nurse who can give specific details and specialized information about follow-up eye care and adjustment to loss. The principles of applying an eye pad and shield and teaching the administration of eyedrops are basic procedures that should be familiar to all nurses.

Which clients must be assigned to an experienced RN? Select all that apply. 1. Client who was in an automobile crash and sustained multiple injuries 2. Client with chronic back pain related to a workplace injury 3. Client who has returned from surgery and has a chest tube in place 4. Client with abdominal cramps related to food poisoning 5. Client with a severe headache of unknown origin 6. Client with chest pain who has a history of arteriosclerosis

1356 These clients should be assigned to an experienced RN because all have acute conditions that require close monitoring for any developing complications. Abdominal cramps secondary to food poisoning is an acute condition; however, the cramping, vomiting and diarrhea are usually self-limiting. The client with chronic back pain would be considered physically stable. Although all clients will benefit from care provided by an experienced RN, the client with abdominal cramps and the client with back pain could be assigned to a new RN, an LPN/LVN, or a float nurse.

The charge nurse in the labor and delivery unit needs to assign two patients to one of the RNs because of a staffing shortage. Normally the unit has nurse-patient ratio of 1:1. Which two patients should the charge nurse assign to the RN? 1. A 30-year-old gravida 1, para 0 (G1P0) woman, 40 weeks, 2 cm/90% effaced/-1 station 2. A 25-year-old G3P2 woman, 38 weeks, 8 cm/100% effaced/0 station 3. A 26-year-old G1P1 woman who delivered via normal vaginal delivery 15 minutes ago 4. A 17-year-old G1P0 woman with premature rupture of membranes, no labor at 35 weeks 5. A 40-year-old G6P5 woman with contractions at 28 weeks who has not yet been evaluated by the health care provider

14 Patient 1 is in the latent phase of labor with her first child; she typically will cope well at this point and will have many hours before labor becomes more active. Patient 4 would most likely be managed expectantly at this point and require observation and assessment for labor or signs of infection. Patient 2 can be expected to deliver soon and so requires intensive nursing care. Patient 3 is in the first hour of recovery and therefore requires frequent assessments, newborn assessments, and help with initiation of breast feeding if this is her chosen feeding method. Breast feeding in the first hour of the baby's life supports the Perinatal Core Measure of increasing the percentage of newborns who are fed breast milk only. Patient 5 could be in premature labor and require administration of tocolytic medications to stop contractions or preparation for a preterm delivery if dilation is advanced.

The health care provider prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to assign to an experienced LPN/LVN who is working in the emergency department? Select all that apply. 1. Attaching cardiac monitor leads 2. Giving heparin 5000 units IV push 3. Administering morphine sulfate 4 mg IV 4. Obtaining a 12-lead electrocardiogram (ECG) 5. Asking the client about pertinent medical history 6. Having the client chew and swallow aspirin 162 mg

146 Attaching cardiac monitor leads, obtaining an ECG, and administering oral medications are within the scope of practice for LPN/LVNs. An experienced LPN/LVN would be familiar with these activities. Although anticoagulants and narcotics may be administered by LPNs/LVNs to stable clients, these are high-alert medications that should be given by the RN to this unstable client. Obtaining a pertinent medical history requires RN-level education and scope of practice.

Which patient will the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)? 1. A patient with kidney stones scheduled for lithotripsy this morning 2. A patient who has just undergone surgery for renal stent placement 3. A newly admitted patient with an acute urinary tract infection (UTI) 4. A patient with chronic kidney failure who needs teaching on peritoneal dialysis

2 A nurse from the surgical ICU will be thoroughly familiar and comfortable with the care of patients who have just undergone surgery. The patient scheduled for lithotripsy may need education about the procedure. The newly admitted patient needs an in-depth admission assessment, and the patient with chronic kidney failure needs teaching about peritoneal dialysis. All of these interventions would best be accomplished by an experienced nurse with expertise in the care of patients with kidney problems.

A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to assign to an LPN/LVN? 1. Develop a "quit plan" 2. Explain how to apply a nicotine patch 3. Discuss strategies to avoid relapse 4. Suggest ways to deal with urges for tobacco

2 An LPN/LVN is versed in medication administration and able to teach patients standardized information. The other options require more in-depth assessment, planning, and teaching, which should be performed by the RN. Helping patients with smoking cessation is a Core Measure.

