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Difficulty: HardClient Care Assignments and Collaboration

A practical nurse (PN) is assigned to a team of clients on an adult medical unit. The PN must collaborate with a registered nurse (RN) and an assistive personnel (AP) to provide safe care. Which of the following decisions by the PN demonstrates correct application of delegation principles and professional scope of practice?

  1. Directing the AP to feed a client who experiences bilateral hand tremors but maintains an intact and functional swallowing reflex.Answer
  2. B
    Accepting a directive from the unit charge nurse to formulate the initial nursing care plan for a client admitted directly from the emergency department.
  3. C
    Recording a client's morning serum potassium level of 2.7 mEq/L (2.7 mmol/L) in the chart, with the intention to notify the provider during afternoon rounds.
  4. D
    Proceeding to apply bilateral soft wrist restraints to a confused client who repeatedly touches their surgical dressing, prior to attempting less restrictive interventions.

Answer

The correct decision is directing the AP to feed a client who experiences bilateral hand tremors but maintains an intact and functional swallowing reflex.
The correct decision represents safe and effective delegation. While feeding a client with a high risk of aspiration (such as following an acute stroke with dysphagia) requires a licensed nurse, feeding a client who merely has motor difficulties (like tremors) but a fully intact swallowing reflex is a routine activity of daily living (ADL) that can be safely delegated to an assistive personnel (AP).

Step-by-Step Solution

1
Evaluate the appropriateness of delegating the feeding task to the AP.
Determine that because the client has an intact swallowing reflex (no dysphagia), feeding is a routine, low-risk task that safely falls within the AP's scope.
The 'right task' and 'right circumstance' of delegation are met when a client is stable and the task does not require nursing judgment.
2
Analyze the acceptance of formulating an initial care plan.
Identify that the initial comprehensive assessment and care plan formulation are strictly within the RN's scope of practice.
PNs cannot accept delegated tasks that require independent, complex nursing judgment, even if instructed by a charge nurse.
3
Assess the management of the critical laboratory value.
Recognize that a potassium level of 2.7 mEq/L is a critical panic value requiring immediate intervention.
Safe collaborative practice mandates immediate escalation of critical diagnostic findings to prevent adverse client outcomes, such as arrhythmias.
4
Review the protocol for applying physical restraints.
Conclude that applying restraints before trying alternatives violates safety protocols and legal guidelines.
Least restrictive measures must always be exhausted and documented before utilizing physical restraints to protect client autonomy and prevent injury.

Key Concept

Delegation, Scope of Practice, and Interprofessional Collaboration
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Topics

Client Care Assignments and Collaboration

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