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Question

Difficulty: MediumClient Care Assignments and Collaboration

The unit coordinator is distributing client assignments to nursing staff on an acute medical-surgical floor. Which assigned client situation should prompt a practical nurse (PN) to immediately request an assignment change from the supervising registered nurse (RN)?

  1. A
    A client scheduled for a routine colonoscopy who requires a nurse to witness the signature on the informed consent form.
  2. A newly admitted client presenting with an acute asthma exacerbation who requires an initial comprehensive assessment and care plan development.Answer
  3. C
    A client diagnosed with chronic heart failure who requires reinforcement of previously taught dietary sodium restrictions.
  4. D
    A client with resolving pneumonia who requires routine pulse oximetry monitoring and administration of scheduled oral antibiotics.

Answer

The practical nurse must decline the assignment for the newly admitted client presenting with an acute asthma exacerbation who requires an initial comprehensive assessment.
The correct answer identifies a newly admitted client with an acute condition requiring a comprehensive assessment. The practical nursing scope of practice dictates that PNs care for stable clients with predictable outcomes. Initial comprehensive assessments and the development of initial care plans require the advanced clinical judgment of a registered nurse and cannot be delegated to a PN.

Step-by-Step Solution

1
Analyze the practical nurse scope of practice regarding assessments, client stability, and care planning.
Practical nurses are legally permitted to care for stable clients with predictable outcomes and perform focused, ongoing data collection rather than comprehensive assessments.
To determine the legal and safety boundaries for accepting a client care assignment.
2
Evaluate each assigned client for complexity, stability, and required nursing interventions.
The newly admitted client is unstable and requires an initial comprehensive assessment, which must be performed by an RN. The other clients require routine tasks (witnessing a signature, reinforcing education, and administering oral medications) that are within the PN scope.
To identify which specific assignment exceeds the practical nurse's legal scope of practice and requires escalation.

Key Concept

Delegation and Scope of Practice for the Practical Nurse
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Topics

Client Care Assignments and Collaboration

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