A nurse assumes the leading role on the hazardous materials team immediately following a chemical mass casualty incident in the community. As clients arrive at the designated triage area outside the hospital, which of the following actions should the nurse take?

Rationale:

A. Discuss the client's wishes with the interprofessional team is the correct action. The nurse’s role is to advocate for the client by ensuring the healthcare team is aware of the client’s preferences for end-of-life care. Collaboration ensures that the DNR order is implemented appropriately and respected across all care settings.

B. Requesting a provider's prescription to discontinue chemotherapy is not directly related to a DNR order. A DNR only addresses resuscitation efforts in the event of cardiac or respiratory arrest, not ongoing treatment decisions like chemotherapy.

C. Counseling the client to postpone the DNR prescription would violate the client’s autonomy. Clients have the right to make informed decisions about their own care, including the choice to implement a DNR.

D. Verifying that the family agrees with the client’s DNR request is not required. A DNR decision is the client’s legal right, and the nurse should respect the client’s wishes even if the family disagrees, provided the client is competent.

Rationale:

A. Administering a hepatitis B vaccine is within the scope of practice for an LPN. LPNs are trained and licensed to administer routine injections and vaccines, monitor for immediate adverse reactions, and document administration. This task does not require the higher-level assessment skills of an RN, making it appropriate for delegation. Administering immunizations to newborns is a standard, routine intervention that aligns with an LPN’s responsibilities under RN supervision.

B. Conducting a newborn hearing screening involves specialized assessment techniques and interpretation of results. This task is typically performed by a trained RN, audiologist, or certified hearing screener, as it requires advanced assessment skills and understanding of neonatal hearing protocols. Assigning this to an LPN is inappropriate.

C. Performing a New Ballard assessment (used to determine gestational age) requires advanced neonatal assessment skills, including observation of neuromuscular and physical maturity signs. This is a competency reserved for RNs or clinicians trained in neonatal assessments and is beyond the typical LPN scope of practice.

D. Obtaining vital signs is a basic nursing task that can be delegated to an assistive personnel (AP). APs are competent to measure and record temperature, heart rate, respiratory rate, and blood pressure, freeing RNs and LPNs to perform tasks that require more skill and clinical judgment.