Supplemental Material
1. The nurse is preparing a client for exploratory laparoscopy for severe
abdominal pain. The client begins asking about the procedure, the
risks, and recovery time. The nurse checks the client’s chart and
notices that the informed consent has not been obtained. Which
action should the nurse take next?
A. Answer the client’s questions as thoroughly as possible.
B. Call the surgeon performing the exploratory laparoscopy.
C. Reassure the client that everything will be fine.
D. Complete the informed consent paperwork and document it in the
chart.
STEP 2: What are the Informed Consent Responsibilities of the Provider,
Client, and Nurse. Can a patient refuse a consent form?
STEP 3: What are the Informed Consent Guidelines? Review Emancipated
minors, competent adult, legal guardian.
STEP 4: The nurse should intervene if the nurse notes a staff member
A. Obtaining a clients consent prior to their operative procedure after
receiving Ativan (lorazepam)
B. Placing a client on the affected side following surgical repair of a
retinal detachment
C. Handling a wet cast with the palms of the hands
D. Using a broad base of support while transferring a client
____________________________________________________________
2. Four clients recently returned to the unit following diagnostic testing.
The nurse should immediately assess which client:
A. Client complaining of abdominal pain after laparoscopic procedure
B. Had a cardiac catheterization and took a sip of water
C. Is observed flexing and extending the legs two hours after
echocardiogram
D. Had an ERCP and is constantly swallowing
STEP 2: Review each Procedure and apply Expected Vs Unexpected…
, ____________________________________________________________
3. The nurse working in the labor and delivery room has become aware
of the following client situations. The nurse should first assess the
client who is
A. In the first phase of labor and the fetal heart rate ranges from 128 to
140 between contractions
B. In the second phase of labor and the fetal heart rate is consistently
beating at 125 beats per minute
C. In the third phase of labor and the fetal heart rate has decelerated to
its lowest point at the acme of the contraction
D. In the third phase of labor and the contractions are lasting 60-70
seconds
STEP 2: Review Labor & Delivery Second stage of Labor - Expected Vs.
Unexpected: Contractions, Cervix dilation, FHR, Blood loss during labor
____________________________________________________________
4. DELEGATION CHECK LIST
INSTRUCTIONS: PLACE CHECK MARK IN APPROPRIATE COLUMN OR COLUMNS.
CAN BE CAN BE CAN ONLY BE
ASSIGNED TO DELEGATED TO COMPLETED BY
AN LVN CNA RN
OBSERVES SKIN FOR SIGNS
OF BREAKDOWN
ADMINISTERS ENEMAS
DEVELOPS PLAN OF CARE
DEVELOPS A NEW MOTHER
TEACHING PLAN ON
BREASTFEEDING
COLLECTS URINE SPECIMEN
FROM FOLEY CATHETER
PERFORMS VAGINAL
IRRIGATIONS
OBTAINS CAPILLARY BLOOD
TO TEST SUGARS
SUCTIONS TRACHEAL
SECRETIONS
1. The nurse is preparing a client for exploratory laparoscopy for severe
abdominal pain. The client begins asking about the procedure, the
risks, and recovery time. The nurse checks the client’s chart and
notices that the informed consent has not been obtained. Which
action should the nurse take next?
A. Answer the client’s questions as thoroughly as possible.
B. Call the surgeon performing the exploratory laparoscopy.
C. Reassure the client that everything will be fine.
D. Complete the informed consent paperwork and document it in the
chart.
STEP 2: What are the Informed Consent Responsibilities of the Provider,
Client, and Nurse. Can a patient refuse a consent form?
STEP 3: What are the Informed Consent Guidelines? Review Emancipated
minors, competent adult, legal guardian.
STEP 4: The nurse should intervene if the nurse notes a staff member
A. Obtaining a clients consent prior to their operative procedure after
receiving Ativan (lorazepam)
B. Placing a client on the affected side following surgical repair of a
retinal detachment
C. Handling a wet cast with the palms of the hands
D. Using a broad base of support while transferring a client
____________________________________________________________
2. Four clients recently returned to the unit following diagnostic testing.
The nurse should immediately assess which client:
A. Client complaining of abdominal pain after laparoscopic procedure
B. Had a cardiac catheterization and took a sip of water
C. Is observed flexing and extending the legs two hours after
echocardiogram
D. Had an ERCP and is constantly swallowing
STEP 2: Review each Procedure and apply Expected Vs Unexpected…
, ____________________________________________________________
3. The nurse working in the labor and delivery room has become aware
of the following client situations. The nurse should first assess the
client who is
A. In the first phase of labor and the fetal heart rate ranges from 128 to
140 between contractions
B. In the second phase of labor and the fetal heart rate is consistently
beating at 125 beats per minute
C. In the third phase of labor and the fetal heart rate has decelerated to
its lowest point at the acme of the contraction
D. In the third phase of labor and the contractions are lasting 60-70
seconds
STEP 2: Review Labor & Delivery Second stage of Labor - Expected Vs.
Unexpected: Contractions, Cervix dilation, FHR, Blood loss during labor
____________________________________________________________
4. DELEGATION CHECK LIST
INSTRUCTIONS: PLACE CHECK MARK IN APPROPRIATE COLUMN OR COLUMNS.
CAN BE CAN BE CAN ONLY BE
ASSIGNED TO DELEGATED TO COMPLETED BY
AN LVN CNA RN
OBSERVES SKIN FOR SIGNS
OF BREAKDOWN
ADMINISTERS ENEMAS
DEVELOPS PLAN OF CARE
DEVELOPS A NEW MOTHER
TEACHING PLAN ON
BREASTFEEDING
COLLECTS URINE SPECIMEN
FROM FOLEY CATHETER
PERFORMS VAGINAL
IRRIGATIONS
OBTAINS CAPILLARY BLOOD
TO TEST SUGARS
SUCTIONS TRACHEAL
SECRETIONS
