prioritization-delegation-and-assignment-practice-exercises-for-the-nclex-examination-4th-edition

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IntroductionRuth Hansten, PhD, MBA, BSN, RN, FACHE20
Outcomes focusExpert nurses have discovered that the most successful method of approachingtheir practice is to maintain a laser-like focus on the outcomes that the patientsand their families want to achieve. To attempt to prioritize, delegate, or assigncare without understanding the patient's preferred results is like trying to puttogether a jigsaw puzzle without the top of the puzzle box that shows thepuzzle picture. Not only does the puzzle player pick up random pieces thatdon’t fit well together, wasting time and increasing frustration, but also theprocess of puzzle assembly is fraught with inefficiencies and wrong choices. Inthe same way, a nurse who scurries haphazardly without a plan, unsure ofwhat could be the most important, lifesaving task to be done first, or whichperson should do which tasks for this group of patients, is not fulfilling his orher potential to be a channel for healing.Let's visit a change-of-shift report in which a group of nurses receivesinformation about two patients whose blood pressure is plummeting at thesame rate. How would one determine which nurse would be best to assign tocare for these patients, which patient needs to be seen first, and which taskscould be delegated to assistive personnel, if none of the nurses is aware of eachpatient's preferred outcomes? Patient A is a young mother who has beenreceiving chemotherapy for breast cancer; she has been admitted this shiftbecause of dehydration from uncontrolled emesis. She is expecting to regain hernormally robust good health and watch her children graduate from college.Everyone on the health care team would concur with her long-term goals.Patient Z is an elderly gentleman, 92 years of age, whose wife recently diedfrom complications of repeated cerebrovascular events and dementia.Yesterday while in the emergency department (ED), he was given the diagnosisof acute myocardial infarction and preexisting severe heart failure. He wouldlike to die and join his wife, has requested a “do not resuscitate” (DNR) order,and is awaiting transfer to a hospice. These two patients share critical clinicaldata but require widely different prioritization, delegation, and assignment. Asavvy charge RN would make the obvious decisions: to assign the most skilledRN to the young mother and to ask assistive personnel to function in asupportive role to the primary care RN.The elderly gentleman needs palliative care and would be best cared for byan RN and care team with excellent people skills. Even a novice nursingassistant could be delegated tasks to help keep Mr. Z and his familycomfortable and emotionally supported. The big picture on the puzzle box forthese two patients ranges from long-term “robust good health” requiringimmediate emergency assessment and treatment to “a supported andcomfortable death” requiring timely palliative care, including supportiveemotional and physical care. Without envisioning these patients’ pictures andknowing their preferred outcomes, the RNs cannot prioritize, delegate, orassign appropriately.There are many times in nursing practice, however, when correct choices are21
Page 2 and 3: Prioritization, Delegation, andAssi
Page 4 and 5: Table of ContentsCover imageTitle p
Page 6 and 7: Chapter 10: Visual and Auditory Pro
Page 8 and 9: QuestionsAnswer KeyCase study 5: Di
Page 10 and 11: Answer KeyIllustration CreditsChapt
Page 12 and 13: Names: LaCharity, Linda A., author.
