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Difficulty: Very hardClient Care Assignments and Collaboration

A severe weather event has disrupted normal staffing matrixes at an acute care facility, requiring the interdisciplinary team to restructure client care delivery on a busy telemetry unit. A practical nurse (PN) is reviewing directives delegated by the shift director. Which specific task must the PN decline as exceeding the practical nursing scope of practice, thereby escalating it to a registered nurse (RN)?

  1. A
    Signing as a witness on an informed consent document after the attending surgeon has fully explained the risks of a pending procedure to the client.
  2. B
    Contacting the healthcare provider to urgently report a critical serum potassium level of 2.8 mEq/L (2.8 mmol/L) for a client with a history of cardiac arrhythmias.
  3. C
    Applying prescribed bilateral soft wrist restraints to a delirious client attempting to dislodge a central venous catheter, following the failure of alternative de-escalation tactics.
  4. Synthesizing collected clinical data to formulate an initial, comprehensive discharge teaching plan for a client newly diagnosed with congestive heart failure.Answer

Answer

The task of synthesizing collected clinical data to formulate an initial, comprehensive discharge teaching plan for a newly diagnosed client exceeds the practical nursing scope of practice and must be escalated to a registered nurse.
The correct answer identifies that formulating an initial, comprehensive teaching plan requires the synthesis of clinical data and complex educational planning. Under national scope of practice guidelines, the Registered Nurse (RN) is solely responsible for creating the initial care and teaching plans. The Practical Nurse (PN) is legally restricted to reinforcing education that has already been initiated and planned by the RN.

Step-by-Step Solution

1
Analyze the legal scope of practice for a Practical Nurse (PN) regarding the nursing process.
The PN is authorized to collect data, participate in care planning, and implement interventions, but the Registered Nurse (RN) retains sole responsibility for comprehensive assessment, nursing diagnosis, and the initial formulation of the care plan.
Identifying the boundaries of the PN's role within the nursing process is the fundamental step in safe delegation and assignment acceptance.
2
Evaluate the task of formulating an initial, comprehensive discharge teaching plan.
This task requires synthesizing complex clinical data to identify learning needs and create a novel educational strategy.
Initial teaching and the creation of the teaching plan fall strictly under the RN's scope of practice; the PN's role is limited to reinforcing this previously established teaching.
3
Evaluate the remaining tasks for scope compliance.
Witnessing consent, reporting critical laboratory values to providers, and applying prescribed restraints after alternative measures fail are all safely within the established legal and clinical scope of the PN.
Eliminating tasks that are within the PN's scope confirms the single inappropriate assignment that must be refused.

Key Concept

The Registered Nurse (RN) is exclusively responsible for the initial comprehensive assessment, formulation of the nursing care plan, and initial client education. The Practical Nurse (PN) may only reinforce established teaching and contribute data to the assessment.
Estimated Time:1m 30s
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Topics

Client Care Assignments and Collaboration

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