Prioritization, Delegation, & Management of Care for the NCLEX-RN

Prioritization, Delegation, & Management of Care for the NCLEX-RN Each problem that I solved became a rule which served afterwards to solve other problems. —Rene Descartes This book is designed to assist the student nurse in nursing school and in taking nursing examinations, particularly the NCLEX-RN® exam for licensure as a registered nurse (RN). Prioritization, Delegation & Management of Care for the NCLEX-RN® Exam focuses on aspects of management such as setting priorities for client care, delegating and assigning nursing tasks, and managing clients and staff. It contains practice questions on these topics in a wide variety of nursing arenas, including medical, surgical, critical care, pediatric, geriatric, reha- bilitation, home health, and mental health nursing. Answers—and why each possible response is correct or incorrect—are given for all questions. Management, prioritizing, and delegation questions are some of the most difficult questions for the student and new graduate to answer because there is no reference book in which to find the correct answers. Answers to these types of questions require knowl- edge of basic scientific principles, standards of care, pathophysiology, and psychosocial behaviors, and leadership qualities and the ability to think critically. It is important to note that the test taker may not always agree with the authors’ rationale for the correct answer. It is poor test taking to read rationales for the incorrect answers; the students will remember reading the rationale but not if the rationale was for the correct or incor- rect answer. Many of the answers in this book include tips to help the test taker. Termed “Making Nursing Decisions,” these tips provide help for the student in identifying exactly what the question is asking, in analyzing the question, and in determining the correct response. A Comprehensive Examination with answers and rationales is also included for each field of nursing. Practice questions and answers and practice examinations are valuable in preparing for an examination, but the test taker should remember that there is no substitute for studying the material. (For general information on how to prepare for an examination and on the types of ques- tions used in nursing examinations, refer to Fundamentals Success: A Q&A Review Applying Critical Thinking to Test Taking by Patricia Nugent, RN, MA, MS, EdD, and Barbara Vitale, RN, MA.) NCSBN BLUEPRINT FOR QUESTIONS The National Council of State Boards of Nursing (NCSBN) provides a blueprint that assists nursing faculty in developing test questions for the NCLEX-RN®. Content included in management of care provides and directs nursing care that enhances the care delivery setting to protect clients, family/significant others, and healthcare personnel. Related content includes, but is not limited to, advance directives, advocacy, case management, client rights, collaboration with the interdisciplinary team, delegation, establishing priorities, ethical 1 2 PRIORITIZATION, DELEGATION, AND MANAGEMENT OF CARE FOR THE NCLEX-RN® EXAM practice, informed consent, information technology, and performance improvement. Other topics also include legal rights and responsibilities, referrals, resource management, staff education, supervision, confidentiality/information security, and continuity of care. The questions in this book follow this blueprint. GUIDELINES FOR MAKING A DECISION Nurses* base their decisions on many different bodies of information in order to arrive at a course of action. Among the basic guidelines to apply in nursing practice—and in answering test questions—are the nursing process and Maslow’s Hierarchy of Needs. The Nursing Process One of the basic guidelines to apply in nursing practice is the nursing process, which consists of five steps—assessment, nursing diagnosis, planning, intervention, and evaluation—usually completed in a systematic order. Many questions can be answered based on “assessment.” If a priority-setting question asks the test taker which step to implement first, the test taker should look for an answer that would assess for the problem discussed in the stem of the question. EXAMPLE There are numerous words, such as “check,” that can be used to indicate assessment. The test taker should not discard an option because the word “assess” or “assessment” is not used. Alternatively, the test taker shouldn’t assume that an option is correct merely because the word “assess” is used. The test taker must also be aware that the assessment data must match the problem stated in the stem, regardless of terminology. The nurse must assess for the correct information. If option 2 in the above example said, “Assess uri- nary output,” it would not be a correct option even though it includes the word “assess,” since urinary output is not related to heart failure or breathing difficulties. In addition, the test taker should be aware that assessment is not always the correct answer when the question asks which should be done first. Suppose, for example, that the above question had listed option 3 as “Apply oxygen via nasal cannula at 2 LPM.” In that case, assessment does not come first. The nurse would first attempt to relieve the client’s distress and then assess. When a question asks what a nurse should do next, the test taker should determine from the information given in the question which steps in the nursing process have been completed and then choose an option that matches the next step in the nursing process. In this book, the term “nurse,” unless otherwise specified, refers to a licensed registered nurse (RN). An RN can assign tasks to an LPN or delegate to unlicensed assistive personnel (UAP), which may be known under other terms such as medical assistant or nurse’s aide. An LPN can delegate tasks to UAP. Each state will have specific regulations that govern what duties/tasks can be delegated/assigned to each of these types of personnel. The term “healthcare provider,” as used in this book, refers to a client’s primary provider of medical care. It includes physicians (including osteopathic physicians), nurse practitioners (NPs), and physician assistants (PAs). Depending on state regulations, many NPs and some PAs have prescriptive authority at least for some categories of prescribed drugs. CHAPTER 1 INTRODUCTION TO PRIORITIZATION, ASSIGNMENT, DELEGATION, AND MANAGEMENT 3 EXAMPLE The nurse has assessed the client and formulated a nursing diagnosis. The next step in the nursing process is implementation. The nurse should proceed to a nursing intervention appropriate to the situation. These types of questions are designed to determine if the test taker can set priorities in client care. Maslow’s Hierarchy of Needs If the test taker has looked at the question and the nursing process can’t help in determining the correct option, then using a tool such as Maslow’s Hierarchy of Needs (Fig. 1-1) can assist in choosing the correct answer.