A registered nurse (RN) and an experienced licensed practical nurse (LPN) are caring for a group of clients. Which of the following tasks should the RN delegate to the LPN? SELECT ALL THAT APPLY
Monitoring vital signs of postoperative clients.
Administering routine medications to stable clients.
Performing wound care on a client with a Stage III pressure ulcer.
Developing a teaching plan for a client newly diagnosed with Type II Diabetes.
Providing oral care to an unconscious client.
Correct Answer : A,B,C,E
Choice A reason:
Monitoring vital signs of postoperative clients is a task that can be safely delegated to an experienced LPN. LPNs are trained to monitor and report vital signs, which is a routine and essential part of postoperative care. This task does not require the advanced assessment skills of an RN, making it appropriate for delegation.
Choice B reason:
Administering routine medications to stable clients is within the scope of practice for LPNs. They are trained to administer medications and monitor clients for adverse reactions. As long as the clients are stable and the medications are routine, this task can be delegated to an LPN.
Choice C reason:
Performing wound care on a client with a Stage III pressure ulcer is a task that an experienced LPN can perform. LPNs are skilled in wound care and can manage complex dressings and treatments under the supervision of an RN. This delegation allows the RN to focus on more complex tasks that require their advanced skills.
Choice D reason:
Developing a teaching plan for a client newly diagnosed with Type II Diabetes is a task that should not be delegated to an LPN. This task requires comprehensive knowledge of diabetes management, patient education, and individualized care planning, which are within the RN’s scope of practice. The RN should develop the teaching plan and may involve the LPN in reinforcing the education.
Choice E reason:
Providing oral care to an unconscious client is a task that can be delegated to an experienced LPN. Oral care is essential for preventing infections and maintaining hygiene, and LPNs are trained to perform this care safely and effectively.
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Correct Answer is D
Explanation
Choice A reason:
Blunt force trauma refers to injuries caused by impact with a blunt object, resulting in contusions, abrasions, lacerations, or fractures. While blunt force trauma can occur in explosions, it is typically associated with tertiary blast injuries, where the victim is thrown against a solid object. Secondary injuries from high-order explosives are more specifically related to penetrating injuries caused by flying debris and shrapnel.
Choice B reason:
Hollow organ damage is a type of primary blast injury caused by the overpressure wave from an explosion. This wave can cause significant damage to gas-filled organs such as the lungs, intestines, and ears. However, secondary injuries are not typically characterized by hollow organ damage. Secondary injuries are more commonly associated with penetrating trauma from debris and shrapnel.
Choice C reason:
Post-trauma stress disorder (PTSD) is a psychological condition that can develop after experiencing or witnessing a traumatic event. While PTSD is a serious and common consequence of exposure to explosions and other traumatic events, it is not classified as a secondary injury. Secondary injuries refer to physical injuries caused by flying debris and shrapnel, not psychological conditions.
Choice D reason:
Penetrating injuries are the hallmark of secondary blast injuries. These injuries occur when fragments from the explosive device or surrounding materials are propelled at high velocity, causing wounds that penetrate the skin and underlying tissues. These injuries can be severe and life-threatening, requiring immediate medical attention. The nurse should anticipate and be prepared to manage penetrating injuries in clients exposed to high-order explosives.
Correct Answer is C
Explanation
Choice A reason:
“It’s not unusual to feel that way at first, but once you learn the routine, you’ll enjoy it.” While this response acknowledges the client’s feelings, it does not provide specific information about the benefits of cardiac rehabilitation. The client needs to understand how rehabilitation can help them recover and improve their quality of life.
Choice B reason:
“Diet and exercise are good for you and good for your heart.” This statement is true but too general. It does not address the client’s specific concerns about the purpose and benefits of cardiac rehabilitation. The client needs more detailed information about how the program can help them.
Choice C reason:
“Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back to your previous level of activity safely.” This response directly addresses the client’s concerns and provides clear information about the benefits of cardiac rehabilitation. It explains that while the damage cannot be reversed, rehabilitation can help the client regain strength, improve cardiovascular health, and safely return to their daily activities.
Choice D reason:
“Your doctor is the expert here, and I’m sure they would only recommend what is best for you.” While this statement supports the doctor’s recommendation, it does not provide the client with specific information about the benefits of cardiac rehabilitation. The client needs to understand how the program can help them personally.