a charge nurse is making client care assignments

b. A nurse is administering a cold therapy application to a client. So what is wrong with option #1? 4. d. Message, 67. Provide positive feedback to the UAP. 2. Select all that apply The nurse does not know the skills of the new UAP. b. Irrigate the NG tube with 100 mL of sterile water a. I'll provide more stimulation in his environment 4. The charge nurse delegates a licensed practical nurse (LPN) to perform an intervention that is not within the scope of practice for the LPN. December 5, 2020. Richied5864 Richied5864 . c. They tend to use more verbal communication Correct: All facilities are required to develop a disaster plan, per JCAHO (Joint Commission on Accreditation of Healthcare Organizations) regulations, though the plans vary. The nurse could definitely be part of the committee. A nurse in a long-term care facility is caring for an older client who has dementia and begins to have frequent episodes of urinary incontinence. 1., 2., 4., & 5. Hold the penis at a 30 to 45 degree angle when inserting the catheter What is the appropriate assignment? Nothing by mouth (NPO). Correct: Talking to the nurses about client concerns and completing the client assignment sheet for oncoming staff will provide for a thorough shift change report. a. 3. d. Bend at the knees when picking up an object, 99. The nurse should immediately assess this client, implement seizure precautions and remain with client for safety. Serve milk products separately from meals Which of the following statements should the nurse identify as an indication that the client needs further teaching? Which of the following activities should the nurse perform in this zone? Initiate oxygen and IV lines as needed. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes? Which of the following findings indicates that the client is meeting this goal? This is not a situation that requires the LPN to notify the primary healthcare provider. d. I have a set of my brothers' crutches in the basement I can also use, a. A nurse is working with an AP while caring for a surgical client who is 1 day postoperative. 2. 5. What task would be best to assign to the LPN/LVN? This perceived lack of control can create distrust and frustration among personnel, ultimately impacting client care. 3. c. The client's culture Briefly assess every client. Headache following this procedure is a potential side effect and would not be the priority concern for the nurse. Diltiazem is a calcium channel blocker that has been ordered as a titrated drip to slow heart rate and restore a regular rhythm. Correct: Assisting clients with activities of daily living are within the UAPs scope of practice. Report of feeling pressure 3. b. Each state BON differs in that also some have treatment programs they administer themselves. Those residing in long term care facilities benefit greatly from time spent with family or even older friends. 3. Administering 3 g/hr IV of morphine would be extremely dangerous. 2. 1. b. Removing the abdominal dressing The client will need to be assessed, but there is no specific indication the respiratory status is presently compromised. Which of the following actions should the nurse take? A distance of 5.00 cm is measured between two adjacent nodes of a standing wave on a 20.0-cm-long string. c. Hallucinations at the onset of sleep, 65. c. The chances of a malpractice suit are minimal as long as you follow our policies and procedures Incorrect: The concern here is the client being fed their meal. 4. Incorrect: The RN is responsible for assessment and evaluation. Place the client in a lateral position When completing an incident report about the pressure ulcer, the nurse should take which of the following actions? a. 2. This should not be delegated to the LPN/LVN. Which of the following actions should this nurse take? Which of the following tasks should the nurse delegate to AP? Incorrect: There are situations in which the LPN must notify the primary healthcare provider. 1) Bathe a client who had an amputation 2 days ago. d. What have you done in the past to cope with this issue? Channel Where on the body is each type of skin found? 2. 1. This individual should be provided appropriate comments of appreciation for this accomplishment. This could be devastating to the client if the decimal point is missed and the client receives 200 mg instead of the intended 20 mg of lisinopril. a. A newly hired nurse in a long term care facility has been asked to assist with revising old policies regarding family visitation schedules. Incorrect: Dealing with a client's emotional state requires a formative evaluation to gauge readiness and requires the knowledge of the RN. 2. Correct: The only procedure listed that is within the LPN/LVN's practice range is changing the colostomy bag. c. Washes and rinses her hands for 10 seconds Serve food that have a hot/cold balance Which prescription should the nurse question and have corrected? Which clients should the nurse assign to the LPN/LVN based on skill level and scope of practice? Select all that apply _____The house that we lived in for nine years has been sold. b. 2. Which of