Page 14 and 15: Department of Nursing The Universit
Page 16 and 17: To faculty and other usersPatient c
Page 18 and 19: AcknowledgmentsWe would like to tha
Page 22 and 23: not so apparent. Patients in all ca
Page 24 and 25: 2. The second level is immediately
Page 26 and 27: SupervisionWhenever a nurse delegat
Page 28 and 29: or evaluated activities of assistiv
Page 30 and 31: Delegation and assignment: the five
Page 32 and 33: leadership and direction would that
Page 34 and 35: for surgery and procedures and befo
Page 36 and 37: Errors can result in uncompensated
Page 38 and 39: Principles for implementation ofpri
Page 40 and 41: 2008;34(10):17-25.Kozlowski S., Ilg
Page 42 and 43: Recommended resourcesAlfaro-Lefevre
Page 44 and 45: C H A P T E R 144
Page 46 and 47: Questions1. Which postoperative cli
Page 48 and 49: measures. What action should the ch
Page 50 and 51: 50
Page 52 and 53: 4. Seek family assistance in resolv
Page 54 and 55: 29. The nurse is caring for a clien
Page 56 and 57: provider.3. Withhold the pain medic
Page 58 and 59: unconfirmed.4. Ask the HCP to valid
Page 60 and 61: Activity level and function address
Page 62 and 63: who present with first-time onset o
Page 64 and 65: 30. Ans: 2, 5, 6 The client who is
Page 66 and 67: 42. Ans: 3 If the social worker can
Page 68 and 69: Cancer68
Page 70 and 71:
night shift nurse?1. “How many ti
Page 72 and 73:
2. Nausea3. Paresthesia4. Anorexia1
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24. For a patient with osteogenic s
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assisting patients in cessation of
Page 78 and 79:
years, biennial or annual mammograp
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9. Ans: 2, 3, 5, 6 Mouthwash should
Page 82 and 83:
23.oxygenation and perfusion. Pulse
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29. Ans: 2 Hyponatremia is a concer
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Focus: Prioritization.86
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Immunologic Problems88
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of prednisone due3. A patient with
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4. Newly graduated RN who needs exp
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1. The patient is currently taking
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Answer Key1. Ans: 1 Because antihis
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to the unit would not have experien
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are given with other medications. M
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Fluid, Electrolyte, and Acid-BaseBa
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6. The health care provider has wri
Page 106 and 107:
4. Serum magnesium level of 0.8 mEq
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2. Potassium level3. Chloride level
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Answer Key1. Ans: 3 An adult should
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muscle weakness. Although the other
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acidosis. Older adults may be takin
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Safety and Infection Control116
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4. Take off gown.5. Perform hand hy
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2. Communicating with other departm
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2. Appropriate antibiotics have bee
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3. Labetalol 20 mg IV over a 2-min
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airborne or contact precautions. Fo
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hand hygiene readily available for
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cholinergic crisis, a possible effe
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Respiratory Problems132
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3. Completing in-depth admission as
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1. Avoid potential environmental as
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1. Encourage the patient to eat foo
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4. Observing whether the patient's
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4. The student nurses uses a twirli
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6. Ans: 1 When the oxygen flow rate
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changed daily but may be reinforced
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32. Ans: 4 Infections are always a
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C H A P T E R 7150
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Questions1. The clinic nurse is eva
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apply.1. Referral to community prog
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4. Persisting chest pain at a level
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Which action will the nurse take fi
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4. Assisting the client in cleaning
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38. The clinic nurse obtains this i
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Answer Key1. Ans: 1 Dark or tarry s
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13. Ans: 2 Because combination angi
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contractions in the setting of myoc
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information are activities that can
Page 172 and 173:
Hematologic Problems172
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6. The nurse is reviewing the compl
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16. A patient with iron deficiency
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4. Educating the patient about ways
Page 180 and 181:
Answer Key1. Ans: 2 Guidelines for
Page 182 and 183:
prescribed actions also should be i
Page 184 and 185:
infection when a patient has a low
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Neurologic Problems186
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1. Documenting the seizure2. Perfor
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5. Developing the nursing plan of c
Page 192 and 193:
1. Position the client sitting up i
Page 194 and 195:
most appropriate for this client?1.
