Medications should be given through what? Central line The nurse working on a medical surgical unit is delegating tasks to unlicensed personnel. Which of the following delegated task would REQUIRE FOLLOW UP by the charge nurse? A. Assisting a client who had a paracentesis 2 hours ago to get out of bed for the first time. Rationale – anytime a client is doing something for the first time the RN needs to do it The nurse is prioritizing patient care after a change of shift report. The nurse should first plan to see the patient who: B. Had an endoscopic retrograde cholangiopancreatography 30 minutes ago and is reporting difficulty swallowing Rationale – Difficulty swallowing – ABC’s! The nurse working on the mom/baby unit has become aware of the following client situations. Which of the following clients should the nurse INITIALLY assess? C. a neonate who is 4 hours old, whose resting HR is 95 BPM. Rationale – Normal HR for a newborn is 120-140 BPM – 95 is a LOW BPM A nurse working on a medical surgical unit has just received a handoff report on the following clients. The nurse should FIRST plan to assess the client who has: D. Acute pancreatitis and is reporting the development of pain on deep inspiration Rationale – “acute” if not caught early, will possible burst and patient will become septic The nurse working on a pediatric unit is caring for the following children who have been admitted in the past 12 hours. It would be a priority goal for the nurse to initiate an interdisciplinary conference for the child who:


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