Which client is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general medical-surgical unit? 1. Client requiring discharge teaching about coronary artery stenting before going home today 2. Client receiving IV furosemide to treat acute left ventricular failure 3. Client who just transferred in from the radiology department after a coronary angioplasty 4. Client just admitted with unstable angina who has orders for a heparin infusion and aspirin

2 An RN who worked on a medical-surgical unit would be familiar with left ventricular failure, the administration of IV medications, and ongoing monitoring for therapeutic and adverse effects of furosemide. The other clients need to be cared for by RNs who are more familiar with the care of clients who have acute coronary syndrome and with collaborative treatments such as coronary angioplasty and coronary artery stenting.

For clients coming to the ambulatory care gastrointestinal clinic, which task would be most appropriate to assign to an LPN/LVN? 1. Teaching a client self-care measures for an ulcer 2. Assisting the health care provider to incise and drain a pilonidal cyst 3. Evaluating a client's response to sitz baths for an anorectal abscess 4. Describing the basic pathophysiology of an anal fistula to a client

2 Assisting with procedures for clients in stable condition with predictable outcomes is within the educational preparation of the LPN/LVN. Teaching the client about self-care or pathophysiology and evaluating the outcome of interventions are responsibilities of the RN.

The LPN/LVN is assigned to provide care for a patient with pheochromocytoma. Which physical assessment technique should the RN instruct the LPN/LVN to avoid? 1. Listening for abdominal bowel sounds in all four quadrants 2. Palpating the abdomen in all four quadrants 3. Checking the blood pressure every hour 4. Assessing the mucous membranes for hydration status

2 Palpating the abdomen can cause the sudden release of catecholamines and severe hypertension. All of the other assessments are appropriate for the LPN/LVN assigned to care for this patient.

The nurse assigns an LPN/LVN to administer prochlorperazine 10 mg orally to an older adult patient experiencing nausea. Which specific instruction would the nurse give the LPN/LVN regarding monitoring this patient after the drug has been given? 1. "You should expect the patient's bowel sounds to decrease after he takes this drug." 2. "Be sure to monitor his level of consciousness and watch for sedation." 3. "Apply oxygen by nasal cannula in case his respiratory rate decreases." 4. "The patient should be able to ambulate on his own to the bathroom.

2 Prochlorperazine is a phenothiazine antiemetic drug. These drugs commonly have sedation as a side effect, and the sedation (especially in older adults) is what helps control the sensation of nausea when they are given to a patient. Bowel sounds should not change after this drug. Although the nurse should monitor for respiratory depression, oxygen is not necessary unless the patient experiences respiratory difficulties. Because of the sedation effects of this drug, a patient should be instructed to call for help and be assisted to ambulate to the bathroom at least until the effects of the drug on a patient are known.

The nurse is preparing to admit a client with a seizure disorder. Which action can be assigned to an LPN/LVN? 1. Completing the admission assessment 2. Setting up oxygen and suction equipment 3. Placing a padded tongue blade at the bedside 4. Padding the side rails before the client arrives

2 The LPN/LVN scope of practice includes setting up the equipment for oxygen and suctioning. The RN should perform the complete initial assessment. Controversy exists as to whether padded side rails actually provide safety, and their use may embarrass the client and family. Tongue blades should not be at the bedside and should never be inserted into the client's mouth after a seizure begins.

Which client would the charge nurse assign to the step-down unit nurse who was floated to the intensive care unit for the day? 1. A 68-year-old client on a ventilator with acute respiratory failure and respiratory acidosis 2. A 72-year-old client with chronic obstructive pulmonary disease (COPD) and normal blood gas values who is ventilator dependent 3. A newly admitted 56-year-old client with diabetic ketoacidosis receiving an insulin drip 4. A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis

2 The client with COPD, although ventilator dependent, is in the most stable condition of the clients in this group and should be assigned to the float nurse from the step-down unit. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with diabetic ketoacidosis is a new admission and require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.

