Exam (elaborations)
UWORLD NCLEX REVIEW LEADERSHIP & MANAGEMENT BATCH 9 A+
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UWORLD NCLEX REVIEW LEADERSHIP & MANAGEMENT BATCH 9 A+
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2/29/24, 3:26 PM 447895699 Uworld Prioritization Delegation docxUWORLD NCLEX REVIEW REGISTERED NURSES (RNs)
LEADERSHIP & MANAGEMENT The nurse delegating a task
BATCH 9 remains legally responsible for the
11/30/2017 client’s total care during the shift,
and may be held liable for
Licensed Practical Nurse delegating inappropriately.
They should be assigned to clients IV medication administration is
who are medically stable and have reserved for RNs.
expected outcomes. Frequent assessment of unstable
They should NOT be assigned to clients with changes in condition is
clients who require complex care an exclusive RN task.
and clinical judgment and have
potential negative outcomes. LICENSED PRACTICAL NURSES LPNs)
Are trained in many nursing skills;
RESPONSIBILITY OF THE RNs & SHOULD these include but are not limited
NEVER BE DELEGATED: limited to nasatrachael suctioning,
1. Teaching Foley catheter and nasogastric
2. Assessment tube insertion, dressing changes,
3. Clinical Judgment and subcutaneous, intramuscular,
4. Evaluation and oral medication
5. Planning administration. However, IV
6. Implementation of complex care MEDICATION ADMINISTRATION is
typically reserved for the RN.
ACUTE PANCREATITIS
These clients can develop several
complications (Ex. Hypocalcemia,
Acute Respiratory Distress
Syndrome) And need aggressive
supportive care (Ex. Pain
management, IV Fluids).
TOTAL THYROIDECTOMY
Can be complicated by bleeding
(throat compression) or
hypocalcemia (if parathyroids
were removed inadvertently).
Care in these clients is complex.
THYROIDECTOMY
ALCOHOL WITHDRAWAL
Swelling if the neck and Increased
Can develop into delirium tremens
Pain Post Thyroidectomy may
or seizures; both are serious
indicate Hematoma formation or
conditions. Clients need frequent
increased tissue inflammation.
doses of Benzodiazepines (Ex.
These complications have a high
Lorazepam, Diazepam) and
priority due to potential
aggressive supportive care.
interference with airway patency.
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The nurse should assess for signs Two (2) Popular frameworks can
and symptoms of airway assist the nurse in making these
compromise (Ex. Stridor, Use of decisions and setting priorities:
accessory muscle, Restlessness). A. “First, Second, and Third”
SUCTION EQUIPMENT should be Priority Level Framework
available to clear the airway of 1. ABCs plus V – Airway,
secretions, and a TRACHEOSTOMY Breathing, Circulation and
TRAY should be at the bedside in Vital Signs
case of an emergency 2. Mental Status changes,
tracheotomy is required. Acute Pain, Unresolved
medical issues, Acute
SPRAIN elimination problems,
Bruising, Edema, and Pain in the Abnormal Laboratory
ankle following a popping sound. Values, and Risk
The client should have an x-ray, 3. Longer-term issues such as
receive pain medication (Ex. Health Education, Rest, and
NSAIDs), and have the ankle iced Coping
and immobilized. 4.
“LOWEST PRIORITY” B. Maslow’s Hierarchy of Needs
It is a 5-level framework in
DIABETIC KETOACIDOSIS which the priority needs
Most common signs and progress from the bottom to
symptoms of High Blood glucose, top level of the pyramid.
Dehydration, and Ketonuria .
The client needs an IV Fluid bolus,
Insulin, and likely electrolyte
replacement following additional
diagnostic testing.
This client has potentially
compromised CIRCULATION.
ACUTE ALTERED MENTAL STATUS IN AN
ELDERLY
May indicate infection (Ex. Urinary
Tract). INFANTS
Diagnostic testing is needed to They have a high percentage of
identify the source of the altered body water (70%-80% of body
mental status. weight) and become dehydrated
rapidly.
