Which of the following methods should the nurse plan to use? This client should report an improved respiratory, not shortness of breath. c. Consensus evolves in this stage Correct: The only procedure listed that is within the LPN/LVN's practice range is changing the colostomy bag. In order to reorganize staffing, the nurse manager should initiate which action first? 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). (Select all that apply.) a. 9. Donning gloves and using a gauze pad to grasp and remove dentures d. Have the client practice blood-glucose monitoring using a glucometer, d. When asking if the client took his medications this morning, 81. d. Sleep apnea 3. Select all that apply. A client receiving heparin injections for deep vein thrombosis. An experienced nurse would be assigned to this unstable client due to the possibility of a reoccurring hemorrhagic stroke resulting from the client's hypertension. Therefore, this client would not be a priority over a client who may be experiencing a MI. The client then states, "I have changed my mind and do not want to have the procedure done." A newly hired unlicensed assistive personnel (UAP) has consistently completed all assignments in a safe and timely manner. 4. Select all that apply c. Distended bladder Correct: A long term care facility is considered a client's "home environment", and families are encouraged to visit often. c. imaginary Incorrect: It is out of the UAP's scope of practice to administer medication. The expected standard of care was strict bed rest), 96. For which of the following tasks should the nurse wear protective eye equipment. b. Symbolic communication Ask client if they are eating small, frequent meals. d. Proceed with the preparation of the patient's surgical procedure, 15. Incorrect: Aplastic anemia is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. nursing brain nurse sheets night documentation hour rotation sheet icu care assessment charting plan nurses assignment patient shift report rn. Anyone over age 18 can have an Advanced directive. Which of the following actions is the priority for the nurse to include in the client's plan of care? 4. Include any relevant statements the client made about the ulcer, 64. c. Document in the client's medical record that she completed an incident report Which task would be appropriate for the nurse to assign to the unlicensed assistive personnel (UAP)? Cleanse the wound with 0.9% sodium chloride saline irrigation before obtaining the specimen (nurse should remove all wound exudate and any residual antimicrobial ointment or cream to avoid altering the culture results), 56. Photo comes from the Greek word for light. Electric comes from the Latin word for amber, a substance which readily takes a static electric charge. A nurse is caring for a client who is postoperative following an appendectomy. 3. A. nurse is caring for a client who is not cooperating with his care and demonstrates defiant behavior. Select all that apply 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. This could cause a medical emergency. Client diagnosed with inoperative brain tumor who is confused. Correct: The nurse has not been able to determine the skill of vital sign assessment for this new UAP. Accept assignment, documenting personal concerns regarding work conditions. Incorrect: Is phantom pain something that is unexpected with above the knee amputations? Though it may benefit staff to have one particular goal, some clients cannot tolerate to have everything performed at one time, and instead need short rest periods during personal care. a. The command center is the only reliable source of information and will make any decisions needed by hospital personnel. b. Summarization Which tasks should the charge nurse delegate to the nursing assistant? Which of the following interventions should the nurse use to help maintain the integrity of the client's skin? Which of the following tasks should the charge nurse reassign to a licensed nurse? Select all that apply. 2. 2. 2. a. I will wear gloves when removing food from the freezer Complete a neurological check (appropriate nursing intervention when a client displays sudden confusion). Additional data includes pulse 100/min, RR 24/min, BP 124/76 mm Hg, and temp 36.8C (98.2 F). 1. Teaching insulin self administration to a diabetic client. d. Go to employee health services, b. b. Urinary frequency for several days A nurse is preparing an in-service presentation for a group of newly licensed nurses about the use of restraints. 3. 2. INCORRECT: There is no information regarding how recent was the surgery or the degree of pain being experienced. This is normal for clients with hemorrhoids. Answer the following question to test your understanding of the preceding section: A nurse instructs a female client about collecting a midstream urine sample. d. Your provider has prescribed antibiotic therapy to be administered intravenously every 6 hours, 95. a. a charge nurse is making client care assignments for the day. Could you try contacting a support group 4. This client would be the priority based on the need for prompt recognition and treatment of the neutropenia and signs of infection present. Ask the primary healthcare provider to suggest the best oral care procedure. 3. 3. Incorrect: It is important to hear what the nurse is saying and not to dismiss the request by refusing to reassign the clients. Making client care assignments As the RN charge | Chegg.com Science Nursing Nursing questions and answers Making client care assignments As the RN charge nurse, you are preparing to make assignments for the oncoming shift in the medical-surgical unit. Which of the following actions by the nurse is considered an indirect nursing care activity? A list of current medications is sent to the facility. Incorrect: Moistening the dentures will ease insertion. a. Evaluate client's safety risk factors. These individuals are selected by the charge nurse, and do not have to be nurses. 