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Difficulty: MediumAccident, Error, and Injury Prevention

A charge nurse is observing a newly hired registered nurse (RN) prioritize and delegate care for a group of post-surgical clients. Which action by the new RN compromises client safety and requires immediate intervention by the charge nurse?

  1. A
    Instructing the UAP to immediately notify the RN if a confused client attempts to remove their peripheral intravenous line.
  2. B
    Asking the UAP to reapply sequential compression devices (SCDs) to a client's lower extremities after assisting with a bed bath.
  3. Assigning an unlicensed assistive personnel (UAP) to assist a client with their initial ambulation following a total hip arthroplasty.Answer
  4. D
    Directing the UAP to measure and document the hourly urine output from a stable client's indwelling urinary catheter.

Answer

The action that requires immediate intervention is assigning a UAP to assist a client with their initial ambulation following a total hip arthroplasty.
The initial ambulation of a client following a major surgery, such as a total hip arthroplasty, requires comprehensive nursing assessment. The RN must evaluate the client for dizziness, orthostatic hypotension, muscle strength, and pain, while ensuring hip precautions are maintained to prevent joint dislocation or severe falls. Because UAPs cannot perform physiological assessments, delegating this task places the client in immediate danger, compromises environmental safety, and requires immediate intervention by the charge nurse.

Step-by-Step Solution

1
Analyze the RN's delegation choices for safety risks and scope of practice violations.
Routine tasks (SCD application, measuring urine, observing behavior) are within the UAP scope. Initial post-operative ambulation poses a high risk for falls and orthostatic hypotension.
Delegating tasks outside of a UAP's scope can directly lead to client injury.
2
Determine the assessment requirements for a client ambulating for the first time after major orthopedic surgery.
The initial ambulation requires the RN to evaluate the client for dizziness, pain tolerance, muscle strength, and proper adherence to joint precautions.
Only a licensed nurse can perform physiological assessments and evaluate a client's tolerance to a new, high-risk activity.
3
Identify which delegated task constitutes improper delegation that could lead to immediate client injury.
Delegating the initial ambulation of the total hip arthroplasty client places them at severe risk of a fall or joint dislocation.
The UAP lacks the clinical training to assess for or properly react to sudden post-operative complications during movement.

Key Concept

Delegation of High-Risk Mobility Tasks and Fall Prevention
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Topics

Accident, Error, and Injury Prevention

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