Exam (elaborations) PRIORITIZATION, DELEGATION, AND ASSIGNMENT Practice Exercises for the NCLEX Examination 4TH EDITION (2018, Mosby) Linda A

PRIORITIZATION, DELEGATION, AND ASSIGNMENT Practice Exercises for the NCLEX Examination 4TH EDITION (2018, Mosby) Linda A PRIORITIZATION, DELEGATION, AND ASSIGNMENT: Practice Exercises for the NCLEX Examination 4TH EDITION (2018, Mosby) By Linda A. LaCharity, Candice K. Kamugai and Barbara Bartz ISBN: 978-0-323-49828-9 736 PAGES Prioritization, Delegation, and Assignment Practice Exercises for the NCLEX® Examination FOURTH EDITION Linda A. LaCharity, PhD, RN Formerly, Accelerated Program Director, Assistant Professor, College of Nursing, University of Cincinnati, Cincinnati, Ohio Candice K. Kumagai, MSN, RN Formerly, Instructor in Clinical Nursing, School of Nursing, University of Texas at Austin, Austin, Texas Barbara Bartz, MN, ARNP Formerly, Nursing Instructor, Yakima Valley Community College, Yakima, Washington With an introduction by Ruth Hansten, PhD, MBA, BSN, RN, FACHE 2 Principal, Hansten Healthcare PLLC, Santa Rosa, California 3 Table of Contents Cover image Title page Copyright Contributors and Reviewers Preface To faculty and other users To students Acknowledgments Part 1: Introduction Introduction Outcomes focus Definition of terms Assignment process Delegation and assignment: the five rights Practice based on research evidence Principles for implementation of prioritization, delegation, and assignment Part 2: Prioritization, Delegation, and Assignment in Common Health Scenarios Chapter 1: Pain Questions 4 Answer Key Chapter 2: Cancer Questions Answer Key Chapter 3: Immunologic Problems Questions Answer Key Chapter 4: Fluid, Electrolyte, and Acid-Base Balance Problems Questions Answer Key Chapter 5: Safety and Infection Control Questions Answer Key Chapter 6: Respiratory Problems Questions Answer Key Chapter 7: Cardiovascular Problems Questions Answer Key Chapter 8: Hematologic Problems Questions Answer Key Chapter 9: Neurologic Problems Questions Answer Key 5 Chapter 10: Visual and Auditory Problems Questions Answer Key Chapter 11: Musculoskeletal Problems Questions Answer Key Chapter 12: Gastrointestinal and Nutritional Problems Questions Answer Key Chapter 13: Diabetes Mellitus Questions Answer Key Chapter 14: Other Endocrine Problems Questions Answer Key Chapter 15: Integumentary Problems Questions Answer Key Chapter 16: Renal and Urinary Problems Questions Answer Key Chapter 17: Reproductive Problems Questions Answer Key Chapter 18: Problems in Pregnancy and Childbearing Questions 6 Answer Key Chapter 19: Pediatric Problems Questions Answer Key Chapter 20: Pharmacology Questions Answer Key Chapter 21: Emergencies and Disasters Questions Answer Key Chapter 22: Psychiatric–Mental Health Problems Questions Answer Key Part 3: Prioritization, Delegation, and Assignment in Complex Health Scenarios Case study 1: Chest Pressure, Indigestion, and Nausea Questions Answer Key Case study 2: Dyspnea and Shortness of Breath Questions Answer Key Case study 3: Multiple Clients on a Medical-Surgical Unit Questions Answer Key Case study 4: Shortness of Breath, Edema, and Decreased Urine Output 7 Questions Answer Key Case study 5: Diabetic Ketoacidosis Questions Answer Key Case study 6: Home Health Questions Answer Key Case study 7: Spinal Cord Injury Questions Answer Key Case study 8: Multiple Patients With Adrenal Gland Disorders Questions Answer Key Case study 9: Multiple Clients With Gastrointestinal Problems Questions Answer Key Case study 10: Multiple Patients With Pain Questions Answer Key Case study 11: Multiple Clients With Cancer Questions Answer Key Case study 12: Gastrointestinal Bleeding Questions Answer Key 8 Case study 13: Head and Leg Trauma and Shock Questions Answer Key Case study 14: Septic Shock Questions Answer Key Case study 15: Heart Failure Questions Answer Key Case study 16: Multiple Patients With Peripheral Vascular Disease Questions Answer Key Case study 17: Respiratory Difficulty After Surgery Questions Answer Key Case study 18: Long-Term Care Questions Answer Key Case study 19: Pediatric Clients in Clinic and Acute Care Settings Questions Answer Key Case study 20: Multiple Patients With Mental Health Disorders Questions Answer Key Case study 21: Childbearing Questions 9 Answer Key Illustration Credits Chapter 1 Chapter 2 Chapter 7 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 19 Chapter 21 Case Study 5 Case Study 13 Case Study 14 10 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 PRIORITIZATION, DELEGATION, AND ASSIGNMENT: PRACTICE EXERCISES FOR THE NCLEX® EXAMINATION, FOURTH EDITION ISBN: 978-0-323-49828-9 Copyright © 2019, Elsevier Inc. All rights reserved. Previous editions copyrighted 2014, 2011, and 2006. