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Difficulty: HardClient Care Assignments and Collaboration

Following a multi-disciplinary care conference at a skilled nursing facility, a practical nurse (PN) proceeds to complete the afternoon interventions for a group of clients. Which clinical action performed by the PN falls outside legal practice boundaries and necessitates immediate intervention by the supervising registered nurse (RN)?

  1. A
    Informing the healthcare provider that a client does not fully understand a scheduled surgical procedure prior to witnessing the consent signature
  2. B
    Refusing an assignment to administer an intravenous (IV) push dose of a high-alert antiarrhythmic medication to a client with tachycardia
  3. Formulating a new nursing diagnosis and modifying the care plan after noting a client's sudden onset of acute confusionAnswer
  4. D
    Stopping an unlicensed assistive personnel (UAP) from discussing a client's pending discharge destination while standing in the facility's public waiting room

Answer

Formulating a new nursing diagnosis and modifying the care plan after noting a client's sudden onset of acute confusion
The correct answer identifies an action that directly violates the practical nurse's legal scope of practice. Formulating nursing diagnoses and independently modifying the plan of care require comprehensive assessment, analysis, and clinical judgment, which are strictly the responsibility of the registered nurse (RN). This highlights the critical difference between the PN's role in focused data collection and the RN's responsibility for comprehensive assessment and evaluation of new, unstable clinical findings.

Step-by-Step Solution

1
Analyze each clinical action presented in the options to determine if it falls within the legal scope of practice for a practical nurse (PN).
Three actions demonstrate safe, legal nursing practice, while one represents a scope violation.
The question asks to identify the action that requires immediate intervention by the RN due to falling outside legal boundaries.
2
Evaluate the PN's role in the nursing process, specifically regarding assessment and care planning.
The PN contributes to the care plan through focused data collection, but independent modification of the plan and formulation of new diagnoses require RN-level comprehensive assessment.
Understanding the critical distinction between PN data collection and RN comprehensive assessment is essential for safe delegation.
3
Review the distractors against safe practice principles (informed consent, delegation limits, and confidentiality).
Advocating for a client's understanding before witnessing consent, refusing unsafe IV push assignments, and preventing public HIPAA breaches are all correct, mandatory PN responsibilities.
Recognizing proper advocacy and safety interventions helps eliminate the distractors.
4
Select the option that describes the PN overstepping professional boundaries.
The option describing the modification of a care plan for a client with new acute confusion is the correct answer.
This action requires independent clinical evaluation of an unstable finding, which is strictly the responsibility of the RN.

Key Concept

Scope of Practice and Delegation Boundaries
Estimated Time:1m 15s
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Topics

Client Care Assignments and Collaboration

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