The nurse is working in a clinic and sees a resident of a long-term-care facility, age 82 years, who has come in to be checked by her physician.
The caregiver accompanying her reports that the client has been displaying the following: drowsiness, excessive sleeping, decreased attention span, irritability, and signs of depression.
The client's daughter and family, who usually visit her, moved away from the area 6 weeks ago due to the husband's job.
The nurse suspects which problem?

Choice A rationale

A physician's license is primarily concerned with their medical practice, diagnosis, and treatment of patients. While medication security is important in patient care, the direct responsibility for the secure storage and accurate documentation of narcotics in a facility, according to its policies, falls on the nursing staff. Disciplinary actions related to these specific failures would typically target those directly involved in the lapse of protocol.

Choice B rationale

A pharmacist's license governs the dispensing and management of medications within a pharmacy setting. While pharmacists play a crucial role in the supply chain and providing information about medications, the day-to-day secure storage and inventory control of narcotics within a long-term care facility, as per the facility's policies, is the responsibility of the nurses on duty.

Choice C rationale

A facility's license pertains to the operational standards and overall compliance of the healthcare institution. While the failure to secure narcotics and maintain proper documentation could potentially lead to issues with the facility's licensing if it reflects systemic problems, the initial disciplinary actions for direct violations of nursing policies regarding medication handling would likely target the individual nurses involved.

Choice D rationale

Nurses are directly responsible for adhering to the policies and procedures of the healthcare facility regarding the handling and documentation of medications, especially controlled substances like narcotics. Failing to keep narcotics in a locked, secure location and neglecting to document counts before and after each shift are direct violations of these professional responsibilities and institutional guidelines, potentially leading to disciplinary actions against their nursing licenses.

Choice A rationale

Creating a plan of care for a client recovering from a stroke requires comprehensive assessment, synthesis of complex data, and the establishment of nursing diagnoses and interventions. This falls within the scope of practice of a registered nurse who has the education and expertise in complex patient management.

Choice B rationale

Assessing a pressure injury involves observing and documenting wound characteristics. While an RN may perform this, an LVN, under the supervision of an RN, can also contribute to this task by collecting and reporting data about the wound.

Choice C rationale

Providing oral suctioning is a basic nursing skill that can be performed by both RNs and LVNs, following appropriate training and established protocols, to maintain airway patency for a client with pneumonia.

Choice D rationale

Administering internal feedings through a nasogastric tube is a task that can be delegated to an LVN who has received specific training and demonstrated competency, under the supervision of an RN, provided the client is stable and the feeding protocol is well-established.

Choice E rationale

Inserting a urinary catheter can be performed by both RNs and LVNs who have received the necessary education, training, and demonstrated competency in this invasive procedure, according to facility policies and state regulations.