Question 1

The charge nurse in the ICU receives a call from the ED.They have three patients who require a bed.Which patient should be transferred first?

Accepted Answer

A) A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention 
B) A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion 
C) A patient in sickle cell crisis with a PCA pump to manage his pain 
D) A patient in DKA for new-onset diabetes mellitus 
A) A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention 
B) A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion 
C) A patient in sickle cell crisis with a PCA pump to manage his pain 
D) A patient in DKA for new-onset diabetes mellitus B

Question 2

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

Accepted Answer

A) An LPN administers IVP Lasix (furosemide)to a patient in heart failure. 
B) An RN administers IVP Lasix (furosemide)to a patient in heart failure. 
C) An LPN obtains a blood glucose level on a diabetic patient. 
D) An RN obtains a blood glucose level on a diabetic patient. 
A) An LPN administers IVP Lasix (furosemide)to a patient in heart failure. 
B) An RN administers IVP Lasix (furosemide)to a patient in heart failure. 
C) An LPN obtains a blood glucose level on a diabetic patient. 
D) An RN obtains a blood glucose level on a diabetic patient. A

Question 3

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

Accepted Answer

A) A UAP removes the wrist restraints on a patient and provides ROM exercises when giving a bath. 
B) An LPN assists a patient back to bed from the bathroom. 
C) A UAP replaces the monitor electrodes on a patient after he has taken a shower. 
D) An LPN assesses LOC on a stable patient 3 days after surgery. 
A) A UAP removes the wrist restraints on a patient and provides ROM exercises when giving a bath. 
B) An LPN assists a patient back to bed from the bathroom. 
C) A UAP replaces the monitor electrodes on a patient after he has taken a shower. 
D) An LPN assesses LOC on a stable patient 3 days after surgery. C

Question 4

A nurse must delegate some responsibilities of the care of patients on a particularly busy and chaotic day to the LPN and UAP team members.Which of the following can be appropriately delegated to the LPN?

Accepted Answer

A) Assisting with a central line insertion 
B) Giving bath supplies to patients who are capable of bathing themselves 
C) Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia 
D) Transporting a patient in a wheelchair for discharge 
A) Assisting with a central line insertion 
B) Giving bath supplies to patients who are capable of bathing themselves 
C) Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia 
D) Transporting a patient in a wheelchair for discharge

Question 5

When incorporating the five rights of delegation,the right circumstance is used in which of the following situations?

Accepted Answer

A) The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip. 
B) The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema. 
C) The RN asks the UAP to draw blood on a newly admitted patient with pneumonia. 
D) The RN asks a new UAP to draw blood on a patient known to be a "hard stick." 
A) The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip. 
B) The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema. 
C) The RN asks the UAP to draw blood on a newly admitted patient with pneumonia. 
D) The RN asks a new UAP to draw blood on a patient known to be a "hard stick."

Question 6

Which action by a UAP requires an immediate intervention by the nurse?

Accepted Answer

A) Application of a skin barrier/protection ointment 
B) Releasing wrist restraints on a patient to allow ROM 
C) Assisting a patient to the bedside commode 
D) Obtaining a urine culture from a patient 
A) Application of a skin barrier/protection ointment 
B) Releasing wrist restraints on a patient to allow ROM 
C) Assisting a patient to the bedside commode 
D) Obtaining a urine culture from a patient

Question 7

When incorporating the five rights of delegation,the right supervision is used in which of the following situations?

Accepted Answer

A) The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. 
B) The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL. 
C) The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL. 
D) The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL. 
A) The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. 
B) The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL. 
C) The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL. 
D) The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL.

Question 8

After receiving the shift report,which of the following requires a priority action by the nurse?

Accepted Answer

A) Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain. 
B) Make assignments for the team. 
C) Talk to a patient who has changed his mind about having a procedure today. 
D) Round on all the patients on their team. 
A) Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain. 
B) Make assignments for the team. 
C) Talk to a patient who has changed his mind about having a procedure today. 
D) Round on all the patients on their team.