4. A nurse has just finished a wound irrigation for a client who requires contact precautions. A nurse is orienting a new assistive personal (AP) to the unit. Relief of urinary retention A newborn is admitted to the nursery with a diagnosis of rule out cytomegalovirus (CMV). c. The restraints should promote the client's safety and prevent injuries A client receives a wrong medication. Which of the following info should the nurse include? The other options may be correct but are not the best first action. Demonstrate principles of collaborative practice within the nursing and healthcare teams fostering mutual respect and shared decision-making to achieve stated outcomes of care. "The client is weak on the right side, so please assist the client with dressing . Offer to take one of the clients. Documentation is a communication tool for the interprofessional health care team. This would be out of the UAP's scope of practice. b. which of the following actions should the nurse perform? a. Elicit info from the client c. Explore the client's feelings about dietary modifications c. We administer all medications intravenously to clients in this unit Report of feeling pressure Changing a colostomy bag. Did you think dehydration and fluid volume deficit? This is on the "Do Not Use" list of abbreviations because the period after the "Q" can be mistaken for "I", which would be interpreted as qid (four times a day) instead of the intended once daily dosage. 3. A lack of rapid eye movement (REM) sleep 4. Inform the client of the need to avoid irritants such as carbonated beverages. The third client that should be sent back for treatment is the female client stating she has been raped. 1. The nurse is using which level of communication at this time? Which of the following actions should this nurse take? The nursing supervisor may be able to assist with client care until another nurse can come in to work. 1. 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. A nurse asks a client to share personal stories. They are more direct when discussing issues (men focus on issues and discuss them more directly and readily than women do), 20. The first client needing the nurse's attention is the one reporting a headache and has a fruity odor to their breath. A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Which of the following actions should the nurse take? d. Identity vs role confusion, b. Assigning tasks to an AP (delegation is considered indirect care), 13. This situation requires an immediate neurovascular check to determine if intervention is needed to relieve the pressure and restore circulation. Comatose client with end stage chronic obstructive pulmonary disease. Assigning blame for the changes to administration will not help staff adjust. Correct: First, you must recognize that this client has the signs and symptoms of postpartum preeclampsia. c. Request a tray without pork Teaching can be reinforced by the LPN/LVN, but they cannot perform the initial teaching. A nurse is performing care activities for a client in the zone of touch that requires his consent. A nurse is caring for a client within the intimate zone of the client's personal space. The client's self-report of pain severity a. I wish I didn't have to attach the electrodes to my skin The charge nurse (an RN) must determine how best to assign another RN and one licensed practical nurse/licensed vocational nurse (LPN/LVN) to provide care to a group of clients on the day shift. 2. d. Reduced blood viscosity, a. Auscultating heart sounds Skill level and scope of practice of each staff member, Exit HESI (Actual hesi hints), EXIT HESI 2, Julie S Snyder, Linda Lilley, Shelly Collins. A nurse is preparing a sterile field. I am feeling much better since my discharge from the hospital and I think my kidneys are working again." c. Interpersonal (interpersonal communication is face-to-face interaction with another person. a. Assist client to brush and floss teeth. They are able to manage tasks related to basic care. Provides day to day direction and supervision to assigneddirect patient care staff . During report, the nurse notes that the float nurse appears disheveled, flushed, and is trembling slightly while drinking coffee. Following the teaching, the nurse asks the client to describe one physical effect. 5. Temporary urinary retention (common for clients to develop after removal), 90. (Select all that apply.). Which of the following of Erikson's developmental stages should the nurse consider in the planning? a. Gathering needed equipment and supplies is within the scope of duties for the UAP. 1. a. 1. Incorrect: The concern here is the client being fed their meal. The nurse is reviewing some clients' prescriptions. b. The charge nurse is determining morning care assignments for several elderly clients awaiting discharge to an assisted living facility, including a client on bed rest with a skin tear and hematoma from a fall 5 days ago. Correct: It would be best to explore the reason the RN thinks the assignment is too heavy. The client is receiving IV fluids through an IV catheter inserted in the basilic vein on the right forearm. Therefore, this client needs the advanced assessment skills of the RN and should not be assigned to the LPN. Which task would be appropriate for the nurse to assign to an LPN/VN? A nurse working on the pediatric oncology unit is beginning the shift and has received report which included some new laboratory data for the clients. 1, 3 & 5. 2. This should not be delegated to the LPN/LVN. Family cannot withdraw the Advance Directive and make decisions that go against the client's wishes made within the document. Identify and assess each incoming client. M2.4 Making Client Care Assignments - GECC.pdf - Course Hero

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