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Difficulty: Very hardClient Care Assignments and Collaboration

A practical nurse (PN) is collaborating with a registered nurse (RN) and an assistive personnel (AP) to care for a client admitted with an acute exacerbation of heart failure. The client is scheduled for a transesophageal echocardiogram (TEE). Which action by the PN represents a safe and appropriate application of client care assignments and collaboration?

  1. A
    Accepting the RN's delegation to titrate a continuous intravenous dobutamine infusion based on the client's hourly urine output and mean arterial pressure.
  2. B
    Evaluating the client's comprehension of the alternative diagnostic procedures for heart failure before securing their signature on the TEE informed consent document.
  3. Directing the AP to obtain the client's blood pressure while the PN auscultates the apical pulse prior to administering a scheduled oral dose of digoxin.Answer
  4. D
    Accessing the electronic health record of the client's spouse, who was recently discharged from the facility, to verify the family's preferred pharmacy for discharge planning.

Answer

Directing the AP to obtain the client's blood pressure while the PN auscultates the apical pulse prior to administering a scheduled oral dose of digoxin.
The correct action involves appropriate delegation and safe scope of practice. Directing an assistive personnel (AP) to obtain a routine vital sign (blood pressure) falls within safe delegation guidelines. Simultaneously, the practical nurse is performing focused data collection (auscultating the apical pulse) to safely administer a scheduled oral medication (digoxin). Both actions are squarely within the respective scopes of practice for the AP and the PN.

Step-by-Step Solution

1
Analyze the clinical scenario to identify the personnel involved (PN, RN, AP) and the client's condition (acute heart failure).
The situation requires careful delegation and adherence to scope of practice due to the high-acuity environment and interprofessional team.
Identifying the context establishes the boundaries for what tasks can be legally and safely performed or delegated by the PN.
2
Evaluate the option regarding intravenous dobutamine titration.
Determine that titrating vasoactive drips requires advanced assessment and is outside the PN scope of practice.
The PN must recognize and refuse assignments that require RN-level comprehensive assessment and clinical judgment.
3
Evaluate the option regarding informed consent for the TEE.
Determine that evaluating comprehension of alternative procedures is the provider's and RN's role, not the PN's role.
The PN's role in informed consent is limited to witnessing the signature voluntarily given after the provider has explained the risks, benefits, and alternatives.
4
Evaluate the option regarding accessing the spouse's health record.
Determine that this is a HIPAA violation, despite the helpful intention for discharge planning.
Nurses may only access the medical records of clients to whom they are directly assigned.
5
Evaluate the option involving delegating to the AP and administering digoxin.
Determine that delegating a routine blood pressure check to the AP is appropriate, and auscultating an apical pulse for an oral medication is safe focused data collection for the PN.
This action perfectly aligns with the NCSBN five rights of delegation and the legal scope of practice for both the PN and the AP.

Key Concept

Delegation and Scope of Practice for the Practical Nurse within an Interprofessional Team
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Topics

Client Care Assignments and Collaboration

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