A nurse asks a client how he is feeling. The best practice committee utilizes current research in their recommendations. They are able to manage tasks related to basic care. The assignment process requires constant evaluation and reevaluation of information and priorities. Which of the following items should the nurse offer the client? Soaking the dentures in hot water 2. a. 3. 1. A nurse who is breastfeeding her 4 month old. a. Auscultate breath should at least ever 2 hr The spouse can rescind the Advance Directive if the client becomes unresponsive. b. On an ongoing basis, the charge nurse evaluates individual and collective outcomes of the patient care provided during their shift, compares patient care delivery to accepted standards, adjusts assignment of resources as necessary, and reports changing needs and outcomes to the health care staff. a. The charge nurse tells a nurse that multiple sick calls from the upcoming shift has occurred. 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. Sudden attacks of sleep A high concentration of carbon monoxide can cause death The nurse should not be assigned to provide care if impairment is suspected. Therefore, the RN must perform this task and cannot delegate this to the LPN/LVN. Obtain a bedside commode for the client's use 1 However, it remains true pain for this client and the client would need intervention to help manage this pain. Client diagnosed with a hemorrhagic stroke 1 week ago, who currently has a blood pressure of 170/96. c. 214 Request a prescription for a medication to ease the client's anxiety It's unfortunate that I have to be in the hospital for this treatment A 10 year old school-age child would also be more cooperative, making it easier for the LPN to interact with that client. The RN with 2 weeks' experience on the postpartum unit. The client asks the nurse, "Why do I need that? 3. 1. c. Review a low-sodium diet for the client who has hypertension 2. What client should the nurse assess first? a. A nurse in a clinic is teaching a group of clients about preventing low back pain and injury. a. c. Changing a dressing, 78. A nurse is implementing direct nursing care for a group of clients in an acute care facility. Nursing questions and answers. Because a scope is inserted through the urethra for this procedure, the client may experience burning or frequency immediately following this test. This template is beneficial for nursing students and veteran nurses alike, and can be used in any unit. Which client should the nurse see first? The second client that should be given a treatment room is the elderly client who fell and fractured the left femoral neck. Client #5 -It is considered within the scope of practice for an LPN/LVN to monitor a transfusion of a blood product. Changing a colostomy bag. This action will promote the client's self-esteem, and may reduce the quarrelsome behavior. Some general guidelines are necessary, with input from clients and family to individualize any special requests with assistance from the facility. Which of the following methods should the nurse plan to use? Encourage the client to use self-exploration Furosemide 40 mg PO q.d. A client requesting assistance packing his belongings for discharge later today.. You would be jeopardizing the limb of this client to take the time to do discharge teaching for the client waiting to go home. d. Remove and reinsert the NG tube, a. c. Make sure the client has an intake of 2,000-3,000 mL of fluid/day Which of the following types of torts has the nurse committed? The client is getting better. c. Malpractice Correct: The client must have lost decision-making capacity because of a condition that is not reversible or must be in a condition that is specified under state law, such as a terminal, persistent vegetative state, irreversible coma, or as specified in the Advanced Directive. 2. The charge nurse should be informed that the delegated intervention is not appropriate according to the state's Nurse Practice Act. Incorrect: Is phantom pain something that is unexpected with above the knee amputations? The nurse chooses to confront the client. e. Dysuria, 49. Secondly, staff will be far too busy to watch television or listen to the radio with all the activity occurring hospital wide. Once the client is stable, the UAP could perform this task. These individuals are selected by the charge nurse, and do not have to be nurses. Which of the following responses should the nurse provide? 1. What was the rationale for this plan? The nurse is evaluating care provided by an unlicensed assistive personnel (UAP). the nurse responds, "don't worry, no one will harm your family." Document current functional status assessment Nursing Brain Sheet 4 Patients - luoe.expertoendermatologia.es Write N next to the nonessential clauses and E next to the essential clauses. 