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Difficulty: HardClient Care Assignments and Collaboration

Following the morning interdisciplinary meeting, the care team coordinates the daily workflow on a cardiopulmonary step-down unit. A practical/vocational nurse (PN/VN) is working collaboratively with a registered nurse (RN) and assistive personnel (AP). Which action by the PN/VN demonstrates an appropriate application of scope of practice and delegation guidelines?

  1. A
    Explaining the potential physiological complications of a scheduled cardiac catheterization to a client prior to witnessing the consent signature.
  2. B
    Directing the AP to obtain vital signs and oxygen saturation for a client who just reported a sudden onset of severe chest pressure.
  3. Recording the hourly output of an established closed-chest drainage system and reinforcing the RN's earlier teaching regarding splinting techniques.Answer
  4. D
    Discussing the declining condition of a shared client with the consulting respiratory therapist while riding in a crowded public hospital elevator.

Answer

Recording the hourly output of an established closed-chest drainage system and reinforcing the RN's earlier teaching regarding splinting techniques.
The practical/vocational nurse (PN/VN) is responsible for ongoing data collection and reinforcing teaching that has already been initiated by the registered nurse (RN). Monitoring the output of an established (clinically stable) closed-chest drainage system and reminding the client to use previously taught splinting techniques are highly appropriate, within-scope actions.

Step-by-Step Solution

1
Analyze the PN/VN's legal scope of practice regarding data collection versus comprehensive assessment and initial teaching.
Identified that the PN/VN can collect data on stable systems and reinforce existing teaching plans.
Establishing the baseline rules for PN/VN practice eliminates out-of-scope actions.
2
Evaluate the clinical stability of the clients described in the distractors.
Recognized that 'sudden onset of severe chest pressure' is an unstable condition requiring direct nursing assessment, not AP delegation.
Delegation parameters dictate that APs can only be assigned routine tasks for stable clients.
3
Review legal responsibilities regarding informed consent and confidentiality.
Determined that explaining surgical risks is the provider's duty, and discussing cases in public elevators violates confidentiality.
These are distinct areas of the safe and effective care environment tested on the NCLEX.
4
Select the action that aligns with all regulatory and safety standards.
Selected the option involving routine data collection on an established chest tube and teaching reinforcement.
This is the only option that represents safe, legal, and within-scope nursing practice for a PN/VN.

Key Concept

Scope of practice and safe delegation for the Practical/Vocational Nurse (PN/VN)
Estimated Time:1m 30s
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Topics

Client Care Assignments and Collaboration

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