CH.6 Delegation and Prioritization of Client Care Staffing

The nursing assistant tells a nurse that a patient who is receiving oxygen at a flow rate of 6L/min by NC is complaining of nasal passage discomfort. What intervention should the nurse suggest to improve the patient's comfort for this problem? A) Suggest that the patient's oxygen be humidified. B) Suggest that a simple face mask be used instead of a NC. C) Suggest that the patient be provided with an extra pillow. D) Suggest that the patient sit up in a chair at the bedside.

A) Suggest that the patient's oxygen be humidified. -When the oxygen flow rate is higher than 4 L/min, the mucous membranes can be dried out. The best treatment is to add humidification to the oxygen delivery system. Application of a water-soluble jelly to the nares can also help decrease mucosal irritation.

A nurse is helping an NAP provide a bed bath to a comatose patient who is incontinent. Which of the following actions requires the nurse to intervene? A) The NAP answers the phone while wearing gloves. B) The NAP log-rolls the client to provide back care. C) The NAP places an incontinence diaper under the client. D) The NAP positions the client on the left side, head elevated.

A) The NAP answers the phone while wearing gloves. -The gloves are contaminated and should be removed before answering the phone.

A nurse is caring for a patient who has a pulmonary embolus. The patient is receiving anticoagulation with IV heparin. What instructions should the nurse give the NAP who will help the patient with activities of daily living? Select all that apply. A) Use a lift sheet when moving and positioning the patient in bed. B) Use an electric razor when shaving the patient each day. C) Use a soft-bristled toothbrush or tooth sponge for oral care. D) Use a rectal thermometer to obtain a more accurate body temperature. E) Be sure the patient's footwear has a non-slip sole when the patient ambulates.

A) Use a lift sheet when moving and positioning the patient in bed. B) Use an electric razor when shaving the patient each day. C) Use a soft-bristled toothbrush or tooth sponge for oral care. E) Be sure the patient's footwear has a non-slip sole when the patient ambulates. -These are appropriate to the care of a patient receiving anticoagulants.

An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit? A. A 58-year-old on airborne precautions for tuberculosis (TB) B. A 68-year-old who just returned from bronchoscopy and biopsy C. A 69-year-old with COPD who is ventilator dependent D. A 72-year-old who needs teaching about the use of incentive spirometry

D. A 72-year-old who needs teaching about the use of incentive spirometry -Many surgical patients are taught about coughing, deep breathing, and the use of incentive spirometry preoperatively.

A nurse is caring for a patient who has COPD and is 2 days postop after a laparoscopic cholecystectomy. Which intervention for airway management should the nurse delegate to an NAP? A) Assisting the patient to sit up on the side of the bed. B) Instructing the patient to cough effectively. C) Teaching the patient to use incentive spirometry. D) Auscultating breath sounds every 4 hours.

A) Assisting the patient to sit up on the side of the bed. -Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant.

An experienced LPN is working under the supervision of the RN. The LPN is providing nursing care for a patient who has a respiratory problem. Which activities should the RN delegate to the experienced LPN? Select all that apply. A) Auscultate breath sounds. B) Administer meds via metered-dose inhaler (MDI). C) Complete in-depth admission assessment. D) Initiate the nursing care plan. E) Evaluate the patient's technique for using MDIs.

A) Auscultate breath sounds. B) Administer meds via metered-dose inhaler (MDI). -The experienced LPN is capable of gathering data and making observations, including noting breath sounds and performing pulse oximetry. Administering meds, such as those delivered via metered dose inhalers (MDIs), is within the scope of practice of the LPN.

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) Observe how well the patient performs 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) Observe how well the patient performs pursed-lip breathing. -Experienced LPNs and LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught.

A nurse is caring for a patient who is diagnosed with coronary artery disease and sleep apnea. Which action should the nurse delegate to the NAP? A) Discuss weight-loss strategies such as diet and exercise with the patient. B) Teach the patient how to set up the CPAP machine before sleeping. C) Remind the patient to sleep on his side instead of his back. D) Administer modafinil (Provigil) to promote daytime wakefulness.

C) Remind the patient to sleep on his side instead of his back. -The NAP can remind patients about actions that have already been taught by the nurse and are part of the patient's POC.

A nurse is assigned to care for the following patients. Which patient should the nurse assess first? A) A 60-year-old with patient on a ventilator for whom a sterile sputum specimen must be sent to the laboratory. B) A 55-year-old with COPD and a pulse oximetry reading from the previous shift of 90% saturation. C) A 70-year-old with pneumonia who needs to be started on IV antibiotics. D) A 50-year-old with asthma who complains of SOB after using a bronchodilator.

D) A 50-year-old with asthma who complains of SOB after using a bronchodilator. -The patient with asthma did not achieve relief from SOB after using the bronchodilator and is at risk for respiratory complications. This patient's needs are urgent.

A respiratory therapist performs suctioning on a patient with a closed head injury who has a tracheostomy. Afterward, the NAP obtains vital signs. The nurse should communicate that the NAP needs to report which vital sign value immediately? Select all that apply. A) HR of 96 bpm B) RR 24 bpm C) O2 95% D) Tympanic temp 101.4 (38.6)

D) Tympanic temp 101.4 (38.6) -The patient has a tracheostomy and is at risk for infection. A tympanic temperature of 101.4 (38.6) indicates an infection and needs to be reported immediately.