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Difficulty: HardClient Care Assignments and Collaboration

An interprofessional healthcare team is coordinating care for a client who was recently admitted with acute pyelonephritis and an exacerbation of chronic heart failure. As the licensed practical/vocational nurse (LPN/VN) on the team reviews the prescribed interventions, which of the following actions fall within their legal scope of practice? (Select all that apply)

  1. Inserting a straight urinary catheter to obtain a sterile urine specimen as prescribed.Answer
  2. B
    Developing the primary nursing care plan to address the client's acute pain and risk for infection.
  3. Administering a scheduled oral sulfonamide antibiotic and monitoring for expected therapeutic effects.Answer
  4. D
    Explaining the procedural risks of a scheduled renal ultrasound to the client before obtaining the consent signature.
  5. Auscultating lung sounds and collecting data on peripheral edema to monitor the client's chronic heart failure status.Answer
  6. F
    Administering an intravenous (IV) push dose of a loop diuretic to rapidly address increasing dyspnea.

Answer

The actions within the LPN/VN scope of practice include inserting a straight urinary catheter, administering scheduled oral antibiotics, and auscultating lung sounds to monitor chronic heart failure.
The correct selections represent tasks that align with established LPN/VN delegation guidelines. Inserting a urinary catheter is a standard sterile procedure included in practical nursing education. Administering routine oral medications is a primary responsibility for the LPN/VN. Additionally, auscultating lung sounds and checking for edema in a client with a known history of heart failure is considered focused data collection rather than an initial comprehensive assessment. These actions involve gathering objective data on predictable conditions to report back to the registered nurse (RN).

Step-by-Step Solution

1
Analyze the clinical scenario and the client's current acuity.
The client has acute pyelonephritis and a history of chronic heart failure, requiring interventions of varying complexity.
Understanding client stability and condition predictability is essential for determining which tasks can be safely performed by the LPN/VN.
2
Evaluate each intervention against the LPN/VN legal scope of practice regarding data collection versus comprehensive assessment.
Auscultating lung sounds for a known condition constitutes focused data collection, which is allowed, whereas developing a primary care plan involves RN-level comprehensive assessment.
LPN/VNs gather data to contribute to the overall care plan but do not autonomously formulate the initial plan or perform comprehensive assessments.
3
Evaluate medication administration and procedural tasks for scope compliance.
Sterile catheterization and oral medication administration are acceptable. Administering IV push medications for acute respiratory distress and explaining procedure risks exceed the scope.
High-risk, complex interventions and obtaining informed consent must be escalated to the RN or provider.

Key Concept

The LPN/VN scope of practice centers on focused data collection, executing established interventions on stable clients, and contributing to the care plan, while avoiding tasks that require independent comprehensive assessment, clinical judgment for unstable clients, or provider-level responsibilities.
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Topics

Client Care Assignments and Collaboration

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