1., 2., 3., & 4. A nurse is caring for a client whose partner asks to speak with the nurse. b. Demonstrate principles of collaborative practice within the nursing and healthcare teams fostering mutual respect and shared decision-making to achieve stated outcomes of care. c. Confrontation Select all that apply. b. I'll use the cleansing wipes from the front to back 3. A client who is disoriented and awaiting transfer to a long-term care facility. Allowing staff to vent is acceptable but the nurse manager should focus on constructive methods of adjustment to the impending mandated changes. Incorrect: This option would create total chaos, interrupting sleep patterns and staffing schedules. Incorrect: Delegating 2 nurses to work with the client does not address the client's behavior. What proposal would the nurse determine to best meet the needs of families and clients in long term care? 6. a. Which of the following findings reported by the LPN indicates to the nurse the client has phlebitis at the IV insertion site? c. Use intermittent eye contact 4. Correct: Advance directives do consist of two types of legal documents: Power of Attorney and a Living Will. d. Arrange the food groups clockwise on the client's place, b. I'll use the cleansing wipes from the front to back, 51. Where on the body is each type of skin found? Performing passive range of motion (ROM) on the client with right sided paralysis. This client is not the nurse's first priority. b. Incorrect: Gloves should be worn to remove dentures and a gauze used to grasp the dentures. 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. a. A charge nurse is making client care assignments. Prior to shift report, the charge nurse is making assignments for the nurses on the shift. b. American Sickle Cell Anemia Association Incorrect: This prescription is written correctly. This item: Nursing Brain Sheet Multiple Patient Notebook - Nurse and CNA Report Sheet - 3 Patients per Template $1999 BadgeGuru by Tribe RN - 52 Cheat Sheets on 26 Nurse Badge Cards - Designed by Nurses, for Nurses - Essential for Nurses and Nursing Students - Bonus Access to Our Digital Resource Library - Inverted $1997 ($0. Administering 3 g/hr IV of morphine would be extremely dangerous. a. I will wear gloves when removing food from the freezer There are a total of 10 adult clients. The client was lying on the floor next to his bed Correct: The nurse should recognize that this child has a very low absolute neutrophil count (ANC), which is referred to a neutropenia. b. c. Changing a dressing Narrative interaction Nothing will get passed the complete blockage. The partner relates her concerns about her spouse abusing alcohol and having difficulty maintaining employment. Explain to the RN that all the nurses have the same number of clients. The first client the nurse needs to assess is the elderly client admitted 30 minutes ago with reports of constipation for four days. So, now you must decide which of these high priority clients should be seen in what order. Incorrect: This will take some time and would be best accomplished by sitting with the family to discuss options. a. Elicit info from the client Correct: The LPN/LVN can monitor for behavioral changes and can look for potential safety hazards. The charge nurse is developing patient care assignments for the evening shift and needs to assign clients to a licensed practical nurse/licensed vocational nurse (LPN/LVN) and a certified nursing assistant (CNA). A nurse is caring for a client who has had an allogenic hematopoietic stem-cell transplant. (Sclect all that apply) A. Bathe a client who had an amputation 2 days ago. Which of the following of Erikson's developmental stages should the nurse consider in the planning? c. I should purchase a carbon monoxide detector for my home (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 This client is stable and predictable. 1. What is the best care assignment for this client? In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. What is the major histological difference between thick and thin skin? Incorrect: Irrigating a client's ear canal is outside the UAP's scope of practice. Phone report to the receiving nurse. The client is reporting anxiety, discomfort, and a feeling of bloating. Focusing Following the teaching, the nurse asks the client to describe one physical effect. Witness the client's signature This service began with the client's admission to the hospital You get this vitamin from eating foods such as meat, poultry, shellfish, eggs, and dairy products. Talk to each nurse about concerns related to assigned clients. A nurse is planning care for a female client who has an indwelling urinary catheter. is a new graduate in orientation. Monitor for GI upset 30 minutes after meals. 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. So what is wrong with option #1? . Incorrect: Discharging a client includes teaching and a review of medications to be taken at home. Incorrect: The RN is responsible for developing the plan of care which would include necessary referrals. 4. a. A nurse observes an adolescent client who has paraplegia sitting in a wheelchair crying. d. Place the tablet directly into a medication cup, 36. Which nursing intervention should the charge nurse implement? Dr. Frankenstein had seen himself as a(n) ?\underline{? 