Nursing Acceleration Challenge Exam I PN-RN Management of Care Questions and Answers 1 — Questions and Answers
Question 1: An RN on a medical-surgical unit is planning assignments for the upcoming shift. The team consists of another RN, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which task is most appropriate for the RN to delegate to the LPN?
- Completing the initial admission assessment for a new client.
- Developing the nursing plan of care for a client with a new diagnosis of diabetes.
- Performing a sterile dressing change on a client's 10-day old surgical wound. (Correct answer)
- Administering a dose of intravenous (IV) push furosemide.
Correct answer: Performing a sterile dressing change on a client's 10-day old surgical wound.
The scope of practice for an LPN typically includes performing routine procedures like sterile dressing changes on chronic or stable wounds. Initial assessments, developing the plan of care, and administering IV push medications are complex tasks that require the advanced assessment and clinical judgment of an RN.
Question 2: A nurse receives a change-of-shift report on four clients. Which client should the nurse assess first?
- A client postoperative day two following a cholecystectomy who is requesting pain medication.
- A client with pneumonia who has a new onset of confusion and an oxygen saturation of 88% on 2L of oxygen. (Correct answer)
- An older adult client who is scheduled for discharge and has questions about their new medications.
- A client admitted with gastritis who is reporting nausea and has not eaten breakfast.
Correct answer: A client with pneumonia who has a new onset of confusion and an oxygen saturation of 88% on 2L of oxygen.
The client with pneumonia showing a new onset of confusion and low oxygen saturation is the highest priority. These are signs of worsening respiratory status and hypoxia, which is a life-threatening condition requiring immediate assessment and intervention. The other clients are more stable.
Question 3: A client who is scheduled for a cardiac catheterization in the morning tells the nurse, 'My doctor explained the procedure, but I'm still not sure what all the risks are.' The signed consent form is in the client's chart. What is the nurse's most appropriate action?
- Reassure the client that the procedure is very common and generally safe.
- Have the client's spouse come in so they can explain the risks again.
- Provide the client with a printed brochure that details the procedure's risks.
- Notify the healthcare provider that the client does not fully understand the procedure. (Correct answer)
Correct answer: Notify the healthcare provider that the client does not fully understand the procedure.
It is the provider's legal responsibility to obtain informed consent, which means ensuring the client understands the risks, benefits, and alternatives to the procedure. If the client expresses a lack of understanding, the nurse must act as an advocate and notify the provider to give further clarification. The nurse's role is to witness the signature, not to provide the primary explanation of risks.
Question 4: The nurse is coordinating care for a client being discharged after a stroke, which resulted in moderate dysphagia. To ensure a safe transition home, which of the following referrals is the nurse's priority?
- Physical therapy for gait training.
- Occupational therapy for assistance with activities of daily living.
- A social worker to arrange for financial assistance.
- A speech-language pathologist for a home swallowing therapy plan. (Correct answer)
Correct answer: A speech-language pathologist for a home swallowing therapy plan.
Dysphagia (difficulty swallowing) places the client at high risk for aspiration and pneumonia. The speech-language pathologist is the specialist who assesses swallowing function and creates a safe plan for eating, drinking, and taking medications. While the other referrals are also important for this client's overall recovery, preventing aspiration is a critical safety priority.
Question 5: A nurse is caring for a client who refuses a prescribed blood transfusion due to religious beliefs. The client is hemodynamically unstable. Which action best illustrates the nurse's role as a client advocate while upholding ethical principles?
- Contacting the hospital's ethics committee to override the client's decision.
- Documenting the refusal and notifying the healthcare provider of the client's decision. (Correct answer)
- Administering the blood transfusion because it is a life-saving measure.
- Requesting a family member to convince the client to accept the transfusion.
Correct answer: Documenting the refusal and notifying the healthcare provider of the client's decision.
A competent adult has the right to refuse medical treatment (autonomy), even if it is life-sustaining. The nurse's role is to respect this right, ensure the client is fully informed, document the decision, and communicate it to the provider so that alternative treatment plans can be explored. Overriding the client's wishes or coercing them violates ethical principles.
Question 6: A hospital is transitioning to a new electronic health record (EHR) system. A nurse manager observes a staff nurse who is struggling to use the new system, causing delays in patient care and medication administration. What is the manager's most appropriate initial action?
- Assign the staff nurse a lighter patient load until they become more proficient.
- Arrange for one-on-one training or a 'super-user' to mentor the nurse. (Correct answer)
- Initiate disciplinary action for failing to adapt to the new system.
- Advise the nurse to complete the required online training modules again.
Correct answer: Arrange for one-on-one training or a 'super-user' to mentor the nurse.
The most supportive and effective initial action is to provide direct, personalized support. Arranging for one-on-one training with an educator or a 'super-user' (an experienced peer) addresses the specific learning need without being punitive. This approach promotes competency and patient safety, whereas reducing the workload doesn't solve the skill deficit and disciplinary action is premature.
Nursing Acceleration Challenge Exam I PN-RN Management of Care Questions and Answers 1
An RN on a medical-surgical unit is planning assignments for the upcoming shift.
The team consists of another RN, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP).
Which task is most appropriate for the RN to delegate to the LPN?