the following interventions should the nurse include? However, it is on the "Do Not Use" list of abbreviations because it can be confused with morphine sulfate (MSO4). Which of the following types of torts has the nurse committed? Which tasks should the charge nurse delegate to the nursing assistant? "Please explain what you mean by the word 'nervous'.". Therefore, the nurse with Labor and Delivery experience would be the most appropriate one to assign to care for this client who has postpartum preeclampsia. It involves people who are constantly changing-their conditions improve and deteriorate, they're admitted and discharged, and their nursing needs can change in an instant. The charge nurse on each unit needs to prepare a list of possible discharges or transfers to be given to the appropriate primary healthcare providers for further action. c. I should purchase a carbon monoxide detector for my home Try different methods of oral care on unresponsive clients to see what works best. 3. Based on these findings, to which of the following providers should the nurse request a referral for the client? What action should the nurse implement first to ensure client safety? Ask the client to perform a return demonstration of insulin injection Read all the current literature related to oral care on unresponsive clients. a. Reposition the client every 3 hr Wrapping the dentures in tissue while the client sleeps Correct: It would be best to explore the reason the RN thinks the assignment is too heavy. Assess personal level of fatigue prior to making a decision regarding accepting or refusing assignment. Ask the primary healthcare provider to suggest the best oral care procedure. A nurse is developing a plan of care for a client who does not speak the same language as the nurse. Therefore, the nurse with the labor and delivery experience would be more appropriate to assign to this client. b. I'll use the cleansing wipes from the front to back What was the rationale for this plan? 2. Currently, your census is 11, with one empty bed. A nurse is teaching a client who has a history of falls about home safety. Notify the surgeon that the client wishes to withdraw informed consent for the procedure (the client has the right to withdraw consent therefore the surgeon should be the one notified of the request), 14. Even though this nurse just had a baby, there is no risk of her transmitting this virus to her child. The nurse also needs to be aware of the color and amount of urine voided. 4. b. b. Which of the following of Erikson's developmental stages should the nurse consider in the planning? Total abdominal hysterectomy, bladder suspension with A&P repair, client with breast reduction. These areas require the expertise of an RN and would not be appropriate for an LPN/LVN. d. 216, 22. A. Now, in Option #2, we see a dangerous prescription. The nurse suggest that the family might need to respite care services. Write the letter of your choice on the answer line. The client says, "go away, no one can help me." d. Routine acquisition of a urine specimen Flexible hours allow clients and families to spend more quality time together, increasing positive outcomes and satisfaction. Correct: Communication is important in delegation, as is follow-up. A. nurse is caring for a client who is not cooperating with his care and demonstrates defiant behavior. Cystogram reporting burning on urination. c. Open the right flap with the left hand Which of the following statements by the nurse would provide UAP with the best directions about an assignment? A nurse is admitting a client from a long-term care facility. d. Anger, b. 4. The client reports constipation for 4 days which may be an indication of worse problems. Both of these clients are terminal. What task would be best to assign to the LPN/LVN? c. Foot b. Incorrect: Teaching is outside the scope of practice for the LPN/LVN. Disconnect client's nasogastric (NG) tube suction to allow ambulation. Which client should the nurse see first? a. is a new graduate in orientation. Besides, a charge nurse is a leader on the floor and should possess . Following a passenger train derailment, local hospitals are notified to activate disaster protocols on all floors. IV of D5 NS at 75 mL/hour with a 20 gauge catheter. Licenced practical nurses are a little less educated than registered nurses. Which of the following explanations should the nurse provide? Which of the following actions should the nurse take prior to administering the tube feeding? 3. There is a possibility of rejection, which means close assessments and evaluations are needed by the RN. The nurse should use close-ended questions when assessing which of the following factors? d. Arguing, a. I'll apply ankle to my ankle today and tomorrow (the RICE acronym outlines how to treat an ankle sprain: rest, ice, compression, elevation), 16. What was the hint? e. Lemon gelatin, d. Use soap and water to wash the catheter after each use, 33. Delegate 2 nurses to work with the client. B. b. This is outside the scope of practice for the LPN/LVN. Place in priority order. 