3. Correct: The nurse manager is aware that open communication with staff is vital to increase workplace satisfaction and staff retention. Functions as the hemodialysis team leader in the provisionof chronic hemodialysis care and treatment. The charge nurse should notify the nursing supervisor who will seek additional staff. one of the licensed practical nurses Get the answers you need, now! The provider must renew a restraint prescription every 8 hr. Solved A charge nurse is making client care assignments. | Chegg.com Assist a client to ambulate using a gait belt. Drag and Drop the items from one box to the other. The client post PEG placement is stable. The third client that should be assessed by the nurse is the client diagnosed with hemorrhoids who had some spotting of bright red blood on toilet tissue with last bowel movement. Fruity breath. Have another nurse guard the medication preparations until the nurse returns a. Gloves 4. Incorrect: The RN is responsible for assessment and evaluation of clients. Which of the following info should the nurse include? a. Which of the following physiological responses to prolonged immobility should the nurse expect? 1. a. The report should contain consequences. The client receives home health care and spends most of his day in a reclining chair. The primary healthcare provider may have suggestions but this is not the best first action. The LPN/LVN can reinforce teaching. Which of the following infection-control precautions should the nurse use caring for this client? *HURST REVIEW Qbank/Customize Quiz - Manageme, *HURST REVIEW Qbank/Customize Quiz - Adult He, *HURST REVIEW Qbank/Customize Quiz - Basic Ca, *HURST REVIEW Qbank/Customize Quiz - Fundamen, ***HURST REVIEW NCLEX-RN Readiness Exam 1***, The Language of Composition: Reading, Writing, Rhetoric, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses, Edge Reading, Writing and Language: Level C, David W. Moore, Deborah Short, Michael W. Smith. Correct: Traction should never be relieved without a primary healthcare provider's prescription. The client states, "I am so nervous about what the doctor might find during the test." Incorrect: Although this action appears to be opening lines of communication, the nurse manager is actually fostering animosity in a situation where the outcome is already predetermined. c. Consensus evolves in this stage 2. b. Numbness Incorrect: The nurse can measure vital signs; however, agency policy usually states that UAP can perform this task also. 4. b. Announce the new changes at the monthly staff meeting. After the provider determines no medical cause for the client's incontinence, which of the following interventions should the nurse initiate to manage this behavior? a. I'll sit with my knees lower than my hips Which of the following tasks should the nurse delegate to assistive personncl ( AP) ? 5. 2. 3. b. There are a total of 10 adult clients. This stage involves constructive efforts on the part of the group members A nurse has just finished a wound irrigation for a client who requires contact precautions. a. Moistening the dentures prior to inserting them IV of D5 NS at 75 mL/hour with a 20 gauge catheter. 5. A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Asking for an explanation A nurse is caring for a client within the intimate zone of the client's personal space. Which of the following client statements should indicate to the nurse the need for additional teaching? Two nurses lifting the client under the shoulders This is a diabetic clinic. A nurse wants to find out a better way to perform oral care on unresponsive clients. Risperidone .5 mg PO daily But the evidence-based care leaders are trained to help nurses through the proper process of evidence based research. d. Voided 30 mL frequently d. Reduced blood viscosity, a. Auscultating heart sounds Correct: The LPN has the right to refuse a delegated intervention that is not within the scope of practice for the LPN. The second client that needs to be seen by the nurse is the client having weakness, a sign of hypoglycemia. d. Explain oral hygiene to a client receiving chemo Which of the following items should the nurse include on the lunch tray? 4. This is normal for clients with hemorrhoids. butter, which contain 16 g of protein, 7 g of carbohydrates, A nurse is planning home care for a 9-year-old child following an acute exacerbation of asthma. 1. Which of the following statements should the nurse make? b. 2. This situation needs advanced monitoring and care, so this nurse with very little postpartum experience would not be the most appropriate to assign to this client. Remind the client to avoid tight fitting clothes. Electric comes from the Latin word for amber, a substance which readily takes a static electric charge. Which task would be appropriate for the nurse to assign to the unlicensed assistive personnel (UAP)? Each ROM movement should be repeated 5 times during the session. Give magnesium citrate 296 mL at 3 PM today. 1. 