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Question

Difficulty: MediumClient Care Assignments and Collaboration

The charge nurse on an inpatient oncology unit presents the shift assignment to a practical nurse (PN). Which assigned client task should the PN immediately question and return to the registered nurse (RN) for management?

  1. Conducting the initial comprehensive admission assessment for a client arriving from the emergency department.Answer
  2. B
    Witnessing the client's signature on an informed consent form for an upcoming bone marrow aspiration.
  3. C
    Administering scheduled oral opioid analgesics to a client experiencing chronic pain from bone metastasis.
  4. D
    Reinforcing previously established infection prevention teaching for a client with chemotherapy-induced neutropenia.

Answer

Conducting the initial comprehensive admission assessment for a client arriving from the emergency department.
The initial comprehensive admission assessment requires advanced clinical judgment, synthesis of data, and the formulation of an initial nursing care plan. According to national standards and nurse practice acts, these responsibilities strictly fall within the registered nurse (RN) scope of practice and cannot be delegated to or accepted by a practical nurse (PN).

Step-by-Step Solution

1
Analyze the role and scope of practice of the practical nurse (PN) compared to the registered nurse (RN).
The PN can collect data, perform routine procedures, and care for stable clients. The RN is responsible for initial assessments, nursing diagnoses, care planning, and initial education.
Understanding the legal boundaries of the PN scope of practice is essential for safe delegation and assignment acceptance.
2
Evaluate each assigned task to determine if it falls within the PN's legal scope of practice.
Witnessing consent, giving oral narcotics, and reinforcing teaching are all within the PN scope. Conducting an initial comprehensive assessment is exclusively an RN responsibility.
The PN must recognize which tasks require the advanced clinical judgment of an RN to ensure client safety.
3
Identify the task that the PN must refuse or question.
The initial comprehensive admission assessment must be questioned and reassigned to the RN.
Accepting an assignment outside of the PN scope of practice violates the nurse practice act and jeopardizes client safety.

Key Concept

The practical nurse (PN) cannot perform initial comprehensive assessments or develop initial care plans; these tasks must be completed by a registered nurse (RN).
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Topics

Client Care Assignments and Collaboration

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