While working on the cardiac step-down unit, the nurse is precepting a newly graduated RN who has been in a 6-week orientation program. Which client will be best to assign to the new graduate? 1. A 19-year-old client with rheumatic fever who needs discharge teaching before going home with a roommate today 2. A 33-year-old client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 g IV 3. A 50-year-old client with newly diagnosed stable angina who has many questions about medications and nursing care 4. A 75-year-old client who has just been transferred to the unit after undergoing coronary artery bypass grafting yesterday

2 The new RN's education and hospital orientation would have included safe administration of IV medications. The preceptor will be responsible for the supervision of the new graduate in assessments and client care. The other clients require more complex assessment or client teaching by an RN with experience in caring for clients with these diagnoses.

Which client should the charge nurse assign to a new graduate RN who is orientating to the neurologic unit? 1. A 28-year-old newly admitted client with a spinal cord injury 2. A 67-year-old client who had a stroke 3 days ago and has left-sided weakness 3. An 85-year-old client with dementia who is to be transferred to long-term care today 4. A 54-year-old client with Parkinson disease who needs assistance with bathing

2 The new graduate RN who is on orientation to the unit should be assigned to care for clients with stable, noncomplex conditions, such as the client with stroke. The task of helping the client with Parkinson disease to bathe is best delegated to the unlicensed assistive personnel (UAP). The client being transferred to the nursing home, and the newly admitted client with spinal cord injury should be assigned to experienced nurses.

Which pediatric pain patient should be assigned to a newly graduated RN? 1. An adolescent who has sickle cell disease and was recently weaned from morphine delivered via a patient-controlled analgesia device to an oral analgesic; he has been continually asking for an increased dose 2. A child who needs premedication before reduction of a fracture; the child has been crying and is resistant to any touch to the arm or other procedures 3. A child who is receiving palliative end-of-life care; the child is receiving opioids around the clock to relieve suffering, but there is a progressive decrease in alertness and responsiveness 4. A child who has chronic pain and whose medication and nonpharmacologic regimen has recently been changed; the mother is anxious to see if the new regimen is successful

2 The set of circumstances is least complicated for the child with the fracture, and this would be the best patient for a new and relatively inexperienced nurse. The child is likely to have a good response to pain medication, and with gentle encouragement and pain management, the anxiety will resolve. The other three children have more complex social and psychological issues related to pain management.

Which client should the charge nurse assign to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for 1 week? 1. A 34-year-old client with newly diagnosed multiple sclerosis (MS) 2. A 68-year-old client with chronic amyotrophic lateral sclerosis (ALS) 3. A 56-year-old client with Guillain-Barré syndrome (GBS) in respiratory distress 4. A 25-year-old client admitted with a C4-level spinal cord injury (SCI)

2 The traveling nurse is relatively new to neurologic nursing and should be assigned clients whose condition is stable and not complex, such as the client with chronic ALS. The newly-diagnosed client with MS will need a lot of teaching and support. The client with respiratory distress will need frequent assessments and may need to be transferred to the intensive care unit. The client with a C4-level SCI is at risk for respiratory arrest. All three of these clients should be assigned to nurses experienced in neurologic nursing care.

An emergency department clinical nurse specialist is training staff in how to don and doff personal protective equipment (PPE) when caring for clients with infections, such as Ebola. Which staff member has demonstrated the most grievous error during the practice session? 1. Triage nurse forgets to perform hand hygiene before donning PPE. 2. Unlicensed assistive personnel performs self-inspection; then begins to doff PPE. 3. Health care provider forgets to wipe shoes with disinfectant after doffing shoe covers. 4. Emergency medical technician doffs both pairs of gloves first.

4 All team members have made errors, but removing both pairs of gloves puts the emergency medical technician at the greatest risk because the outer surfaces of the remaining PPE are considered contaminated. According to the latest recommendations from the Centers for Disease Control and Prevention, the flow of donning is as follows: hand hygiene, inner gloves, shoe covers, gown, N95 respirator, hood, outer gloves, face shield, inspection (by self and trained observer), range of motion, and hand hygiene. The flow of doffing is inspection (by self and trained observer), hand hygiene, remove shoe covers, remove outer gloves, inspect inner gloves, remove face shield, hand hygiene, remove hood, hand hygiene, remove gown, hand hygiene, remove inner gloves, hand hygiene, apply new gloves, remove n95 respirator, hand hygiene, disinfect shoes, hand hygiene, remove gloves, hand hygiene, and inspection (by self and trained observer).