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Answer Key1. Ans: 3 A change in lev
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14. Ans: 1, 2, 4, 5 All of the stra
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report feeling chilled, but warming
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additional educational preparation
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Visual and Auditory Problems204
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3. Client who requests a home healt
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2. Instill a mydriatic agent, such
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24. The nurse is caring for several
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3. Rest eyes as much as possible an
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the eye. The man needs to have emer
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to the client's report of roaring s
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29. Ans: 1 Topical phenylephrine us
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Musculoskeletal Problems220
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2. Remove throw rugs and other obst
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5. Check the neurovascular status o
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instruct the UAP to respond?1. “Y
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1. A2. B3. C4. D228
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Focus: Assignment, Supervision; Tes
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21. Ans: 1 Moving directly from a l
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C H A P T E R 1 2234
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Questions1. The charge nurse is rev
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had fundoplication to reinforce the
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The unit has several clients with h
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31. The nurse is caring for a clien
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nurse do first?1. Explain that the
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Answer Key1. Ans: 4 Laxatives shoul
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therapist should be contacted to se
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displacement, and the correct posit
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The client is likely to report pain
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Diabetes Mellitus254
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bath.”6. An LPN/LVN is assigned t
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fruity odor to his breath. The char
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hours.”2. “Test your urine for
Page 262 and 263:
262
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Answer Key1. Ans: 1 The older patie
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job includes calling and paging phy
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abdomen) to prevent day-to-day chan
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Other Endocrine Problems270
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4. Teaching the patient about side
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3. Potassium level4. White blood ce
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3. Check vital signs every 2 hours.
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1. Bilateral exophthalmos2. Large v
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frequently have dependent edema. Fo
Page 282 and 283:
increased blood glucose level, decr
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C H A P T E R 1 5284
Page 286 and 287:
Questions1. Which actions will the
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a long-term care facility, which fi
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back, and groin. Which question sho
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3. The client has not eaten anythin
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Answer Key1. Ans: 2, 3, 5, 6 Curren
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appropriate, but therapy will chang
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Prioritization.29. Ans: 2 Dairy pro
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Renal and Urinary Problems300
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should the nurse delegate to an exp
Page 304 and 305:
mouth.”3. “If necessary, your H
Page 306 and 307:
1. Incontinence-associated dermatit
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3. Assist the patient with morning
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the scope of practice of profession
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23. Ans: 1 The underlying pathophys
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check BP in the arm opposite to the
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Reproductive Problems316
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postanesthesia care unit. Which nur
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2. Irrigate the retention catheter
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4. Because nausea and vomiting may
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4. Providing discharge instructions
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6. Ans: 1 An LPN/LVN working in a p
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anxiety needs further assessment ne
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The other actions also require corr
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C H A P T E R 1 8332
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Questions1. A 30-year-old woman wit
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4. Go up the chain of command and c
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when desired.5. Ask the parents if
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26. A 3-day-old breast-fed infant i
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maternity patients, and breast feed
Page 344 and 345:
4. A patient with contractions ever
Page 346 and 347:
transmission of group B streptococc
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Focus: Assignment.16. Ans: 3 Fundal
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Measure of increasing the percentag
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flu but does not go far enough in f
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C H A P T E R 1 9354
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Questions1. A 3-month-old infant ar
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laboratory result would cause the n
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leukemia. The patient's sibling has
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1. A 2-year-old patient with a vent
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3. Obtain a history for the type of
Page 366 and 367:
4. “This behavior may be associat
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is 24% (0.24 volume fraction), and
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Answer Key1. Ans: 1 The infant's be
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Electroencephalography may be indic
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diuretics. The other children shoul
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36. Ans: 2 Passage of brown stool i
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patients are in common waiting area
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C H A P T E R 2 0380
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Questions1. The nurse is caring for
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4. “Storage position is unimporta
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16. The RN team leader has assigned
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4. Ethambutol26. A patient diagnose
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__________ mL36. During a check-up
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drug is taken too long before the m
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depression to worsen. Decreased hea
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blocker used to treat GERD and PUD,
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Emergencies and Disasters398
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vomiting_____, _____, _____, _____5
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department (ED); however, this is t
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2. Accompanying organ donor special
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are the priority interventions for
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2. A firefighter who is showing com
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Test Taking Tip: Use knowledge of g
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18. Ans: 3 The correct intervention
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30. Ans: 4 At least one representat
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42. Ans: 3 The nurse recognizes tha
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Psychiatric-Mental Health Problems4
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me about what you are feeling and w
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concern?1. His heart rate is increa
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2. Tell her to care for the patient
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2. Restrain the patient's arms and
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4. Gently suggest that the patient
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very simple and direct instructions
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17. Ans: 4 Although the patient is
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ensuring that the patient is not ex
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PA R T 3Prioritization, Delegation,
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Chest Pressure, Indigestion, andNau
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4. Ms. S's cardiac telemetry monito
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hours and recording the vital sign
Page 444 and 445:
Answer Key1. Ans: 1, 2, 4, 5, 6 Ris
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admission, is not a priority at thi
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Dyspnea and Shortness of Breath448
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2. Forward bent posture3. Respirato
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2. Keep accurate records of intake
Page 454 and 455:
Answer Key1. Ans: 1, 2, 3, 5 Baseli
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was productive. The changes in Mr.