Question 9

A patient turns his call light on and states,"I'm having trouble breathing." Which team members should be delegated to respond to this call light?

Accepted Answer

A) RN 
B) LPN 
C) Senior student nurse 
D) UAP 
A) RN 
B) LPN 
C) Senior student nurse 
D) UAP

Question 10

A UAP is asked to take a patient's temperature every 4 hours and report that temperature to the RN.Which best demonstrates the correct interpretation of right communication?

Accepted Answer

A) The UAP takes the temperature for the patient every 4 hours. 
B) The UAP charts the temperature for the patient every 4 hours. 
C) The UAP reports that the patient has been afebrile all day. 
D) The UAP reports the temperature for the patient every 4 hours. 
A) The UAP takes the temperature for the patient every 4 hours. 
B) The UAP charts the temperature for the patient every 4 hours. 
C) The UAP reports that the patient has been afebrile all day. 
D) The UAP reports the temperature for the patient every 4 hours.

Question 11

Which of the following patients should the nurse see first after the shift report?

Accepted Answer

A) A patient with a change in heart rhythm who is complaining of lightheadedness 
B) A patient with a newly placed pacemaker who is complaining of shoulder pain 
C) A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg 
D) A patient in first-degree heart block 
A) A patient with a change in heart rhythm who is complaining of lightheadedness 
B) A patient with a newly placed pacemaker who is complaining of shoulder pain 
C) A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg 
D) A patient in first-degree heart block

Question 12

The nurse is working on a medical unit with an LPN and UAP as the team members.Which tasks should the RN delegate to the UAP?

Accepted Answer

A) Vital signs on all patients admitted on the previous shift 
B) Vital signs on a patient being transferred from the ED 
C) Vital signs on a patient being transferred from the ICU 
D) Vital signs on a newly admitted stable patient 
A) Vital signs on all patients admitted on the previous shift 
B) Vital signs on a patient being transferred from the ED 
C) Vital signs on a patient being transferred from the ICU 
D) Vital signs on a newly admitted stable patient

Question 13

Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit?

Accepted Answer

A) A patient being transferred to an ECF for rehabilitation following a hip replacement 
B) A patient following a hip replacement with a history of an acute MI 4 weeks ago 
C) A patient with an external fixator 
D) A patient to be started on a PCA pump requiring instructions 
A) A patient being transferred to an ECF for rehabilitation following a hip replacement 
B) A patient following a hip replacement with a history of an acute MI 4 weeks ago 
C) A patient with an external fixator 
D) A patient to be started on a PCA pump requiring instructions

Question 14

The nurse and UAP are working together with four patients.Which patient should the nurse assign the UAP?

Accepted Answer

A) A patient waiting for discharge instructions before going home 
B) A patient who received morphine 20 minutes ago and now has the call light on 
C) A patient with diabetes who needs her blood glucose checked 
D) A patient returning from a bronchoscopy 
A) A patient waiting for discharge instructions before going home 
B) A patient who received morphine 20 minutes ago and now has the call light on 
C) A patient with diabetes who needs her blood glucose checked 
D) A patient returning from a bronchoscopy

Question 15

Which delegation should a UAP consider to have the highest priority?

Accepted Answer

A) Obtaining a routine blood glucose level from a patient with diabetes 
B) Giving a bath to a patient scheduled for a colonoscopy 
C) Feeding a patient who needs assistance doing so. 
D) Helping an elderly patient to the bathroom 
A) Obtaining a routine blood glucose level from a patient with diabetes 
B) Giving a bath to a patient scheduled for a colonoscopy 
C) Feeding a patient who needs assistance doing so. 
D) Helping an elderly patient to the bathroom

Question 16

Which statement made by the clinical instructor would represent feedback to a student nurse?

Accepted Answer

A) "Explain to me the actions of this medication before you give it." 
B) "Can you explain to me why Mr.W.did not receive a bath this morning?" 
C) "Stop the urinary catheter insertion now.You have contaminated the catheter." 
D) "You need to use your critical thinking skills when caring for patients." 
A) "Explain to me the actions of this medication before you give it." 
B) "Can you explain to me why Mr.W.did not receive a bath this morning?" 
C) "Stop the urinary catheter insertion now.You have contaminated the catheter." 
D) "You need to use your critical thinking skills when caring for patients."