1. Select all that apply 4. If the client is unstable, the nurse would retain the role of measuring the vital signs. PURPOSE AND SCOPE: Supports FMCNA's mission,vision, core values and customer service philosophy. Remove all metal necklaces b. Removing the client's dentures A nurse is caring for a client who has had an allogenic hematopoietic stem-cell transplant. Select all that apply The client states, "I am so nervous about what the doctor might find during the test." Teach caregivers memory enhancement aids. Because positioning on a bedpan requires rolling of the client, an RN should be assigned to assess the insertion site and monitor for the presence of bleeding. 5. This referral would be appropriate. Assigning blame for the changes to administration will not help staff adjust. Incorrect: This will take a lot of time and is best initiated from the "best practice" committee. Protective The first vital sign check was performed by the nurse. a. b. 2. A client with COPD complaining of shortness of breath on exertion. 4. 2. d. I decline this opportunity at this time, b. There is a possibility that a hypothermia blanket may be prescribed. 5. The women's health charge nurse is making assignments for the next shift. A nurse is preparing an education presentation about organ donation for a group of newly licensed nurses. Alert all off-duty personnel to stand by in case of call- in. A charge nurse is planning a room assignment for a client who has a productive cough, a questionable x-ray, and a positive Mantoux test. nursing brain nurse sheets night documentation hour rotation sheet icu care assessment charting plan nurses assignment patient shift report rn. Incorrect: The scope of practice for the UAP encompasses basic personal care needs, ambulating, and taking vitals; however, the nurse must still verify that all tasks are accomplished in a safe manner. Dr. Frankenstein had seen himself as a(n) ?\underline{? 4. Airborne 2. Personal liability coverage is not mandatory, but you should consider purchasing your own coverage (c) Ba2+(aq)+CO32(aq)BaCO3(s);K=3.8108\mathrm{Ba}^{2+}(a q)+\mathrm{CO}_3^{2-}(a q) \longrightarrow \mathrm{BaCO}_3(s) ; K=3.8 \times 10^8Ba2+(aq)+CO32(aq)BaCO3(s);K=3.8108 c. I will make sure my visitors smoke outside Remind the client to avoid tight fitting clothes. Gown The client with chronic emphysema has expected shortness of breath. d. Perception A nurse is caring for a client who has rheumatoid arthritis and is experiencing difficulty feeding herself using adaptive devices. The option does not say the client is terminal, in a vegetative state, or in a coma. 4. Find a mentor Most nurses learn to make nurse-patient assign-ments from a colleague. The nurse caring for the client at the time of death requests organ donation 2. d. I hope I don't have to take as many pain pills, d. Left forearm (allows for easy access and doesn't interfere with the IV catheter), 46. Incorrect: An experienced neurological nurse should be assigned to this client due to the possibility that damage to the hypothalamus which controls body temperature has occurred. Tenderness over the symphysis pubis Review a low-sodium diet for a client with hypertension. The charge nurse tells a nurse that multiple sick calls from the upcoming shift has occurred. D. Incorrect: This is a nursing responsibility and the best practice committee is the best place to begin. 1. This is an appropriate and safe action for the unlicensed nursing assistant to do. 2. b. INCORRECT: There is no information regarding how recent was the surgery or the degree of pain being experienced. "The client is weak on the right side, so please assist the client with dressing . A nurse is teaching a client about the physical effects of chemotherapy. This client is stable and predictable. c. Measurement of residual urine after urination 4. For Option #3, you may have recognized MgSO4 as being magnesium sulfate. e. Talking with the client's partner, 79. Assessing this client and titrating the diltiazem requires the skills of an RN. 5. Which of the following statements by the newly licensed nurse indicates understanding of the purpose of documentation? 4. c. Face shield b. I can detect the presence of carbon monoxide by a metallic odor d. I'll use each cleansing wipe twice, d. I decline this opportunity at this time (assertive because it contains an "I" statement and it is clear and firm), 52. b. Of my three brothers and sisters, my sister Giselle has the best sense of humor. This is normal for clients with hemorrhoids. 3. Additionally, off-duty personnel may be needed and should be alerted to stand by; however, the command center alone makes the determination whether extra personnel should be called in, or if it would put more individuals in jeopardy. The unit is short one staff member and will receive a nurse from the medical surgical unit. The nurse received a client following surgery 8 hours ago. Determining the client's length of stay A Medical Power of Attorney is a type of Advance Directive that appoints a health care agent to make decisions on the client's behalf when the client is unable to do so. Even though this nurse just had a baby, there is no risk of her transmitting this virus to her child. The second client the nurse needs to see is the client diagnosed with gastroenteritis who had two 300 mL diarrhea stools in one hour. 1. Perform range of motion (ROM) exercises at least 2-3 times daily 3. 