Page 458 and 459:
C A S E S T U D Y 3458
Page 460 and 461:
QuestionsThe RN is the leader of a
Page 462 and 463:
9. The UAP is delegated the task of
Page 464 and 465:
1. Check bilateral pedal pulses eve
Page 466 and 467:
educational scope of the UAP. Focus
Page 468 and 469:
Page 470 and 471:
QuestionsMs. J is a 63-year-old wom
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1. Assisting the patient to replace
Page 474 and 475:
19. What intervention is required a
Page 476 and 477:
high. Focus: Prioritization.7. Ans:
Page 478 and 479:
failure) are essential at this time
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Diabetic Ketoacidosis480
Page 482 and 483:
2. Checking and reporting Mr. D's b
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interested in knowing?1. Mental sta
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19. Which member of the health care
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Answer Key1. Ans: 1, 2, 4, 5, 6 The
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range.11. Ans: 2 Her calculations a
Page 492 and 493:
Page 494 and 495:
QuestionsThe nurse who is working f
Page 496 and 497:
1. Discontinue the patient's oxygen
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13. The nurse still has visits to m
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Answer Key1. Ans: 1, 4, 5, 6 Ms. A'
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12. Ans: 2 The focus in home health
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Page 506 and 507:
QuestionsMr. M is a 32-year-old man
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1. Set up an oxygen delivery system
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5. Teach the client to perform self
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scope of practice for a UAP. The nu
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role performance, and self-concept.
Page 516 and 517:
Multiple Patients With Adrenal Glan
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6. Fluid restrictions to maintain b
Page 520 and 521:
UAP is best for indicating fluid re
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Answer Key1. Ans: 3 The patient's s
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indicator of fluid retention. The b
Page 526 and 527:
Page 528 and 529:
QuestionsAn RN is the leader of a t
Page 530 and 531:
pending. Ms. H asks, “What should
Page 532 and 533:
16. The UAP asks, “Why can’t Ms
Page 534 and 535:
unsure about follow-up.5. The nursi
Page 536 and 537:
Answer Key1. Ans: 6 Mr. R has sever
Page 538 and 539:
mouth will decrease fecal mass and
Page 540 and 541:
26. Ans: 4 In this circumstance, th
Page 542 and 543:
C A S E S T U D Y 1 0542
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QuestionsThe RN is the leader of a
Page 546 and 547:
6. The team leader is talking to Ms
Page 548 and 549:
4. “I know you are having pain. L
Page 550 and 551:
he is going to have pain. He's a dr
Page 552 and 553:
getting enough pain medication. He
Page 554 and 555:
Answer Key1. Ans: 6, 3, 2, 1, 5, 4
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staff members should be watchful fo
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25. Ans: 3 Mr. H may be experiencin
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position if assessments of the skin
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Multiple Clients With Cancer562
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5. Noting the presence and complexi
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11. The team leader is teaching the
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demonstration of any aspect of colo
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currently receiving high-flow oxyge
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Answer Key1. Ans: 1, 2, 5, 6 When t
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instilled through the catheter, and
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30. Ans: 1 For Mr. U, the tension p
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Gastrointestinal Bleeding578
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3. Insert an NG tube and observe ga
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2. HCP should be notified for possi
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2. Call the HCP and politely state
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insert the tube into the most paten
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awareness of and avoidance of deali
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C A S E S T U D Y 1 3590
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QuestionsMs. A, a 20-year-old colle
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Ms. A's ongoing care?1. RN from a t
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2. Blood pressure3. O 2 saturation4
