Prioritization, Delegation, and Assignment Practice Exercises for the NCLEX ® Examination

Prioritization, Delegation, and Assignment Practice Exercises for the NCLEX ® Examination Leave the first rating Students also studied Terms in this set (106) Science MedicineNursing Save Musculoskeletal practice questions 15 terms Reginec1Preview Healthcare Policy and Healthcare O...25 terms Natalie_Scigliano Preview Professional Nursing Concepts I EA...25 terms Shadwell_Charles Preview

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• 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.b.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.d: 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.

• 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?"

• Beliefs, attitudes, and familial influence are part of the sociocultural dimension

of pain.

• 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)
• Gabapentin is an antiepileptic drug, but it is also used to treat diabetic

neuropathy.

• 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
• Cancer pain generally worsens with disease progression, and the use of opioids

is more generous.

• 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.

• In supervision of the new RN, good performance should be reinforced first and

then areas of improvement can be addressed.

• 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
• Oral hygiene is within the scope of duties of the UAP.
• Which patient is at greatest risk for pancreatic cancer?
• An elderly African-American man who smokes
• young white obese woman with gallbladder disease c.

A young African-American man with type 1 diabetes

• An elderly white woman who has pancreatitis

a: 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.

• 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

• 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

• 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.

• 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.

4. Ans: b,c, e, f, g

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.

• 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?

• A patient with severe anemia secondary to GI bleeding
• A patient who needs enemas and antibiotics to control

GI bacteria c.A patient who needs preoperative teaching for bowel resection surgery d.A patient who needs central line insertion for chemotherapy

• 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

• 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%.

• 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.

• As the nurse manager in a public health department,

you are implementing a plan to reduce the incidence of infection with human immunodeficiency virus (HIV) in the community. Which nursing action will you delegate to health assistants working for the agency?

• Supplying injection drug users with sterile injection

equipment such as needles and syringes

• Interviewing patients about behaviors that indicate a

need for annual HIV testing

• Teaching high-risk community members about the use

of condoms in preventing HIV infection

• Assessing the community to determine which

population groups to target for education

• Supplying sterile injection supplies to patients who are at risk for HIV infection

can be done by staff members with health assistant education. Assessing for high-

risk behaviors, education, and community assessment are RN-level skills. Focus:

Delegation

• You are working with a student nurse to care for an

HIV-positive patient with severe esophagitis caused by Candida albicans. Which action by the student indicates that you need to intervene most quickly?

• Putting on a mask and gown before entering the

patient's room

• Giving the patient a glass of water after administering

the ordered oral nystatin (Mycostatin) suspension

• Suggesting that the patient should order chile con

carne or chicken soup for the next meal

• Placing a "No Visitors" sign on the door of the patient's

room

• Nystatin should be in contact with the oral and esophageal tissues as long as

possible for maximum effect. The other actions are also inappropriate and should be discussed with the student but do not require action as quickly. HIV-positive patients do not require droplet/ contact precautions or visitor restrictions to prevent opportunistic infections. Hot or spicy foods are not usually well tolerated

by patients with oral or esophageal fungal infections. Focus: Prioritization

• You are evaluating an HIV-positive patient who is

receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP) pneumonia. Which information is most important to communicate to the physician?

• The patient is reporting pain at the site of the infusion.
• The patient is not taking in an adequate amount of oral

fluids.

• Blood pressure is 104/ 76 mm Hg after pentamidine

administration.

• Blood glucose level is 55 mg/ dL after medication

administration.

• Pentamidine can cause fatal hypoglycemia, so the low blood glucose level

indicates a need for a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may need to be slowed. The other responses indicate a need for independent nursing actions (such as establishing a new IV site and encouraging oral intake) but are not associated with pentamidine infusion.

Focus: Prioritization

• After interviewing an HIV-positive patient who is

considering starting highly active antiretroviral therapy (HAART), which patient information concerns you the most?

• The patient has been HIV positive for 8 years and has

never taken any drug therapy for the HIV infection.

• The patient tells you, "I have never been very

consistent about taking medications."

• The patient is sexually active with multiple partners and

says "I always use a condom."

• The patient has many questions and concerns

regarding the effectiveness and safety of the medications.

• Drug therapy for HIV infection requires taking medications very consistently.

Failure to take the medications daily can lead to mutations and the emergence of more virulent forms of the virus. Although the other data indicate the need for further assessments or interventions, they will not affect the decision to initiate

antiretroviral therapy for this patient. Focus: Prioritization