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Difficulty: Very hardClient Care Assignments and Collaboration

A practical nurse (PN) is assigned to a client experiencing an acute exacerbation of heart failure. The client is receiving a continuous intravenous furosemide infusion and requires the insertion of an indwelling urinary catheter. Simultaneously, the healthcare provider enters the room to discuss an emergency cardiac catheterization. Which sequence of actions demonstrates the PN operating safely within their legal scope of practice?

  1. Assembling the supplies for the urinary catheter, witnessing the client's signature on the surgical consent after the provider concludes their explanation, and collaborating with a registered nurse (RN) to manage the intravenous furosemide.Answer
  2. B
    Witnessing the consent signature, performing the sterile insertion of the urinary catheter, and independently titrating the intravenous furosemide rate based on the client's initial hourly urine output.
  3. C
    Performing the urinary catheter insertion, explaining the potential complications of the cardiac catheterization to ensure the client is fully informed, and subsequently obtaining the consent signature.
  4. D
    Stepping into the public corridor to verbally brief an unassigned physical therapist about the client's critical cardiac status and procedure, before returning to witness the consent.

Answer

Assembling the supplies for the urinary catheter, witnessing the client's signature on the surgical consent after the provider concludes their explanation, and collaborating with a registered nurse (RN) to manage the intravenous furosemide.
The correct answer demonstrates a comprehensive synthesis of the practical nurse's legal scope of practice. The PN is fully authorized to perform sterile procedural tasks such as indwelling urinary catheter insertions. Furthermore, while the healthcare provider is solely responsible for explaining the risks and benefits of a cardiac procedure, the PN may legally and safely act as a witness to the client's signature. Finally, independently managing and titrating continuous intravenous high-alert medications (such as a furosemide infusion for acute heart failure) falls strictly outside the PN scope of practice in most jurisdictions, safely prompting the PN to collaborate with or hand off that specific task to a registered nurse (RN).

Step-by-Step Solution

1
Analyze the requested clinical interventions presented in the scenario.
Identified three distinct tasks: inserting a urinary catheter, participating in the informed consent process, and managing a continuous IV furosemide infusion.
Breaking down a complex scenario into individual tasks is essential to accurately evaluate the PN's scope of practice for each component.
2
Evaluate the urinary catheter insertion against the PN scope of practice.
Determined that the sterile insertion of an indwelling urinary catheter is a standard procedural skill safely within the PN scope.
PNs receive formal education and licensure to perform routine sterile procedures.
3
Evaluate the PN's role in the informed consent process.
Determined that the PN can legally witness the client's signature, but cannot be the one to explain the risks, benefits, or complications of the procedure.
The provider performing the procedure holds the legal obligation to explain it. The nurse's role is to verify the client's identity, ensure comprehension, and witness the voluntary signature.
4
Evaluate the management of the continuous intravenous furosemide infusion.
Determined that titrating continuous IV medications for an acute, unstable condition requires RN-level intervention and must be handed off or collaboratively managed.
Continuous IV infusions for unstable clients require comprehensive assessment, advanced clinical judgment, and continuous evaluation, which exceed the legal boundaries of practical nursing.

Key Concept

Practical Nurse Scope of Practice, Delegation, and Interprofessional Collaboration
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Topics

Client Care Assignments and Collaboration

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