The charge nurse in a long-term care (LTC) facility that employs RNs, LPNs/LVNs, and unlicensed assistive personnel (UAP) is planning care for a resident with a stage III sacral pressure ulcer. Which nursing intervention is best to assign to an LPN/LVN? 1. Choosing the type of dressing to be used on the ulcer 2. Using the Braden scale to assess for pressure ulcer risk factors 3. Assisting the client in changing position at frequent intervals 4. Cleaning and changing the dressing on the ulcer every morning

4 LPN/LVN education and scope of practice includes sterile and nonsterile wound care. LPNs/LVNs do function as wound care nurses in some LTC facilities, but the choice of dressing type and assessment for risk factors are more complex skills that are appropriate to the RN level of practice. Assisting the client to change position is a task included in UAP education and would be more appropriate to delegate to the UAP.

Which client is the most appropriate to assign to an LPN/LVN under the supervision of an RN? 1. A client with oral cancer who is scheduled in the morning for glossectomy 2. An obese client returned from surgery after a vertical banded gastroplasty 3. A client with anorexia nervosa who has muscle weakness and decreased urine output 4. A client with intermittent nausea and vomiting related to chemotherapy

4 Nausea and vomiting are common after chemotherapy. Administration of antiemetics and fluid monitoring can be done by an LPN/LVN. The RN should perform the preoperative teaching for the glossectomy client. Clients returning from surgery need extensive assessment. The client with anorexia is showing signs of hypokalemia and is at risk for cardiac dysrhythmias.

The charge nurse is making assignments for the day shift. Which patient should be assigned to the nurse who was floated from the postanesthesia care unit (PACU) for the day? 1. A 35-year-old patient with osteomyelitis who needs teaching before hyperbaric oxygen therapy 2. A 62-year-old patient with osteomalacia who is being discharged to a long-term care facility 3. A 68-year-old patient with osteoporosis given a new orthotic device whose knowledge of its use must be assessed 4. A 72-year-old patient with Paget disease who has just returned from surgery for total knee replacement

4 The PACU nurse is very familiar with the assessment skills necessary to monitor a patient who just underwent surgery. For the other patients, nurses familiar with musculoskeletal system-related nursing care are needed to provide teaching and assessment and prepare a report to the long-term care facility.

An LPN/LVN, under the RN's supervision, is assigned to provide nursing care for a client with Guillain-Barré syndrome (GBS). What observation should the LPN/LVN be instructed to report immediately? 1. Reports of numbness and tingling 2. Facial weakness and difficulty speaking 3. Rapid heart rate of 102 beats/min 4. Shallow respirations and decreased breath sounds

4 The priority intervention for a client with GBS is maintaining adequate respiratory function. Clients with GBS are at risk for respiratory failure, which requires urgent intervention. The other findings are important and should be reported to the nurse, but they are not life threatening. *GBS SLOWS MUSCLES*

Which clients can be appropriately assigned to an LPN/LVN who will function under the supervision of an RN or team leader? Select all that apply. 1. Client who needs preoperative teaching about the patient-controlled analgesia pump 2. Client with a leg cast who needs neuro-circ checks and as needed (PRN) hydrocodone 3. Client who underwent a toe amputation and has diabetic neuropathic pain 4. Client with terminal cancer and severe pain who is refusing medication 5. Client who reports abdominal pain after being kicked, punched, and beaten 6. Client with arthritis who needs scheduled pain medications and heat applications

236 The clients with the cast, toe amputation, and arthritis are in stable condition and need ongoing assessment and pain management that are within the scope of practice of an LPN/LVN under the supervision of an RN. The RN should take responsibility for preoperative teaching, and the client with terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication. The client with trauma needs serial assessments to detect occult trauma.

Which client is best for the oncology unit charge nurse to assign to an RN who has floated from the emergency department? 1. Client who needs doxorubicin chemotherapy to treat metastatic breast cancer 2. Client who needs discharge teaching after surgery for stage II ovarian cancer 3. Client with metastatic prostate cancer who requires frequent assessment and treatment for breakthrough pain 4. Client with testicular cancer who requires preoperative teaching about orchiectomy and lymph node resection

3 An RN from the emergency department would be experienced in assessment and management of pain. Because of their diagnoses and treatments, the other clients should be assigned to RNs who are experienced in caring for clients with cancer.

