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Prioritization, Delegation, and Assignment Practice Exercises for the NCLEX ® Examination ScienceMedicineNursing habshico Save Prioritization NCLEX questions 28 terms madisoncastello Preview 25Qw/exp Delegation and Prioritiza...25 terms Preview 75 Free NCLEX Questions - c/o Brilli...75 terms carey47Preview NCLEX 110 term kan 1. You are the charge nurse. A client with chronic pain reports to you that the nurses have not been responding to requests for pain medication.What is your initial action?

• Check the medication administration records (MARs) for the past several days.
• Ask the nurse educator to provide in-service training about pain management.
• Perform a complete pain assessment on the client and take a pain history.
• Have a conference with the nurses responsible for the care of this client.
• Ans: 4 As charge nurse, you must assess the performance and attitude of the staff in relation to this client. After data are gathered from the

nurses, additional information can be obtained from the records and the client as necessary. The educator may be of assistance if a knowledge deficit or need for performance improvement is the problem. Focus: Supervision, prioritization LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). Elsevier Health Sciences. Kindle Edition.

• Family members are encouraging your client to "tough out the pain" rather than risk drug addiction to narcotics. The client is stoically abiding.

You recognize that the sociocultural dimension of pain is the current priority for the client. Which question will you ask?

• " Where is the pain located, and does it radiate to other parts of your body?"
• " How would you describe the pain, and how is it affecting you?"
• " What do you believe about pain medication and drug addiction?"
• " How is the pain affecting your activity level and your ability to function?"
• " What information do you need about pain, healing, and addiction?"
• Ans: 3 Beliefs, attitudes, and familial influence are part of the sociocultural dimension of pain. Location and radiation of pain address the

sensory dimension. Describing pain and its effects addresses the affective dimension. Activity level and function address the behavioral dimension. Asking about knowledge addresses the cognitive dimension. Focus: Prioritization 3.LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). Elsevier Health Sciences. Kindle Edition.

• A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to

nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?

• Gabapentin (Neurontin)
• Corticosteroids
• Hydromorphone (Dilaudid)
• Lorazepam (Ativan)
• Ans: 1 Gabapentin is an antiepileptic drug, but it is also used to treat diabetic neuropathy. Corticosteroids are for pain associated with

inflammation. Hydromorphone is a stronger opioid, and it is not the first choice for chronic pain that can be managed with other drugs.Lorazepam is an anxiolytic that may be ordered as an adjuvant nedication. Focus: Prioritization LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). Elsevier Health Sciences. Kindle Edition.

• Which client is most likely to receive opioids for extended periods of time?
• A client with fibromyalgia
• A client with phantom limb pain in the leg
• A client with progressive pancreatic cancer
• A client with trigeminal neuralgia
• Ans: 3 Cancer pain generally worsens with disease progression, and the use of opioids is more generous. Fibromyalgia is more likely to be

treated with nonopioid and adjuvant medications. Trigeminal neuralgia is treated with antiseizure medications such as carbamazepine (Tegretol).Phantom limb pain usually subsides after ambulation begins. Focus: Prioritization LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). Elsevier Health Sciences. Kindle Edition.

• As the charge nurse, you are reviewing the charts of clients who were assigned to the care of a newly graduated RN. The RN has correctly

charted dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. What action should you take first?

• Make a note in the nurse's file and continue to observe clinical performance.
• Refer the new nurse to the in-service education department.
• Quiz the nurse about knowledge of pain management and pharmacology.
• Give praise for correctly charting the dose and time and discuss the deficits in charting.
• Ans: 4 In supervision of the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking

the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making a note and watching do not help the nurse to correct the immediate problem. In-service training might be considered if the problem persists.

Focus: Supervision, delegation

LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). Elsevier Health Sciences. Kindle Edition.

• You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP?
• Assisting the patient with oral hygiene
• Observing the patient's response to feedings
• Facilitating expression of grief or anxiety
• Initiating daily weighings
• Ans: 1 Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to observe response to treatments and to help

the patient deal with loss or anxiety. The UAP can be directed to weigh the patient but should not be expected to know when to initiate that

measurement. Focus: Delegation

LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168). Elsevier Health Sciences. Kindle Edition.

• A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past

several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?

• Diarrhea/ Constipation related to altered bowel patterns 2. Deficient Knowledge related to the disease process and diagnostic procedure
• Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea
• Anxiety related to unknown outcomes and perceived threats to body integrity
• Ans: 4 The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information

required to make an informed decision. The other diagnoses are relevant, but if the patient leaves the clinic the interventions may be delayed or

ignored. Focus: Prioritization

LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168). Elsevier Health Sciences. Kindle Edition.

• Which patient is at greatest risk for pancreatic cancer? 1. An elderly African-American man who smokes
• A young white obese woman with gallbladder disease 3. A young African-American man with type 1 diabetes
• An elderly white woman who has pancreatitis
• Ans: 1 Pancreatic cancer is more common in African-Americans, males, and smokers. Other associated factors include alcohol use, diabetes,

obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal irradiation. Focus: Prioritization LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168). Elsevier Health Sciences. Kindle Edition.

• Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed

for patients who must be placed on bleeding precautions? (Select all that apply.)

• Provide mouthwash with alcohol for oral rinsing.
• Use paper tape on fragile skin.
• Provide a soft toothbrush or oral sponge.
• Gently insert rectal suppositories.
• Avoid aspirin or aspirin-containing products.
• Avoid overinflation of blood pressure cuffs.
• Pad sharp corners of furniture.
• Ans: 2, 3, 5, 6, 7 Mouthwash should not include alcohol, because it has a drying action that leaves mucous membranes more vulnerable.

Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended. All other options are appropriate. Focus: Prioritization, knowledge LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168). Elsevier Health Sciences. Kindle Edition.

• When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most

appropriate to assign to an LPN/ LVN under the supervision of a team leader RN? 1. A patient with severe anemia secondary to GI bleeding 2. A patient who needs enemas and antibiotics to control GI bacteria

• A patient who needs preoperative teaching for bowel resection surgery
• A patient who needs central line insertion for chemotherapy
• Ans: 2 Administering enemas and antibiotics is within the scope of practice of LPNs/ LVNs. Although some states an facilities may allow the

LPN/ LVN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with central line insertion are the

responsibilities of the RN. Focus: Assignment

LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168). Elsevier Health Sciences. Kindle Edition.

• A few minutes after you have given an intradermal injection of an allergen to a patient who is undergoing skin testing for allergies, the patient

reports feeling anxious, short of breath, and dizzy. Which action included in the emergency protocol should you take first?

• Start oxygen at 4 L/ min using a nasal cannula.
• Obtain IV access with a large-bore IV catheter.
• Give epinephrine (Adrenalin) 0.3 mL intramuscularly.
• Administer 3 mL of nebulized albuterol (Proventil) 0.083%.
• Ans: 3 Epinephrine is the initial drug of choice for treatment of anaphylaxis. Giving epinephrine rapidly at the onset of an anaphylactic reaction

may prevent or reverse cardiovascular collapse as well as airway narrowing caused by bronchospasm and inflammation. Oxygen use is also appropriate, but oxygen would be administered using a nonrebreather mask in order to achieve a fraction of inspired oxygen closer to 100%.Albuterol may also be administered to decrease airway narrowing but would not be the first therapy used for anaphylaxis. IV access will take longer to establish and should not be the first intervention. Focus: Prioritization LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 170). Elsevier Health Sciences. Kindle Edition.