5. Which of the following instructions should the nurse include? d. Wears a respirator mask when entering the room of a client who requires airborne precautions, c. Industry vs inferiority (a school age child (6-12) is in this stage of development), 12. The nurse who made the medication error should take which of the following actions first? d. Reduced blood viscosity, a. Auscultating heart sounds It can result in muscle spasm and tissue damage. d. Identifying the client by name when making a referral for home health services, 30. b. Occupational therapist Protective (clients whose immune system is compromised, such as from chemo, AIDS, or after a stem-cell transplant, require a protective environment), 97. 1. 1. Incorrect: A UAP may not remove and change surgical dressings, which would involve assessment and further education. d. Place the tablet directly into a medication cup, 36. A nurse is having difficulty caring for a client due to variables affecting the communication process. Therefore, the RN must perform this task and cannot delegate this to the LPN/LVN. Temporary urinary retention (common for clients to develop after removal), 90. 4. The healthcare team should recognize the client as the center of the team. Refuse the delegated intervention. Incorrect: The nurse retains the responsibility for the delegated task. Electric comes from the Latin word for amber, a substance which readily takes a static electric charge. (b) H3O+(aq)+OH(aq)2H2O(l);K=1.01014\mathrm{H}_3 \mathrm{O}^{+}(a q)+\mathrm{OH}^{-}(a q) \longrightarrow 2 \mathrm{H}_2 \mathrm{O}(l) ; K=1.0 \times 10^{14}H3O+(aq)+OH(aq)2H2O(l);K=1.01014 Refuse the assignment, being prepared for disciplinary action. Pointing to the two glasses partially filled with water, the magician asked, "Which glass contains the least water?". When he arrives for his first dialysis treatment, he tells the nurse, "I decided to come today, but I am not sure if I will need to come back again this week. d. Offering sympathy, d. Test the pH of gastric aspirate (nurse should verify position of tube, testing pH is acceptable method between x-ray confirmations), 85. The client is apparently stable and does not require any advanced assessment skills or specialized care. 4. Fruity breath. Which of the following findings reported by the LPN indicates to the nurse the client has phlebitis at the IV insertion site? Decide which choice fits best in the blank. Determine the client's level of fluency in his primary language (it is important to determine the client's level of fluency in her primary language and the nurse's language to provide teaching the client can understand). 3. a. Which region of the tRNA pairs with mRNA? Client who is a diabetic experiencing diabetic neuropathy. Correct: An LPN/LVN's scope of practice includes tasks such as wound care. What action should the nurse take after mistakenly administering the wrong medication? The client asks the nurse, "Why do I need that? Battery Teaching about a medication a. Bathe a client who had an amputation 2 days ago Rewrite each incorrect sentence to correct the error. A nurse in a clinic is teaching a group of clients about preventing low back pain and injury. 3. Incorrect: Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12. A client with atrial fibrillation currently on a diltiazem drip. 2. Focusing d. Put the side rails up and tell the client to call the nurse before voiding, d. Two nurses using a friction-reducing device (reduces the risk of injury to the nurses and to the client; nurses can use a draw sheet as a friction-reducing device), 38. 28 week gestation of bed rest, postpartum with HELLP syndrome, breast reconstruction. A medical-surgical LPN has been sent to a short-staffed pediatric unit. 2. a. a. 2. Which of the following instructions should the nurse include? Incorrect: Just because the UAP is able to accomplish all daily assignments efficiently does not mean more work could be handled as effectively. Therefore, measures should be instituted to reduce the risk of the development of an overwhelming infection and sepsis. The nurse did not trust the new UAP. Which of the following actions should the nurse take? Feedback (Select all that apply.) Remind the client to tell the nurse when he has to urinate When asking the client about his receptiveness to the transfer b. The charge nurse is making client assignments for a neuro-medical floor. Changing a colostomy bag. A nurse removes an indwelling urinary catheter that an older client has had in place for 2 days. There are a total of 10 adult clients. A special protein, called intrinsic factor (IF), binds vitamin B12 so that it can be absorbed in the intestines. Two hours after other trays were picked up from the rooms, the nurse notes that the client's untouched tray is still at the bedside. b. The nurse should not lecture, scold or argue with the float nurse. Denial a. c. I suggest you talk with a mental health counselor about your concerns 1. Focus on the client's