The charge nurse observes an LPN/LVN assigned to provide all of these interventions for a patient with Paget disease. Which action requires that the charge nurse intervene? 1. Administering 600 mg of ibuprofen to the patient 2. Encouraging the patient to perform exercises recommended by a physical therapist 3. Applying ice and gentle massage to the patient's lower extremities 4. Reminding the patient to drink milk and eat cottage cheese

3 Applying heat, not ice, is the appropriate measure to help reduce the patient's pain. Ibuprofen is useful to manage mild to moderate pain. Exercise prescribed by a physical therapist would be nonimpact in nature and provide strengthening for the patient. A diet rich in calcium promotes bone health.

A patient with an absolute neutrophil count of 300/μL (0.3 × 109/L) is admitted to the oncology unit. Which staff member should the charge nurse assign to provide care for this patient, under the supervision of an experienced oncology RN? 1. LPN/LVN who has floated from the same-day surgery unit 2. RN from a staffing agency who is being oriented to the oncology unit 3. LPN/LVN with 2 years of experience on the oncology unit 4. RN who recently transferred to the oncology unit from the emergency department

3 Because many aspects of nursing care need to be modified to prevent infection when a patient has a low absolute neutrophil count, care should be provided by the staff member with the most experience with neutropenic patients. The other staff members have the education required to care for this patient but are not as clinically experienced. When LPN/LVN staff members are given acute care patient assignments, they must work under the supervision of an RN. The LPN/LVN in this case would report to the RN assigned to the patient.

A victim of heat stroke arrives in the emergency department. His skin is hot and dry; his body temperature is 105°F (40.6°C). He is confused and demonstrates bizarre behavior. His blood pressure is 85/60 mm Hg, pulse 130 beats/min, and respirations are 40 breaths/min. Which task should be assigned to an experienced LPN/LVN? 1. Insert a rectal probe to measure core body temperature. 2. Administer aspirin or another antipyretic. 3. Insert an indwelling urinary drainage catheter. 4. Assess respiratory effort, hemodynamics, and mental status.

3 Inserting an indwelling urinary catheter is within the scope of practice of an experienced LPN/LVN. Experienced unlicensed assistive personnel should be directed to insert the rectal probe to monitor the core temperature. Initial assessment of new clients and critically ill clients should be performed by the RN. Aspirin and other antipyretics are not given because they won't work to decrease the body temperature and may be harmful. The care of this client would also include arterial blood gases; possible endotracheal intubation; IV fluids; blood for electrolytes, cardiac and liver enzymes, and complete blood count; muscle relaxants (benzodiazepines) if the client begins to shiver; monitoring urine output and specific gravity to determine fluid needs; cooling interventions; and discontinuing cooling interventions when core body temperature is reduced to 102°F (38.9°C).

The nurse is working on a medical unit staffed with LPNs/LVNs and unlicensed assistive personnel (UAP) when a client with stage IV ovarian cancer and recurrent ascites is admitted for paracentesis. Which activity is best to assign to an experienced LPN/LVN? 1. Obtaining a paracentesis tray from the central supply area 2. Completing the short-stay client admission form 3. Measuring vital signs every 15 minutes after the procedure 4. Providing discharge instructions after the procedure

3 LPN/LVN education includes vital sign monitoring after procedures such as paracentesis; an experienced LPN/LVN would recognize and report significant changes in vital signs to the RN. The paracentesis tray could be obtained by a UAP. Client admission assessment and teaching require RN-level education and experience, although part of the data gathering may be done by an LPN/LVN.

The RN is a team leader working with an LPN/LVN and two unlicensed assistive personnel (UAP) to provide care for eight medical patients. Which action would be appropriate for the RN take with regard to nursing care provided by the LPN/LVN? . Delegate the performance of an abdominal dressing change to the LPN/LVN. 2. Supervise and document the patient assessments completed by the LPN/LVN. 3. Assign the LPN/LVN the administration of insulin to a patient with type 1 diabetes. 4. Delegate checking and recording vital signs on all eight patients to the LPN/LVN.

3 LPN/LVNs are licensed and therefore responsible for their own practice. Their scope of practice includes administration of medications. The RN team leader is responsible for supervision as well as making assignments for LPN/LVNs (team leaders also make assignments for other RNs on the team). Delegation of checking and recording vital signs is appropriate for the UAPs. The LPN/LVN could perform the dressing change, but the RN would assign, not delegate, the task.

