An RN has to teach the client initially but can delegate ________to an LPN.
reinforcing the teaching
An LPN can perform ______care.
tracheostomy care
Can an RN delegate to an LPN to perform suctioning?
yes
Can an RN delegate to an LPN to put in a urinary catheter?
yes
Can an RN delegate to an AP to feed a client not on swallow precautions?
yes
Is an RN allowed to delegate to an AP to collect a urine sample?
yes
A nurse delegates to an AP to assist in obtaining vital signs from a postop patient who required naloxone (narcan) for depressed respirations. Is this an appropriate task for the AP?
no
An older adult client who is on fall precautions is found lying on the floor of his hospital room. Which of the following actions is most appropriate for the nurse to take first?
A. Call the client's provider
B. Ask a staff member for assistance getting t
C. Inspect the client for injuries
An RN on a med-surg unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN?
A. Obtain vitals for a client who is 2 hr postop following a cardiac cath
B. Administering a unit of PRBCs
C.
A
A nurse is caring for an older adult client who has left the unit for a radiology procedure. The client's son asks the nurse what med is being given to the client. Which of the following is an appropriate response by the nurse?
A. "I am sorry, but that is
A.
A nurse works in a mental health facility that uses a case management nursing model to provide care. The nurse should recognize that which of the following describes a case management approach to care?
A. A nurse provides total care for several clients
B.
B
A nurse overhears a client talking with an attorney, reporting physical abuse, use of restraints & denial of meals. What action should the nurse take?
A. Report the conversation to the nurse manager to allow for follow-up investigation.
B. Question the cl
A
A nurse manager is planning a department meeting to discuss client advocacy. Which of the following situations should be included in the discussion? Select all that apply.
A. Discussing treatment options w/a client who was pancreatic cancer
B. Notifying t
B, C, D, E
A nurse is assessing a client's negligible progress in following a weight loss program. Which of the following is a likely reason the client was unable to achieve a short-term goal established during the planning phase of the nursing process?
A. The goals
B
A nurse has prepared an IM injection for a client who is preoperative, when another client suddenly calls for assistance. The nurse asks an LPN to give the injection since an AP is waiting to take the client to surgery. Which of the following is an approp
C
A new charge nurse on a busy surgical unit notes a high degree of tension among the nursing staff. Which of the following should be the initial method used for resolving this issue?
A. Work w/the nurses to identify stressors
B. Hire additional staff to de
A
A nurse on a long-term care unit finds that a client receiving dialysis was administered captopril (capoten), which was not prescribed for the client. In which order should the nurse take the actions listed?
___Complete an incident report.
___Contact the
1. Measure the client's vitals
2. Instruct the client to call for assistance when getting out of bed
3. Notify provider
4. Complete an incident report
5. Contact the risk manager
A nurse is caring for a group of clients on a med surg unit. Which of the following tasks should the nurse delegate to the assistive personnel (AP)? Select all that apply.
A. Collecting a stool specimen
B. Providing instructions about using a spirometer
C
A, C, D
A nurse on a med surg unit is planning care of assigned clients. Which of the following clients should the nurse assess first?
A. A client who is newly admitted & is to have an indwelling urinary catheter inserted
B. A client who has kidney stones & repor
D
An RN working w/an LPN is planning client care assignments. Which of the following tasks should the nurse delegate to the LPN?
A. Performing tracheostomy suctioning for a stable client
B. Performing an admission assessment of a client who is preop
C. Init
A
A client is prescribed morphine sulfate IM. Which of the following should the nurse recognize as a requirement for governing controlled substances?
A. Delegate med admin to a RN
B. Ask another nurse to observe disposal of unused med
C. Request another nur
B
An older adult client who has early Alzheimer's disease is living w/an adult child who is employed part-time but is committed to keeping her parent at home. Which of the following options is appropriate for the nurse to discuss w/the client & family at th
B
A nurse is overheard telling other nurses that the unit manager gives preferential treatment to nurses on the night shift. Which of the following approaches by the unit manager reflects an assertive response to resolution of this conflict?
A. Understand t
C
A nurse is caring for a group of clients on a medical unit. Which of the following is the priority finding the nurse should report to the provider?
A. A client receiving metoclopramide (Reglan) reports diarrhea
B. A client receiving tamsulosin (Flomax) re
C
A nurse is caring for a client who has recently been prescribed lithium carbonate (Eskalith). Which of the following is the priority assessment finding for this client?
