A registered nurse assigns the task of tracheostomy suctioning of a client to the Licensed Practical Nurse (LPN). The LPN informs the nurse that the LPN has never performed this procedure on a client. Which of the following is the most appropriate response from the registered nurse?
You are through with your theory class, so you should know.
Ask for help from a nurse who knows how to perform the procedure.
Review the procedure in the manual and act accordingly.
I will assist you in performing the procedure on the client.
The Correct Answer is D
Choice A reason: Assuming the LPN should know tracheostomy suctioning from theory dismisses the need for practical experience. Performing procedures safely requires supervised practice, as inexperience risks airway trauma or infection. This response neglects patient safety and professional mentorship, per nursing delegation standards.
Choice B reason: Asking another nurse for help is insufficient, as it does not ensure proper supervision or competency. The RN is responsible for ensuring the LPN’s ability to perform safely. This approach risks inconsistent training and patient harm, lacking structured guidance, per delegation and patient safety protocols.
Choice C reason: Reviewing the manual alone is inadequate for a hands-on procedure like tracheostomy suctioning, which requires supervised practice to ensure competence. Inexperience may lead to errors, such as hypoxia or infection. This response fails to provide direct oversight, per nursing competency and patient safety guidelines.
Choice D reason: Assisting the LPN in performing tracheostomy suctioning ensures patient safety and builds competency. The RN provides direct supervision, preventing errors like airway obstruction or infection, while mentoring the LPN. This aligns with delegation principles, ensuring effective care and professional development, per nursing practice standards.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Labeling the action as libel, a felony, is incorrect, as libel involves defamatory statements, not clinical errors. Negligence relates to failing to meet care standards, not legal defamation. This mischaracterizes the issue, focusing on legal terms irrelevant to the failure to report critical hypertension, per nursing liability.
Choice B reason: While poor interprofessional communication may have contributed, it does not fully capture the negligence. The primary issue is not reporting a critical blood pressure (202/122), which a prudent nurse would address. Communication is secondary to the nurse’s failure to act on a life-threatening finding, per professional standards.
Choice C reason: Failing to act as a prudent nurse under similar circumstances defines negligence, as not reporting 202/122 mmHg endangered the patient, leading to ICU transfer. A reasonable nurse would have notified the provider, preventing harm, aligning with legal and ethical standards of care and accountability.
Choice D reason: Not reassessing blood pressure is relevant but not the core negligence. The primary issue is failing to report the critical reading, which required immediate action. Reassessment alone would not address the urgency of notifying the provider, making this less comprehensive than negligence, per standards.
Correct Answer is C
Explanation
Choice A reason: Setting mutual goals is important but premature without assessing the patient’s knowledge. Goals depend on understanding gaps, which are identified through assessment. Without this, goals may be irrelevant, reducing teaching effectiveness, per patient education and learning theory principles.
Choice B reason: Teaching what the patient wants to know assumes prior assessment of their needs and knowledge of their baseline. Without assessing existing knowledge, the nurse risks delivering redundant or irrelevant information, decreasing engagement and retention, per adult learning and education strategies.
Choice C reason: Assessing the patient’s current knowledge of hypertension is the first, as it establishes a baseline understanding, identifying gaps and misconceptions. This guides tailored education, ensuring relevance and effectiveness, enhancing patient engagement, and adherence to management, per patient-centered education and health literacy principles.
Choice D reason: Evaluating outcomes follows education, not precedes it. Assessment of knowledge is needed first to inform teaching. Evaluation without teaching is illogical, as there are no interventions to assess, making this step irrelevant at the start, per educational process and nursing teaching frameworks.
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