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data 11 Names: LaCharity, Linda A., author. | Kumagai, Candice K., author. | Bartz, Barbara, author. Title: Prioritization, delegation, and assignment : practice exercises for the NCLEX examination / Linda A. LaCharity, Candice K. Kumagai, Barbara Bartz ; with an introduction by Ruth Hansten. Description: 4th edition. | St. Louis, Missouri : Elsevier Inc., [2019] | Includes bibliographical references. Identifiers: LCCN 9 (print) | LCCN 1 (ebook) | ISBN 8272 (Ebook) | ISBN 8289 (pbk. : alk. paper) Subjects: | MESH: Nursing Care--organization & administration | Delegation, Professional | Nurse's Role | Decision Making | Examination Questions | Case Reports Classification: LCC RT55 (ebook) | LCC RT55 (print) | NLM WY 18.2 | DDC 610.73076--dc23 LC record available at Executive Content Strategist: Lee Henderson Content Development Manager: Lisa Newton Associate Content Development Specialist: Laurel Shea Publishing Services Manager: Deepthi Unni Project Manager: Manchu Mohan Design Direction: Margaret Reid Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 12 Contributors and Reviewers CONTRIBUTORS Martha Barry, MS, APN, RN, CNM Certified Nurse Midwife OB Faculty Practice Advocate Medical Group Chicago, Illinois Adjunct Clinical Instructor College of Nursing University of Illinois at Chicago Chicago, Illinois Mary Tedesco-Schneck, PhD Assistant Professor School of Nursing University of Maine Orono, Maine NURSING FACULTY REVIEWERS Sophia Beydoun, MSN, RN Nursing Instructor Health Sciences Division Henry Ford College Dearborn, Michigan Diane Lynn Cooper-McLean, MSN, BSN, RN Department of Allied Health Nursing Faulkner State Community College Bay Minette, Alabama Laura M. Dechant, MSN, APRN, CCRN, CCNS-BC Clinical Nurse Specialist Department of Heart, Vascular, and Interventional Services Christiana Care Health System Newark, Delaware Kathleen Sanders Jordan, DNP, MS, FNP-BC, ENP-BC, SANE-P Clinical Assistant Professor School of Nursing The University of North Carolina at Charlotte Nurse Practitioner Emergency Department Mid-Atlantic Medicine Associates Charlotte, North Carolina Kari Ksar, MS, RN, CPNP Pediatric Nurse Practitioner Division of Pediatric Gastroenterology, Hepatology, and Nutrition Lucile Packard Children’s Hospital at Stanford Palo Alto, California Judi Kuric, DNP, ACNP-BC, ACNPC, CNRN, SCRN Assistant Professor Department of Nursing University of Southern Indiana Acute Care Nurse Practitioner Kentuckiana Neurosurgery Evansville, Indiana Martha E. Langhorne, MSN, RN, FNP, AOCN Nurse Practitioner Department of Gastroenterology Binghamton Gastroenterology, United Health Services Hospitals Binghamton, New York Casey L. Norris, MSN, RN, PCNS-BC Clinical Assistant Professor 13 Department of Nursing The University of Alabama in Huntsville Huntsville, Alabama Charles D. Chad Rogers, MSN, RN Associate Professor of Nursing Department of Nursing Morehead State University Morehead, Kentucky Jenny Lynn Sauls, PhD, MSN, RN, CNE Professor and Director Department of Nursing Middle Tennessee State University Murfreesboro, Tennessee Jane Tyerman, PhD, MScN, BScN, BA, RN Lecturer Fleming School of Nursing Trent University Peterborough Ontario, Canada STUDENT REVIEWERS Sara Allen Lincoln Land Community College Springfield, Illinois Registered Nurse Memorial Medical Center Springfield, Illinois Rebecca Patrick Lincoln Land Community College Springfield, Illinois ER Procedural Technician HSHS St. John’s Hospital Springfield, Illinois 14 Preface Linda A. LaCharity; Candice K. Kumagai; Barbara Bartz Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX® Examination has evolved since its first edition from a medical-surgical nursing– focused test preparation workbook to a resource that spans general nursing knowledge while emphasizing management of care to assist students in preparing for the NCLEX® Examination. A second and equally important purpose of the book is to assist students, novice nurses, and seasoned nurses in applying concepts of prioritization, delegation, and assignment to nursing practice in today’s patient care settings. 15 To faculty and other users Patient care acuity continues to be higher than ever, while staffing shortages remain very real. Nurses must use all available patient care personnel and resources competently and efficiently and be familiar with variations in state laws governing the practice of nursing, as well as differences in scopes of practice and facility-specific job descriptions. Nurses must also be aware of the different skill and experience levels of the health care providers with whom they work on a daily basis. Which nursing actions can be assigned to an experienced versus a new graduate RN or LPN/LVN? What forms of patient care can the nurse delegate to unlicensed assistive personnel (UAP)? Who should help