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Difficulty: HardClient Care Assignments and Collaboration

At the beginning of a day shift on a medical-surgical unit, a practical nurse (PN) reviews the client roster provided by the charge nurse. Which assigned client exceeds the practical nurse's scope of practice and requires immediate reassignment to a registered nurse (RN)?

  1. A client transferred from the intensive care unit two hours ago following an acute myocardial infarction who is receiving a continuous intravenous amiodarone infusion.Answer
  2. B
    A client scheduled for an elective surgical biopsy who requires the nurse to witness the informed consent signature after the provider has explained the procedure.
  3. C
    A client with a chronic stage III pressure injury who requires a complex sterile wound dressing change and scheduled oral opioid analgesics.
  4. D
    A client with a history of chronic heart failure who requires daily weight monitoring, strict intake and output tracking, and administration of oral furosemide.

Answer

The client recently transferred from the intensive care unit receiving a continuous intravenous amiodarone infusion.
A client who is only two hours post-transfer from an intensive care unit following an acute myocardial infarction is inherently unstable. Furthermore, managing a continuous intravenous infusion of amiodarone—a high-alert antiarrhythmic medication—requires continuous comprehensive assessment, electrocardiogram interpretation, and potential dose titration based on clinical judgment. These responsibilities fall strictly under the scope of a registered nurse (RN).

Step-by-Step Solution

1
Analyze the legal scope of practice for a practical nurse regarding client stability and medication administration.
Practical nurses safely care for clients with stable conditions and predictable outcomes, whereas registered nurses must care for unstable clients requiring complex assessments.
Delegation and assignments must align with the licensure boundaries and the client's current acuity level.
2
Evaluate the acuity and clinical needs of the client with the myocardial infarction.
Being only two hours post-transfer from the intensive care unit and receiving a continuous intravenous high-risk antiarrhythmic medication (amiodarone) indicates high acuity.
Continuous intravenous infusions of high-risk cardiac medications require advanced hemodynamic monitoring, clinical judgment, and potential titration, which are restricted to the RN scope.
3
Compare the remaining options to verify they fall within the acceptable scope of practice for a PN.
Witnessing informed consent, performing sterile dressing changes, and managing stable chronic heart failure are all standard, legally permissible tasks for a practical nurse.
Confirming the validity of the other assignments isolates the single out-of-scope scenario.

Key Concept

Scope of Practice and Delegation: Differentiating between stable clients (appropriate for PNs) and unstable clients requiring continuous comprehensive RN assessment.
Estimated Time:1m 30s
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Topics

Client Care Assignments and Collaboration

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