4. Which of the following statements should the preceptor make? Did you recognize ureterolithiasis as "kidney stones"? d. Identity vs role confusion, b. Assigning tasks to an AP (delegation is considered indirect care), 13. d. principal. c. Leave a nightlight on in the client's room The nurse has another priority. b. Incorrect: This response overlooks a potentially severe problem. Which client should the nurse assess first? The area surrounding the insertion site feels warm to the touch b. I should call my doctor if I find it harder to concentrate Battery This determination is needed to assure client safety is being considered. Relax her abdominal muscles when she lifts an object A nurse is filling out an incident report after finding a client lying on the floor. 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. a. The option does not say the client is terminal, in a vegetative state, or in a coma. b. Which of the following tasks should the nurse delegate to assistive personnel (AP)? Cardiac catheterization with a decreased pedal pulse below insertion site. The nurse voices his concern to the charge nurse. Symbolic communication 3. A nurse on a medical unit is teaching a group of assistive personnel about handling clients' bed linens safely. INCORRECT: There is no information regarding how recent was the surgery or the degree of pain being experienced. a. The first vital sign check was performed by the nurse. A nurse is caring for an older client who states, "I am afraid that I may fall while walking to the bathroom during the night." Warm the feeding solution to the body temperature M2.4 Making Client Care Assignments - GECC.pdf - Course Hero 3. A person can indicate they wish to be a DNR client if their heart stops beating or they stop breathing. Sit side-by-side with the client Which of the following is a characteristic of men that the nurse should consider when beginning the nurse-client relationship? d. Question the charge nurses about the care deficits that might have contributed to the ulcer's development, b. The stem does not indicate any loss of neurological function resulting from the seizure activity. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. c. Nonfat milk Removing the client's dentures Teaching about a medication b. 4. Ask the primary healthcare provider to suggest the best oral care procedure. Which of the following statements by the nurse would provide UAP with the best directions about an assignment? Pain a. The nursing supervisor may be able to assist with client care until another nurse can come in to work. What is the best first action for the nurse to take in order to achieve this goal? Incorrect: Teaching is outside the scope of practice for the LPN/LVN. e. The urge to move the legs when trying to sleep, 66. Which of the following health care professionals is responsible for obtaining informed consent from the client for the procedure? During the admission of pediatric client with a compound fracture of the right femur following a sports injury, which delegation by the charge nurse is most appropriate? The nurse should call for immediate help so that a safe care environment is maintained for all clients. Notify the charge nurse of the observations. Incorrect: A lumbar puncture involves removing cerebrospinal fluid from the subarachnoid space to diagnose specific diseases or the presence of bacteria. & 6. 5. Incorrect: Since this client has an obstruction, anything the client eats will not be able to come out. A. Transporting a client who experienced a stroke 72 hr ago to the radiology department 2. 4. A client with COPD complaining of shortness of breath on exertion. Discuss the issue with the leader of the "best practices" committee. d. Go to employee health services, b. Cystogram reporting burning on urination. This would be an acceptable task to assign to the UAP. Which of the following findings indicates that the client is meeting this goal? A practical guide to making patient assignments in acute care Incorrect: The client does need to be cleaned out below the tumor so that the primary care provider can see the area of concern and complete the biopsy. Incorrect: A colostomy client with diarrhea will have a lot of drainage requiring frequent emptying of the colostomy bag. 4. We see that the temperature is already elevated, which makes us worry that infection is present. c. Washes and rinses her hands for 10 seconds, 11. A nurse is discharging a client who has come to the outpatient clinic with an ankle sprain. Correct: An LPN/LVN's scope of practice includes tasks such as wound care. 1. c. I'll clean the inside of the container with a wipe A charge nurse is observing a group of newly licensed nurses. Which of the following instructions should the nurse give to the client prior to the procedure? (Select all that apply.) What is the best response by the charge nurse? The nurse should identify that this client is demonstrating which of the following kulber-ross stages of grieving? A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. Report of feeling pressure 1. Accept the client's behavior as confrontational. What was the hint? Provides day to day direction and supervision to assigned direct patient care staff. a. I wish I didn't have to attach the electrodes to my skin d. Mask, 83. b. 3. 