HEMATURIA & ELEVATED TEMPERATURE
TRIAGING CLIENTS May be associated with a urinary
Involves decision-making about tract infection or
whose needs/problems are most Glomerulonephritis.
urgent and create the greatest risk ACUTE ABDOMINAL PAIN
to survival. Can be a medical emergency that
could indicate appendicitis,
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ovarian cyst, ectopic pregnancy, first hour, then according to
ureteral colic, or bowel institution policy.
obstruction. d. Report any changes in NVS or
Bleeding to the RN
SCOPE OF PRACTICE UNLICENSED ASSISTIVE PERSONNEL
RN LPN/LVN UAP Possess appropriate skills and
Clinical Monitorin Activities knowledge to meet client’s
assess g RN of daily elimination, hygiene, and comfort
ment findings living needs. Although these tasks could
Initial Reinforci Hygiene be performed safely by an LVN,
client ng Linen
educati educatio change underutilizing UAP would be an
on n Routine, ineffective use of resources.
Dischar Routine stable REGISTERED NURSE
ge Procedur vital signs The RN should perform initial
Educati es (Ex. Document assessments (including vital
on Catheteri ing input/ signs), review the ECG for any
Clinical zation) Output
dysrhythmias, monitor the client
Judgme Most Positionin
nt medicati g for chest pain, and monitor any
Initiatin on infusions of anticoagulants or
g Blood Administr antiplatelet drugs.
Transfu ation If the client is stable after the
sion Ostomy initial assessment, the RN may
Care delegate routine VS
Tube
measurements to the UAP.
patency
& enteral
feeding
Specific ATRIAL FIBRILLATION
assessme The client is at risk for
nts
development of atrial thrombi due
*Limited assessments (Ex. Lung sounds,
to blood stasis, which can
Bowel Sounds, Neurovascular Checks)
embolize and lead to an ISCHEMIC
POST-SURGERY BRAIN ATTACK.
After performing the initial
assessment of the client post-
procedure and comparing it to the
pre=procedure baseline, the
Registered Nurse (RN) may assign
the following tasks to the Licensed
Vocational Nurse (LVN):
a. Administer medications
b. Monitor Neurovascular status of
involved extremity
c. Check for bleeding at catheter
site every 15 minutes for the
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Increased Hematocrit and
Hemoglobin are expected in this
client.
CLOSTRIDIUM DIFFICILE INFECTION
Leukocytosis (WBC >11,000/mm3
[11 x 109/L]) is expected.
GENTAMYCIN
It is a nephrotoxic drug, it is not
important to report to HCP if
creatinine is within normal (0.6-1.3
mg/dL [53-115 umol/L]).
Advance care planning is a process
that includes:
Considering treatments that may
be needed in the future
INR Making decisions to guide future
Normal: 0.75-1.25 treatments, particularly if the
client is no longer able to make
Is a measurement used to assess
own decisions
and monitor coagulation status in Ensuring that treatment decisions
clients receiving anticoagulation are legally documented on the
therapy. appropriate forms, such as the
The Therapeutic INR Level for a advance directive, and in the
client receiving Warfarin medical record (Option 1)
(Coumadin) to treat Atrial Ensuring that advance
directive documents are in
Fibrillation is 2-3.
the medical record so that they
The sub-therapeutic INR of 1.3 is are available to HCPs who care for
the most important result to report the client in the future (Option 3)
to the HCP as the client is at risk Ensuring that the health care
for a stroke and dose adjustment proxy (or durable power of
is needed. attorney for health care)
has information and
documentation to support that
CHRONIC OBSTRUCTIVE PULMONARY role if this person needs to make
DISEASE & CHRONIC BRONCHITIS decisions for the client (Option 2)
Has alveolar hypoxia, which
stimulates erythropoiesis (RBC The nurse's role as advocate includes
Production) and leads to discussing options with the client and
POLYCYTHEMIA (Hematocrit >53% ensuring that the client's wishes are
[0.53} in males, >46% [0.46] in communicated and documented
appropriately so that the health care
females; Hemoglobin >17.5 g/dL
proxy and health care team will have the
[175 g/L] in males, >16 g/dL [160 necessary information.
g/L] in Females).
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