A nurse working in the health department is reviewing the charts of four clients. Which of the following client conditions should the nurse identify as reportable to the CDC?

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.

Rationale:
A. Refusing to participate in an elective abortion is an example of exercising conscientious objection, which is ethically and legally permitted, provided the nurse ensures the client’s care is not compromised and appropriate staff take over. This behavior does not indicate a need for further education.

B. Administering opioids to a terminally ill client is ethically appropriate under the principle of double effect, where the primary intent is pain relief, not hastening death. This is standard palliative care practice and does not indicate a need for further education.

C. Explaining that a DNR order does not include withholding comfort measures demonstrates correct ethical understanding. Comfort measures, such as pain relief and emotional support, are always provided, regardless of resuscitation status. This behavior is correct.

D. Informing a confused client that he must stay at the facility until he is better violates the ethical principle of autonomy. Even if the client lacks full decision-making capacity, coercion or providing false information is unethical. This behavior indicates a need for further education on respecting client rights, informed consent, and ethical care practices.