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Difficulty: MediumClient Care Assignments and Collaboration

After receiving the morning handoff report on a medical-surgical unit, a practical nurse (PN) reviews the tasks delegated by the charge nurse. Which assigned client care activity must the PN decline because it exceeds their legal scope of practice?

  1. Titrating a continuous intravenous heparin infusion based on the morning coagulation laboratory results.Answer
  2. B
    Reinforcing dietary education for a client with newly diagnosed heart failure who is preparing for discharge.
  3. C
    Administering a scheduled intramuscular antibiotic injection to a client admitted with community-acquired pneumonia.
  4. D
    Performing sterile tracheostomy care and suctioning for a client with a stable, long-term airway.

Answer

The practical nurse must decline the task of titrating a continuous intravenous heparin infusion based on laboratory results.
Titrating a continuous intravenous medication like heparin requires interpreting laboratory data and making independent clinical judgments to adjust the dosage of a high-alert medication. This action requires advanced assessment and critical thinking skills that fall exclusively under the registered nurse (RN) scope of practice. Therefore, the practical nurse (PN) must decline this task and return it to the RN.

Step-by-Step Solution

1
Analyze each delegated task against the established practical nurse (PN) scope of practice.
Identify which tasks require comprehensive assessment, initial education, or advanced clinical judgment.
PNs are legally prohibited from performing tasks that require independent registered nurse (RN) judgment.
2
Evaluate the requirement of titrating an intravenous (IV) infusion based on lab results.
Recognize that IV titration requires interpreting laboratory values and adjusting high-alert medications.
This level of clinical judgment and complex IV therapy management is exclusively reserved for the RN.

Key Concept

Practical Nurse Scope of Practice and Delegation Limitations
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Topics

Client Care Assignments and Collaboration

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