The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months of experience) floated from the surgical unit to the medical unit? 1. A 58-year-old patient on airborne precautions for tuberculosis (TB) 2. A 65-year-old patient who just returned from bronchoscopy and biopsy 3. A 72-year-old patient who needs teaching about the use of incentive spirometry 4. A 69-year-old patient with chronic obstructive pulmonary disease (COPD) who is ventilator dependent

3 Many surgical patients are taught about coughing, deep breathing, and the use of incentive spirometry preoperatively. Also, a fairly new nurse should be assigned more stable and less complicated patients. To care for the patient with TB in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. The bronchoscopy patient needs specialized and careful assessment and monitoring after the procedure, and the ventilator-dependent patient needs a nurse who is familiar with ventilator care. Both of these patients need experienced nurses.

Which client in the neurologic intensive care unit should the charge nurse assign to an RN who has been floated from the medical unit? 1. A 26-year-old client with a basilar skull fracture who has clear drainage coming out of the nose 2. A 42-year-old client admitted several hours ago with a headache and a diagnosis of a ruptured berry aneurysm 3. A 46-year-old client who was admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due 4. A 65-year-old client with an astrocytoma who has just returned to the unit after undergoing craniotomy

3 Of the clients listed, the client with bacterial meningitis is in the most stable condition and likely the least complex. An RN from the medical unit would be familiar with administering IV antibiotics. The other clients require assessments and care from RNs more experienced in caring for clients with neurologic diagnoses.

The patient with type 2 diabetes has a health care provider prescription for NPO status for a cardiac catheterization. An LPN/LVN who is assigned to administer medications to this patient asks the supervising RN whether the patient should receive his ordered repaglinide. What is the RN's best response? 1. "Yes, because this drug will increase the patient's insulin secretion and prevent hyperglycemia." 2. "No, because this drug may cause the patient to experience gastrointestinal symptoms such as nausea." 3. "No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO." 4. "Yes, because this drug should be taken three times a day whether the patient eats or not."

3 Repaglinide is a meglitinide analog drug. These drugs are short-acting agents used to prevent postmeal blood glucose elevation. They should be given within 1 to 30 minutes before meals and cause hypoglycemia shortly after dosing when a meal is delayed or omitted.

The postoperative care of a morbidly obese client is being planned. Which task best uses the expertise of the LPN/LVN, under the supervision of the RN team leader? 1. Obtaining an oversized blood pressure cuff and a large-size bed 2. Setting up a reinforced trapeze bar 3. Assisting in the planning of toileting, turning, and ambulation 4. Assigning tasks to unlicensed assistive personnel (UAP) and other ancillary staff

3 The LPN/LVN can offer valuable assistance in planning the interventions, but the RN has ultimate responsibility for the care plan. The LPN/LVN can delegate and assign tasks to UAPs; however, if the RN is the team leader, it is better if UAPs are not receiving instructions from multiple people. Obtaining equipment should be delegated to a UAP. A physical therapist should be contacted to set up specialized equipment.

A patient with graft-versus-host disease after bone marrow transplantation is being cared for on the medical unit. Which nursing activity is best assigned to a travel RN? 1. Administering oral cyclosporine 2. Assessing the patient for signs of infection 3. Infusing 5% dextrose in 0.45% saline at 125 mL/hr 4. Educating the patient about ways to prevent infection

3 The infusion of IV fluids is a common intervention that can be implemented by RNs who do not have experience in caring for patients who are severely immunosuppressed. Administering cyclosporine, assessing for subtle indications of infection, and patient teaching are more complex tasks that should be done by RN staff members who have experience caring for immunosuppressed patients.

A patient who has received a kidney transplant has been admitted to the medical unit with acute rejection and is receiving IV cyclosporine and methylprednisolone. Which staff member is best to assign to care for this patient? 1. RN who floated to the medical unit from the coronary care unit for the day 2. RN with 3 years of experience in the operating room who is orienting to the medical unit 3. RN who has worked on the medical unit for 5 years and is working a double shift today 4. Newly graduated RN who needs experience with IV medication administration

3 To be most effective, cyclosporine must be mixed and administered in accordance with the manufacturer's instructions, so the RN who is likely to have the most experience with the medication should care for this patient or monitor the new graduate carefully during medication preparation and administration. The coronary care unit float nurse and the nurse who is new to the unit would not have experience with this medication.

