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Question

Difficulty: HardClient Care Assignments and Collaboration

A registered nurse (RN) is coordinating care with a practical nurse (PN) on a complex step-down rehabilitation unit. Which observed action by the PN requires the RN to intervene immediately?

  1. Initiating an intravenous (IV) push dose of a loop diuretic for a client who develops sudden severe dyspnea.Answer
  2. B
    Signing as a witness on an informed consent document after confirming the client comprehends the surgeon's explanation.
  3. C
    Discussing a client's updated nutritional laboratory results with the facility's registered dietitian in the private nursing station.
  4. D
    Reinforcing the RN's initial discharge teaching regarding prescribed fluid restriction limits for a client with chronic heart failure.

Answer

The action that requires immediate intervention is initiating an intravenous (IV) push dose of a loop diuretic for a client who develops sudden severe dyspnea.
The correct answer involves the administration of an intravenous (IV) push medication and the management of a sudden, unstable physiological change (severe dyspnea). Both of these clinical elements demand advanced clinical judgment, immediate evaluation, and comprehensive assessment skills that are legally restricted to the registered nurse (RN). A practical nurse (PN) must not initiate IV push medications or independently manage acutely decompensating clients.

Step-by-Step Solution

1
Analyze the question stem.
The question asks to identify an action performed by the PN that is incorrect, unsafe, or outside their legal scope of practice, requiring RN intervention.
Understanding the goal is critical to differentiating between appropriate PN tasks and tasks restricted to the RN.
2
Evaluate the option regarding informed consent.
Determine that witnessing a voluntarily signed consent form after the provider's explanation is a standard and legal responsibility for a PN.
The PN is not providing the explanation, only verifying the voluntary nature of the signature.
3
Evaluate the option regarding information sharing with the dietitian.
Determine that discussing care-related data with the interdisciplinary team in a private setting is standard collaborative practice.
Confidentiality rules (HIPAA) allow for data sharing among team members directly involved in treating the client.
4
Evaluate the option regarding patient education.
Determine that reinforcing previously established teaching regarding fluid restrictions is within the PN scope.
While initial teaching is an RN responsibility, reinforcement of established plans is a core PN competency.
5
Evaluate the option regarding IV push medications and severe dyspnea.
Identify this action as a severe scope of practice violation.
Administration of IV push medications and the management of an acutely unstable client require the comprehensive assessment and clinical judgment exclusive to the RN role.

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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