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Difficulty: Very hardClient Care Assignments and Collaboration

A practical nurse (PN) is coordinating client care with a registered nurse (RN) and an assistive personnel (AP) on a medical-surgical unit. Which of the following decisions by the PN demonstrates the most appropriate application of scope of practice, delegation, and collaborative care principles?

  1. A
    Explaining the potential complications of a scheduled bone marrow biopsy to an anxious client prior to witnessing their signature on the informed consent form.
  2. B
    Independently completing the discharge teaching and medication reconciliation for a client who is going home with a newly prescribed oral anticoagulant regimen.
  3. Monitoring a client receiving a packed red blood cell transfusion and collecting subsequent vital signs 15 minutes after the RN has initiated the infusion and completed the initial assessment.Answer
  4. D
    Delegating the collection of orthostatic vital signs to the AP for a client who is 12 hours post-operative and reports new-onset lightheadedness.

Answer

The correct decision is to monitor a client receiving a packed red blood cell transfusion and collect subsequent vital signs 15 minutes after the RN has initiated the infusion and completed the initial assessment.
The correct decision is to accept the assignment to monitor the client receiving a blood transfusion after the first 15 minutes. While registered nurses must initiate blood products and complete the critical initial 15-minute assessment, practical nurses are legally permitted to monitor the client and collect subsequent vital signs once the client is deemed stable and free of initial transfusion reactions.

Step-by-Step Solution

1
Analyze the practical nurse's legal scope of practice regarding blood transfusions.
Registered nurses must initiate blood products and perform the critical 15-minute assessment. Practical nurses may monitor stable clients and collect vital signs after this initial period.
Identifying boundaries ensures safe care and prevents working outside the legal scope of practice.
2
Evaluate the appropriateness of delegating tasks to assistive personnel (AP).
APs can take vital signs on stable clients, but clients exhibiting new symptoms of instability (like post-operative lightheadedness) require assessment by a licensed nurse.
Delegation requires the client to be medically stable with a predictable outcome.
3
Determine the practical nurse's role in informed consent and discharge teaching.
Practical nurses can only witness consent signatures, not explain procedure risks. They can reinforce teaching, but cannot initiate primary discharge education or perform medication reconciliation.
These tasks require comprehensive assessment and clinical judgment, which are RN and provider responsibilities.
4
Select the option that aligns with safe and legal practice.
Monitoring the blood transfusion after the initial 15-minute RN assessment is the only legally and clinically appropriate action for the PN.
This correctly applies delegation and collaborative care principles within the PN scope.

Key Concept

LPN/VN Scope of Practice, Delegation, and Collaboration
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Topics

Client Care Assignments and Collaboration

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