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Question

Difficulty: HardClient Care Assignments and Collaboration

A unit manager on a step-down rehabilitation ward is revising client care assignments due to an unexpected staff absence. Which specific clinical task is legally and safely within the scope of practice for a practical nurse (PN) to accept?

  1. Applying a prescribed enzymatic debriding agent to a chronic venous stasis ulcer and packing the wound with sterile gauze.Answer
  2. B
    Detailing the physiological risks and alternative therapeutic options for an upcoming bone marrow biopsy before obtaining the client's signature.
  3. C
    Administering a prescribed intravenous push dose of morphine sulfate to a client experiencing severe, breakthrough postoperative pain.
  4. D
    Completing the initial admission assessment and formulating the comprehensive nursing care plan for a client newly admitted with bacterial pneumonia.

Answer

Applying a prescribed enzymatic debriding agent to a chronic venous stasis ulcer and packing the wound with sterile gauze.
The scope of practice for a practical nurse (PN) includes performing complex but predictable clinical tasks on stable clients, such as sterile dressing changes, wound irrigation, and the application of prescribed topical medications. These tasks require technical skill and focused data collection, but they rely on established protocols rather than independent, comprehensive RN-level assessment.

Step-by-Step Solution

1
Analyze the stem to determine the objective.
The goal is to identify a clinical task that falls within the legal scope of practice for a Practical Nurse (PN).
Understanding the boundaries of the PN scope is critical for safe delegation and assignment acceptance.
2
Evaluate the option involving the informed consent document.
Recognize that explaining risks and alternatives is strictly the provider's role. The PN can only witness the signature. This task is out of scope.
Ensures adherence to legal guidelines regarding informed consent.
3
Evaluate the option involving the intravenous push medication.
Recognize that IV push medications, especially opioids, require independent RN-level assessment and rapid intervention capabilities. This task is out of scope.
Maintains patient safety regarding high-alert medication administration.
4
Evaluate the option involving the admission assessment and care plan.
Recognize that comprehensive initial assessments and primary care plan formulation are non-delegable RN responsibilities. This task is out of scope.
Differentiates between PN data collection and RN comprehensive assessment.
5
Evaluate the wound care option.
Recognize that complex but predictable wound care, including sterile technique and prescribed topical medications on a stable chronic wound, is safely within the PN scope of practice.
Confirms the correct application of PN skills to stable, expected clinical scenarios.

Key Concept

Practical Nurse (PN) Scope of Practice and Task Delegation
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Topics

Client Care Assignments and Collaboration

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