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21. As the shift ends, the nurse is
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also be appropriate, but a more dir
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client. Next, the nurse discusses p
Page 604 and 605:
Septic Shock604
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protocols. Which action should the
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10. When assessing the norepinephri
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3. Experienced ICU RN who has been
Page 612 and 613:
before the intubation attempt. To m
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C A S E S T U D Y 1 5614
Page 616 and 617:
QuestionsThe nurse admits Ms. C, an
Page 618 and 619:
4. Assessing lung sounds10. Ms. C's
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dyspnea. She has been receiving dig
Page 622 and 623:
7. Ans: 4 Morphine is used in pulmo
Page 624 and 625:
this client's assessment indicates
Page 626 and 627:
Multiple Patients With PeripheralVa
Page 628 and 629:
the student nurse to avoid?1. Auscu
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13. At noon, the LPN/LVN goes to ca
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6. Check daily international normal
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Answer Key1. Ans: 2, 3, 5 Hypertens
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Assignment, Supervision.11. Ans: 1
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involves surgical revascularization
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Respiratory Difficulty After Surger
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nurse ask the laboratory to draw bl
Page 644 and 645:
9. The HCP assesses Mr. E and presc
Page 646 and 647:
5. Provide oral care several times
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Answer Key1. Ans: 3 The marked decr
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clients who are unconscious or para
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is experiencing. Focus: Prioritizat
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Long-Term Care654
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3. Gently dry after each cleansing.
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2. Administer diphenoxylate 5 mg PO
Page 660 and 661:
Answer Key1. Ans: 2 IAD describes t
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of UAP. In some states, long-term c
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C A S E S T U D Y 1 9664
Page 666 and 667:
QuestionsThe charge nurse is workin
Page 668 and 669:
3. Crackles auscultated on inspirat
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history.4. Perform blood glucose te
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2. A sign of bronchial remodeling3.
Page 674 and 675:
and drained 120 mL over 12 hours. H
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asthma attack. The mother's frustra
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mother should be notified and advis
Page 680 and 681:
Total parenteral nutrition is not s
Page 682 and 683:
C A S E S T U D Y 2 0682
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QuestionsNote: In this case study,
Page 686 and 687:
2. Mr. P (paranoid schizophrenia)3.
Page 688 and 689:
2. Ms. M appears heavily sedated at
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that?”21. Clozapine is prescribed
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4. Other nonpharmacologic therapies
Page 694 and 695:
up his belongings36. As the charge
Page 696 and 697:
historian, and prolonged questionin
Page 698 and 699:
16. Ans: 3 Acknowledging feelings i
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restlessness and agitation are the
Page 702 and 703:
C A S E S T U D Y 2 1702
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QuestionsMs. N is a 20-year-old gra
Page 706 and 707:
5. Call a social worker for a consu
Page 708 and 709:
also get the Tdap vaccine. The clie
Page 710 and 711:
the student at this time that would
Page 712 and 713:
postpartum hemorrhage?1. Hypotensio
Page 714 and 715:
etonogestrel 68 mg. She is happy to
Page 716 and 717:
distress, neonatal death, necrotizi
Page 718 and 719:
18. Ans: 4 The heart rate and respi
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therapeutic way but to always keep
Page 722 and 723:
Chapter 115. From Gray Morris D: Ca
Page 724 and 725:
Chapter 728. From Ignatavicius D, W
Page 726 and 727:
Chapter 1132. From Ignatavicius D,
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Chapter 1331. From Ignatavicius D,
Page 730 and 731:
Chapter 1523. From Ogden SJ, Fluhar
Page 732 and 733:
Chapter 2142. From Aehlert B: EKGs
Page 734 and 735:
Case Study 133. From Ignatavicius D
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