1. The nurse is reviewing a client's chart upon admission. The nurse notes the client has a Living
Will, a Durable Power of Attorney and a prescription for 'allow a natural death' (AND). Define
each type of Advance Directive.
- Living will is a legal document that expresses the client’s wish...
VATI RN COMPREHENSIVE PREDICTOR REMEDIATION QUESTIONS
1. The nurse is reviewing a client's chart upon admission. The nurse notes the client has a Living
Will, a Durable Power of Attorney and a prescription for 'allow a natural death' (AND). Define
each type of Advance Directive.
- Living will is a legal document that expresses the client’s wishes for medical treatment if
the client were to become incapacitated and is facing end-of-life issues.
- Durable power of attorney for health care is a document that appoints a person (health care
proxy) to make decisions regarding the client’s health if they are unable to make decisions
for his/herself
- Provider’s orders means that if a provider does not write a “do not resuscitate” (DNR) or
“allow natural death” (AND) order in the client’s medical chart, the nurse’s job is to begin
CPR when the client does not have a pulse or respirations. The provider will consult the
client and the family before administering a DNR or AND order.
- Nursing role in advance directives is to provide written information about advance
directives for the client and the family; document the client’s advance directives status;
ensure that the advance directives reflect the client’s current decisions; inform all members
of the health care team of the client’s advance directives.
2. A registered nurse (RN) is delegating tasks to an assistive personnel (AP). What are five (5)
factors to consider when delegating tasks?
- Predictability of the outcome – will the completion of the task have a predictable outcome?
(Is it a routine treatment? Is it a new treatment for that client?)
- Potential for harm – (Is there a chance that something negative could happen to the client
(bleeding, aspiration)? Is the client unstable?)
- Complexity of care – (Does the client’s care require complex tasks? Does the state’s
practice act or the facility’s policy allow the delegate (AP) to perform the task, and does she
have the necessary skills?)
- Need for problem solving and innovation – (Is judgment essential while performing the
task? Does it require nursing assessment or data-collection skills?)
- Level of interaction with the client – (Does the delegate need psychosocial support or
education during the performance of the task?)
3. A registered nurse (RN) at the beginning of the shift is delegating tasks to the licensed practical
nurse (LPN) and the assistive personnel (AP). Identify five (5) tasks that the LPN can be
delegated and five (5) tasks the AP can be delegated to complete during their shift.
- Tasks that can be delegated to the LPN: monitoring findings as input to the RNs ongoing
assessment); reinforcing client teaching from a standard care plan; performing
tracheostomy care; suctioning; checking NG tube patency; administering enteral feedings;
inserting a urinary catheter; administering medication (excluding IV medication in some
states)
- Tasks that can be delegated to the AP: activities of daily living (ADLs) [bathing, grooming,
dressing, toileting, ambulating, feeding (without swallowing precautions, positioning)],
routine tasks (bed making, specimen collection, intake and output, vital signs [for stable
clients])
4. A registered nurse (RN) has delegated tasks to the licensed practical nurse (LPN). What are
characteristics of an effective delegator to manage task completion?
- The five rights of delegation: tasks the delegate (right task), to whom (right person), what
information to communicate (right direction and communication), how to oversee and
, appraise (right supervision and evaluation). The nurse should use professional judgment
and critical thinking skills when delegating.
5. A nurse is caring for an infant client with Tetralogy of Fallot. What are cardio/pulmonary
defects noted with this cardiac disorder? What are clinical manifestations associated with this
cardiac disorder?
- Four defects that result in mixed blood flow: pulmonary stenosis, ventricular septal defect,
overriding aorta, right ventricular hypertrophy – cyanosis at birth: progressive cyanosis
over the first year of life; systolic murmur; episodes of acute cyanosis and hypoxia (blue or
“Tet” spells)
- Clinical manifestations – cyanosis; shortness of breath and rapid breathing, especially
during feeding or exercise; fainting; clubbing of fingers and toes; poor weight gain; tiring
easily during play or exercise; irritability; prolonged crying; a heart murmur
6. Diuretics are given regularly in the acute care setting. Which of the following clients is not a
good candidate for diuretics?
Client with pulmonary edema Client with hypercalcemia Client with hypokalemia Client with
kidney stone formation
- Client with hypokalemia because diuretics can cause loss of potassium (unless a potassium-
sparing diuretic)
7. A nurse is caring for a 9-year-old client who has cerebral edema status post MVA. What are
seizure precautions the nurse should ensure are in place?
- Pad side rails of bed, crib, and wheelchair. Keep bed free of objects that could cause injury.
Have suction and oxygen equipment available.
8. A client with thyroid cancer is receiving brachytherapy. Define this therapy.
- Is internal radiation that is placed close to the target tissue through placement in a body
orifice (vagina) or body cavity (abdomen) or delivered via IV such as with radionuclide
iodine, which is absorbed by the thyroid. Brachytherapy provides radiation to the tumor and
a limited amount to surrounding normal tissues. Waste products are radioactive until the
isotope has been completely eliminated from the body. Waste products should not be
touched by anyone.
9. A nurse is providing education on home safety specific to the school-age client to
parents. Identify four (4) examples of home safety concerns for this age group.
- Firearms – be sure to keep them unloaded, locked in somewhere safe where the child
cannot reach it. Teach the importance of never touching a gun. Also be sure to keep the
bullets in a different location from the guns.
- Play injury – do not allow the child to run with candy or anything in the mouth as it could
cause choking or aspiration. Teach the child to wear protective helmets, knee and elbow
pads when needed. Teach the importance of “stranger danger” and avoiding strangers, as
well as keeping parents informed of strangers
- Burns – the water heater setting in the home should be set to no higher than 120’F. Teach
the dangers of playing with matches, fireworks, and firearms and how to properly use
microwave and other cooking utensils
- Poison – teach the child about the hazards and dangers of alcohol, cigarettes, and
prescription, non-prescription, and illegal drugs. Also, keep any potentially dangerous
substances out of reach.
10. What are guidelines when cleaning contaminated equipment a nurse should follow?
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