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Difficulty: MediumClient Care Assignments and Collaboration

A newly hired practical nurse (PN) is assigned to a palliative care unit. The healthcare team includes a registered nurse (RN) and assistive personnel (AP). Which of the following actions performed by the PN indicate an accurate understanding of role responsibilities and safe delegation? Select all that apply.

  1. Directing the AP to provide routine oral hygiene for an unconscious client nearing the end of lifeAnswer
  2. B
    Explaining the potential risks and alternative treatment options for an upcoming palliative surgical procedure prior to obtaining the client's signature on the informed consent form
  3. C
    Accepting an assignment to develop the initial comprehensive plan of care for a client who was just admitted to the unit
  4. Performing focused data collection regarding the respiratory status of a client experiencing increased dyspneaAnswer
  5. E
    Discussing a client's declining prognosis and change in code status with the facility social worker while standing in the public lobby
  6. Administering a scheduled dose of subcutaneous morphine sulfate to manage a client's breakthrough painAnswer

Answer

The correct actions include directing the AP to provide routine oral hygiene, performing focused data collection on a client's respiratory status, and administering a scheduled dose of subcutaneous morphine sulfate.
The practical nurse operates safely by delegating routine, non-invasive tasks like oral hygiene to the AP. Additionally, performing focused data collection on a client's respiratory status and administering subcutaneous medications like morphine are well within the legal scope of practice for a PN.

Step-by-Step Solution

1
Evaluate the tasks delegated to the assistive personnel (AP).
Providing routine oral hygiene to an unconscious client is a standard, non-invasive procedure with a predictable outcome.
Routine basic care tasks can be safely delegated to the AP.
2
Analyze the tasks performed directly by the practical nurse (PN) regarding client assessment and care planning.
The PN can perform focused data collection, but developing the initial comprehensive care plan is solely the responsibility of the registered nurse (RN).
The PN scope of practice involves assisting with care planning and collecting focused data, not initiating the primary comprehensive assessment.
3
Assess the medication administration and ethical responsibilities of the PN.
Administering subcutaneous medications is within the PN scope. Explaining surgical risks and discussing client information in public areas violate legal and ethical boundaries.
The provider must explain surgical risks for informed consent, and client confidentiality must be maintained at all times in accordance with HIPAA.

Key Concept

Practical Nurse (PN) Scope of Practice and Delegation
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Topics

Client Care Assignments and Collaboration

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