Question 17

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

Accepted Answer

A) A UAP checks a diabetic patient's blood glucose level. 
B) An LPN assesses a patient after a fall. 
C) The charge nurse makes changes to the assignments after staff is "pulled" to another area. 
D) An RN assists with administering medication to another nurse's patients during a code. 
A) A UAP checks a diabetic patient's blood glucose level. 
B) An LPN assesses a patient after a fall. 
C) The charge nurse makes changes to the assignments after staff is "pulled" to another area. 
D) An RN assists with administering medication to another nurse's patients during a code.

Question 18

When incorporating the five rights of delegation,the right communication is used when a patient's blood pressure is low in which of the following situations?

Accepted Answer

A) The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low. 
B) The RN tells a UAP to recheck the patient's blood pressure and report back to her before giving the patient a bath. 
C) The UAP gives a bath to a patient with a low blood pressure. 
D) The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure. 
A) The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low. 
B) The RN tells a UAP to recheck the patient's blood pressure and report back to her before giving the patient a bath. 
C) The UAP gives a bath to a patient with a low blood pressure. 
D) The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure.

Question 19

When incorporating the five rights of delegation,the right task is used in which situation?

Accepted Answer

A) The UAP reinforces use of the incentive spirometer to a patient. 
B) The UAP teaches the patient to use the incentive spirometer. 
C) The UAP listens to breath sounds to encourage the patient to use the incentive spirometer. 
D) The UAP is not allowed to work with the patient regarding use of the incentive spirometer. 
A) The UAP reinforces use of the incentive spirometer to a patient. 
B) The UAP teaches the patient to use the incentive spirometer. 
C) The UAP listens to breath sounds to encourage the patient to use the incentive spirometer. 
D) The UAP is not allowed to work with the patient regarding use of the incentive spirometer.

Question 20

Which actions by the UAP would require immediate follow-up by the nurse?

Accepted Answer

A) Informing the nurse she was taking a break 
B) Taking her lunch break on her home floor after being pulled to another floor 
C) Asking the patient to let her know the next time he has a bowel movement 
D) Asking another UAP to obtain a urine sample for her 
A) Informing the nurse she was taking a break 
B) Taking her lunch break on her home floor after being pulled to another floor 
C) Asking the patient to let her know the next time he has a bowel movement 
D) Asking another UAP to obtain a urine sample for her

Exam 3: Delegation of Nursing Tasks

The charge nurse in the ICU receives a call from the ED.They have three patients who require a bed.Which patient should be transferred first?

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

A nurse must delegate some responsibilities of the care of patients on a particularly busy and chaotic day to the LPN and UAP team members.Which of the following can be appropriately delegated to the LPN?

When incorporating the five rights of delegation,the right circumstance is used in which of the following situations?

Which action by a UAP requires an immediate intervention by the nurse?

When incorporating the five rights of delegation,the right supervision is used in which of the following situations?

After receiving the shift report,which of the following requires a priority action by the nurse?

A patient turns his call light on and states,"I'm having trouble breathing." Which team members should be delegated to respond to this call light?

A UAP is asked to take a patient's temperature every 4 hours and report that temperature to the RN.Which best demonstrates the correct interpretation of right communication?

Which of the following patients should the nurse see first after the shift report?

The nurse is working on a medical unit with an LPN and UAP as the team members.Which tasks should the RN delegate to the UAP?

Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit?

The nurse and UAP are working together with four patients.Which patient should the nurse assign the UAP?

Which delegation should a UAP consider to have the highest priority?

Which statement made by the clinical instructor would represent feedback to a student nurse?

Which of the following delegations by the RN would require an immediate intervention by the charge RN?

When incorporating the five rights of delegation,the right communication is used when a patient's blood pressure is low in which of the following situations?

When incorporating the five rights of delegation,the right task is used in which situation?

Which actions by the UAP would require immediate follow-up by the nurse?

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