the postoperative patient who has had a total hip replacement get out of bed and ambulate to the bathroom? Can the nurse ask UAPs such as nursing assistants to check a patient’s oxygen saturation using pulse oximetry or check a diabetic patient’s glucose level? What reporting parameters should the nurse give to an LPN/LVN who is monitoring a patient after cardiac catheterization or to the UAP checking patients’ vital signs? What patient care interventions and actions should not be delegated by the nurse? The answers to these and many other questions should be much clearer after completion of the exercises in this book. Exercises in this book range from simple to complex and use various patient care scenarios. The purpose of the chapters and case studies is to encourage the student or new graduate nurse to conceptualize using the skills of prioritization, delegation, and assignment in many different settings. Our goal is to make these concepts tangible to our readers. The questions are written in NCLEX® Examination format to help faculty as they teach student nurses how to prepare for licensure examination. The chapters and case studies focus on real and hypothetical patient care situations to challenge nurses and nursing students to develop the skills necessary to apply these concepts in practice. The exercises are also useful to nurse educators as they discuss, teach, and test their students and nurses for understanding and application of these concepts in nursing programs, examination preparations, and facility orientations. Correct answers, along with in-depth rationales, are provided at the end of each chapter and case study to facilitate the learning process. The faculty exercise keys include QSEN (Quality and Safety Education for Nurses) categories, concepts, and cognitive levels for each question, as well as IPEC (Interprofessional Education Collaborative) categories where appropriate. Additionally, 10 unfolding case studies in PowerPoint format are available on Evolve for use by faculty in the classroom setting. 16 To students Prioritization, delegation, and assignment are essential concepts and skills for nursing practice. Our students and graduate nurses have repeatedly told us of their difficulties with the application of these principles when taking program exit and licensure examinations. Nurse managers have told us many times that novice nurses and even some experienced nurses lack the expertise to effectively and safely practice these skills in real-world settings. Although several excellent resources deal with these issues, there is still a need for a book that incorporates management of care concepts into real-world practice scenarios. Our goal in writing the fourth edition of Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX® Examination is to provide a resource that challenges nursing students, as well as novice and experienced nurses, to develop the knowledge and understanding necessary to effectively apply these important nursing skills: examination preparation and real-world practice. From the original focus on medical-surgical nursing, subsequent editions have expanded to include pediatrics, labor and delivery, psychiatric nursing, and long-term care as well as the role of the nurse in a variety of nonacute care settings. Additionally, we have made changes that reflect the current focus on evidence-based best practices, fundamentals of safe practice, and expansion of diabetes care. For the fourth edition, we responded to requests for more questions, especially about medications. New questions, including drug-related questions, have been added to each chapter, as well as a new pharmacology-focused chapter. We also added questions specific to the needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. New questions were added and revised throughout the book to broaden comprehension of key concepts and knowledge areas and to update current knowledge levels. Each new copy of the book comes with a fully interactive version of the book content, with scoring, on Evolve at the book helps to simulate the experience of taking the NCLEX® Examination. Students can use this interactive option to create multiple different test versions for practice and self-assessment. 17 Acknowledgments We would like to thank the many people whose support and assistance made the creation of the fourth edition of this book possible. Thanks to our families, colleagues, and friends for listening, reading, encouraging, and making sure we had the time to research, write, and review this book. We truly appreciate the expertise of our two contributing authors, Martha Barry (reproductive health) and Mary Tedesco-Schneck (pediatrics), who each contributed an excellent chapter and case study related to their areas of expertise. Special thanks to Ruth