A. Fine hand tremors
B. Weight gain of 2.7 kg (6 lb)
C. Report of nausea
D. Poor motor
D
A nurse manager is reviewing the function of "Code of Ethics for Nurses with Interpretive Statements" during a staff meeting. The nurse manager recognizes that this document is:
A. legally binding
B. mandatory for the practice of nursing
C. a description
D.
A nurse manager finds an increased incidence of health-care associated infections (HAIs) on a long term care unit. Which of the following is the priority action the nurse manager should take to address the problem?
A. Monitor the staff's hand hygiene tech
D
A nurse manager is about to write a 2 month performance appraisal for a newly graduated nurse. Which of the following factors should the nurse manager take into consideration when planning a performance appraisal interview for this nurse?
A. The written a
D
A nurse working at a rehab facility attends an interdisciplinary team meeting for a client who has had a left hemispheric stroke. Which of the following members of the interdisciplinary team should the nurse expect to contribute to the plan of care? Selec
A, B, C, D
A nurse is writing a goal for a client's reaction following the admin of a med. Which of the following phases of the nursing process should the nurse modify?
A. Planning
B. Evaluation
C. Analyzing
D. Assessment
A
The actual writing of an expected outcome is done in the planning phase of the nursing care plan.
A charge nurse on a med surg unit is assigning client care to an RN and an LPN. Which of the following tasks should the nurse assign to the RN? Select all that apply.
A. Performing colostomy care
B. Administering blood to a client
C. Developing a plan of
B, C, D
A nurse manager is providing info about the audit process to members of the nursing team. Which of the following statements should the nurse manager include? Select all that apply.
A. A structure audit evaluates the setting & resources available to provid
A, B, C, E
A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following will provide the most relevant info regarding the efficacy of the procedure?
A. Frequency w/which the procedure is performed
B.
C
A nurse manager has received a performance appraisal from the unit manager. Which of the following actions by the unit manager requires intervention?
A. The evaluation was conducted in the unit manager's office
B. Data that was collected for the previous
C
A nurse is preparing to transfer an older adult client who is 72 hr postop from a surgical procedure to a long term care facility. Which of the following should the nurse include in the transfer report? Select all that apply.
A. Type of anesthesia used
B.
B, D, E
A nurse is participating in an interprofessional conference for a client who has a recent C6 spinal cord injury. The client worked as a construction worker prior to his injury. Which of the following members of the interprofessional team should also parti
A, C, D, E
A nurse manager is working with a committee of nurses whose task is to update the policies for new employee orientation. The nurse manager directs the team to collect as much data as possible & recommend several options. Which of the following decision-ma
D.
A nurse who has just assumed the role of unit manager is examining her skills in interprofressional collaboration. Which of the following actions support interprofessional collaboration? Select all that apply.
A. Use aggressive communication when addressi
B, D, E
A nurse is caring for a client who is being prepared for surgery. The client hands the nurse info about advance directives & states, "Here, I don't need this. I am too young to worry about life-sustaining measures & what I want done for me." Which of the
C
A nurse is serving as a preceptor to a newly licensed nurse & is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? Select all that apply.
A. Verifying that a client understands what is done duri
A, C, D
A nurse manager is providing info to the nurses on the unit about ensuring client rights. Which of the following outlines the rights of individuals in health care settings?
A. American Nurses Association Code of Ethics
B. HIPAA
C. Patient Self-Determinati
D
A nurse is reviewing a client's health care record & discovers that the client's DNR order has expired. The client's condition is not stable. Which of the following actions should the nurse take?
A. Assume that the client does not want be resuscitated, &
D
A home health nurse is assessing the safety of a client's home. Which of the following factors may increase the client's risk for falls? Select all that apply.
A. History of a previous fall
B. Reduced vision
C. Impaired memory
D. Takes rosuvastatin (Crest
A, B, C, E, F
A client is brought back to the unit after a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, & repeatedly attempts to get out of bed. Which of the following actions should the nurse
A, B, C
A nurse is observing a newly licensed nurse & an AP pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates a need for further education?
A. The nurse spreads his legs apart
B. The nurse uses his bod
C
An AP reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. The client's morning finger-stick blood glucose was 285 mg/dL. The client is asymptomatic for hypoglycemia, & his next dose of insulin is scheduled to be adm
A
A nurse discovers that a client was administered an antihypertensive med in error. Number the following actions in the appropriate sequence that the nurse should follow.
___A. Call the client's provider
___B. Monitor the client's vitals
___C. Notify the r
1. B
2. E
3. A
4. D
5. C
A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following statements should the nurse manager include? Select all that apply.
A. A description of the incident should be documented in t
A, B, C, E