The nurse hears in hand-off report that, 1 hour ago, the health care provider requested that the client be given the maximum dose of magnesium hydroxide. Which instruction is the nurse most likely to give to unlicensed assistive personnel? 1. Client will frequently need assistance to the bathroom for bowel evacuation. 2. Client may experience some dizziness when ambulating or changing position. 3. Client is frequently vomiting and may need linen and gown changes. 4. Client needs to be encouraged and assisted to eat and drink as much as possible.

1 The maximum dose of magnesium hydroxide is given for bowel evacuation and cleansing. It is expected that the medication should have effect within 2 to 6 hours.

Which tasks are appropriate to assign to an LPN/LVN who is functioning under the supervision of an RN? Select all that apply. 1. Administering sulfacetamide sodium 10% to a child with conjunctivitis 2. Reviewing hand-washing and hygiene practices with clients who have eye infections 3. Showing clients how to gently cleanse eyelid margins to remove crusting 4. Assessing nutritional factors for a client with age-related macular degeneration 5. Reviewing the health history of a client to identify risk for ocular manifestations 6. Performing a routine check of a client's visual acuity using the Snellen eye chart

1236 Administering medications, reviewing and demonstrating standard procedures, and performing standardized assessments with predictable outcomes in noncomplex cases are within the scope of the LPN/LVN. Assessing for systemic manifestations and behaviors, risk factors, and nutritional factors is the responsibility of the RN.

Which clients can be appropriately assigned to a newly graduated RN who has recently completed orientation? Select all that apply. 1. Anxious client with chronic pain who frequently uses the call button 2. Client on the second postoperative day who needs pain medication before dressing changes 3. Client with acquired immune deficiency syndrome who reports headache and abdominal and pleuritic chest pain 4. Client with chronic pain who is to be discharged with a new surgically implanted catheter 5. Client who is reporting pain at the site of a peripheral IV line 6. Client with a kidney stone who needs frequent as needed (PRN) pain medication

256 The client who is second day postoperative, the client who has pain at the IV site, and the client with the kidney stone have predictable needs and require routine care that a new nurse can manage. The anxious client with chronic pain needs an in-depth assessment of the psychological and emotional components of pain and expert intervention. The client with acquired immune deficiency syndrome has complex issues that require expert assessment skills. The client pending discharge will need special and detailed instructions.

Which client is best for the nurse manager on the burn unit to assign to an RN who has floated from the oncology unit? 1. A 23-year-old client who has just been admitted with burns over 30% of the body after a warehouse fire 2. A 36-year-old client who requires discharge teaching about nutrition and wound care after having skin grafts 3. A 45-year-old client with infected partial-thickness back and chest burns who has a dressing change scheduled 4. A 57-year-old client with full-thickness burns on both arms who needs assistance in positioning hand splints

3 A nurse from the oncology unit would be familiar with dressing changes and sterile technique. The charge RN in the burn unit would work closely with the float RN to provide partners to assist in providing care and to answer any questions. Admission assessment and development of the initial care plan, discharge teaching, and splint positioning in burn clients all require expertise in caring for clients with burns. These clients should be assigned to RNs who regularly work on the burn unit.

The charge nurse is making the daily assignments on the medical-surgical unit. Which patient is best assigned to a float RN who has come from the postanesthesia care unit (PACU)? 1. A 30-year-old patient with thalassemia major who has an order for subcutaneous infusion of deferoxamine 2. A 43-year-old patient with multiple myeloma who requires discharge teaching 3. A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy 4. A 65-year-old patient with pernicious anemia who has just been admitted to the unit

3 A nurse who works in the postanesthesia care unit will be familiar with the monitoring needed for a patient who has just returned from a procedure such as a colonoscopy, which requires moderate sedation or monitored anesthesia care (conscious sedation). Care of the other patients requires staff with more experience with various types of hematologic disorders and would be better to assign to nursing personnel who regularly work on the medical-surgical unit.

The charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? 1. A 58-year-old patient with urothelial cancer receiving multiagent chemotherapy 2. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy 3. A 24-year-old patient with acute pyelonephritis and severe flank pain 4. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI)

34 Both of these patients will need frequent assessments and medications. The patient receiving chemotherapy and the patient who has just undergone surgery should not be exposed to any patient with infection.