present circumstances instead of his personal stories Which clients should be assigned to the CNA? & 6. Adheres to the FMCNA Compliance Program, including followingall regulatory and FMS policy requirements. This client is likely in metabolic acidosis due to diabetic ketoacidosis (DKA). A nurse in a dialysis center is caring for a client who has a new diagnosis of end-stage kidney disease. A nurse is working with an LPN to care for a client who is receiving a continuous IV infusion. Only a plain enema or soap enema can be given by the UAP. Client diagnosed with Crohn's disease who had three semi-formed stools over the past shift. The client should be assessed first to rule out respiratory difficulty and hemorrhage. Showing disapproval 4. An increased temperature will have a direct effect on the brain's metabolism and function. (SATA) -Bathing a client who had an amputation 2 days ago. Which action should the nurse interrupt the UAP from performing? c. Review a low-sodium diet for the client who has hypertension There are a total of 10 adult clients. Determine which personnel could be sent to the command center. 3. Correct: This client is at risk for respiratory depression caused by morphine and should be assessed. The supervisor can only send one LPN/LVN to the floor. 4. A nurse is adhering to standard precautions while caring for a group of clients. 2. Client scheduled for breast reconstruction after mastectomy. A charge nurse is reviewing the list of tasks that have been delegated to the assistive personnel (AP) by the staff nurse. Keep a personal copy of this documentation, provide a copy to the immediate supervisor, and send a copy to the Local Unit Officer. Perform the Heimlich maneuver The responsibility of the nurse manager is to implement change in a positive manner, while assisting staff adaptation even to unpopular modifications. Besides yourself, there are the following staff: Your unit has 12 beds. This schedule may leave some clients too exhausted to visit with family. This is a task that can be delegated to the LPN/LVN. This determination is needed to assure client safety is being considered. The LPN should refuse the intervention. Left upper forearm Which of the following items should the nurse offer the client? 1. the nurse responds: "It must be very frustrating to encounter this kind of attitude." A client with diabetes admitted for debridement of a foot ulcer. b. Massage any bony prominences to promote circulation a. I'll urinate a little then stop c. Nonfat milk In the following sentences, circle each incorrectly used lowercase letter. Incorrect: By encouraging the client to be more cooperative, the nurse is denying the client's feelings and concerns. a. What is the primary factor for the charge nurse to consider when delegating care? Limit the client's fluid intake in the evening Documentation is a communication tool for the interprofessional health care team. The nurse can accept the assignment, documenting your personal concerns regarding working conditions in which management decides the legitimacy of employee's personal concerns. The charge nurse knows what client would be most appropriate for this LPN? A nurse is talking with a client who is about to start using transcutaneous electrical nerve stimulation (TENS) to manage chronic pain. Evaluate pain relief after narcotic administration. b. Which of the following indications should the nurse include? The last client that should be sent back for care is the client experiencing epigastric pain and nausea after eating. A client with epilepsy reporting an odd smell in the room. The client receives home health care and spends most of his day in a reclining chair. It also helps the client deal with issues that are important to him), 19. The stem does not indicate any loss of neurological function resulting from the seizure activity. A nurse is assisting a client who has received crutches in an urgent care center following a foot injury. 4. a. It is not a routine task. (Select all that apply.) Which of the following info should the nurse include? Incorrect: If alcohol or drug dependency is suspected, confrontation will result in hostility and denial. The partner relates her concerns about her spouse abusing alcohol and having difficulty maintaining employment. Making patient assignments is an important charge nurse role that lacks theoretical support and practical guidelines. Each ROM movement should be repeated 5 times during the session. Since the enema would clean below the obstruction, the client would be able to expel the enema and any feces in this part of the colon. Currently, your census is 11, with one empty bed. a. Shakes the soiled linen to remove any toilet paper remnants The client's self-report of pain severity, 88. Use double bagging to remove soiled linen from the client's room The client with cystitis is stable and has a predictable outcome. 3. c. Use intermittent eye contact Which of the following nursing statements indicates the nurse understands when discharge plans should be implemented? This client should report an improved respiratory, not shortness of breath.

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