3. (a) HCN(aq)+H2O(l)H3O+(aq)+CN(aq);K=4.91010\mathrm{HCN}(a q)+\mathrm{H}_2 \mathrm{O}(l) \longrightarrow \mathrm{H}_3 \mathrm{O}^{+}(a q)+\mathrm{CN}^{-}(a q); K=4.9 \times 10^{-10}HCN(aq)+H2O(l)H3O+(aq)+CN(aq);K=4.91010 Which of the following actions should the nurse take? b. Client #1 has COPD, and, although complaining of shortness of breath, that is not unusual for clients with this diagnosis. b. I will keep the fluorescent ceiling light on in my room at night 1. 2. It contains a blank and is followed by four answer choices. 2. 1. The Role of the Registered Nurse as Charge Nurse NUR 204 ATI Management of Care Ch. 1-9 Flashcards | Quizlet Incorrect: Atrial fibrillation places the client at risk for blood clots. 3. Although this is a correct thing to inform the client, this teaching should be done by the RN and not delegated to the UAP. Incorrect: This will take a lot of time and is best initiated from the "best practice" committee. A nurse is caring for a client who is postoperative. A new UAP is efficiently completing all daily assignments accurately and in a timely manner. The charge nurse is preparing the patient care assignments for the day shift, assigning clients to a LPN/LVN and a certified nursing assistant (CNA). Also, making a surgical bed for the client returning from surgery is a basic procedure. The second client the nurse needs to see is the client diagnosed with gastroenteritis who had two 300 mL diarrhea stools in one hour. Notify clients that the disaster plan has been put into effect. A nurse is developing a plan of care for a client who does not speak the same language as the nurse. Which of the following actions should the nurse take? The nurse would then start the 24 hour urine once the 1st void has been discarded. 3. One nurse lifting as the client pushes with his feet 2. b. I can detect the presence of carbon monoxide by a metallic odor a. This client needs careful monitoring and specialized care. 2. M2.4 Making Client Care Assignments - GECC As the RN charge nurse, you are preparing to make assignments for the oncoming shift on the medical-surgical unit. Administer tap water enemas until clear at 6 AM. Incorrect: Most adults have already been exposed to the virus and are not at risk for adverse effects of the infection. 4., & 5. Correct: First, you must recognize that this client has the signs and symptoms of postpartum preeclampsia. b. A charge nurse is making client care assignments. Which actions should be instituted by each unit's charge nurse? Start MgSO4 at 3g/hr IV A nurse is caring for a client who has rheumatoid arthritis and is experiencing difficulty feeding herself using adaptive devices. a. Which of the following actions should the nurse take regarding informed consent? Which referral would most likely be appropriate for the nurse to make? A nurse is discussing indications for urinary catheterization with a newly licensed nurse. Incorrect: The charge nurse does not have to assess every client. Could you try contacting a support group a. d. I will place a bath seat in my shower to use when I bathe, b. Request that the nursing assistant obtain equipment for the client's care while the RN talks with the client and the family. Besides yourself, there are the following staff: Your unit has 12 beds. a. Clarifying c. Shivering (shivering is a systemic response to cold therapy as the body attempts to promote heat production), 77. b. A nurse is caring for a client who is postoperative following an appendectomy. Teaching insulin self administration cannot be delegated to the LPN. A client with fibromyalgia reporting generalized pain of 7 out of 10. Jooble - LVN Charge Nurse - SIGN-ON BONUS $2500 Include any relevant statements the client made about the ulcer, 64. b. c. Contact the provider to question the dosage (when a nurse believes there is an error in a prescription, the nurse must question the provider). 1. b. Correct: The client may be experiencing a myocardial infarction and requires further assessment. 1. a. Making Client Care Assignment NUR 211: Module 4 Assignment Rationale: The patient is stable, she will need to teaching on self-care after a pacer insertion. d. Respite care is a continuation of psychological support after a family member dies. Which of the following actions should the nurse take? b. Irrigate the wound with an antiseptic prior to obtaining the specimen A nurse is caring for a client who has emphysema and has difficulty with mobility. c. When asking the client how he completes his ADLs A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. 1., 4., & 5. CORRECT: The client is potentially experiencing symptoms of an impending seizure, which can include seeing halos around lights or detecting odd smells. A newly hired nurse in a long term care facility has been asked to assist with revising old policies regarding family visitation schedules. 2. A nurse is caring for a client who states, "I have got to get out of this hospital! NURSING ASSIGNMENT- delegation in the workplace | Studymonk d. What have you done in the past to cope with this issue?
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