Chapter 21: LPN/LVN Charge Nurse Skills: Management, Including Assignment and Delegation My Nursing Test Banks

Chapter 21: LPN/LVN Charge Nurse Skills: Management, Including Assignment and Delegation

Test Bank

MULTIPLE CHOICE

1. The most fundamental requirement for assuming the practice role of LPN/LVN charge nurse is

a.

licensure in the state of practice.

b.

experience with resident assignment.

c.

the ability to coordinate patient care services.

d.

a knowledge of the principles of delegation.

ANS: A

The LPN/LVN practice role requires that the individual be licensed as an LPN/LVN in the state in which he or she is practicing. The other qualifications are important but are not the most basic.

DIF: Cognitive Level: Knowledge REF: p. 272|p. 279

OBJ: 1 TOP: LPN/LVN charge nurse KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

2. Which duty would exceed the LPN/LVN scope of practice if included in the job description for an LPN/LVN charge nurse?

a.

Assigning patient care

b.

Independently developing written treatment protocols

c.

Assisting physicians in diagnostic and therapeutic measures

d.

Maintaining a safe and hazard-free environment

ANS: B

Treatment protocols are written by members of the treatment team who are professionals, often with input from the LPN/LVN. The other options are within the scope of practice of the LPN/LVN.

DIF: Cognitive Level: Application REF: pp. 281-282 OBJ: 1

TOP: Scope of practice KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

3. The 3 to 11 shift LPN/LVN charge nurse on a 20-bed nursing home unit is asked by the only other staff member on duty, a nursing assistant, Will it be all right if I go home tonight while you are giving report to the night shift? My husband needs the car so he can go to work. The best response by the charge nurse is

a.

Its all right tonight, but dont make a habit of it.

b.

Sure, our residents will be sound asleep by 11 PM.

c.

Have you lost your mind? What would happen if the owner dropped in for a surprise visit?

d.

That wont be possible. You must be here to answer lights while I give report to the night staff.

ANS: D

The LPN/LVN is not responsible for the problems the nursing assistant (NA) has at home and must uphold institutional policies. This response sets limits and explains the reason the NA is needed on the unit. Responding not to make a habit of it and stating that it is permissible because the residents will be sound asleep by 11 PM create an unsafe environment for residents. The remaining option does not explain the major reason the NA is needed on the unit.

DIF: Cognitive Level: Application REF: pp. 277-278 OBJ: 5

TOP: Institutional policies KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

4. Which information can be omitted when the LPN/LVN charge nurse gives the change-of-shift report?

a.

Routine care for each resident

b.

New problems for any resident

c.

Prn medication administered

d.

New medical orders

ANS: A

Routine care should not be included in the change-of-shift report. It is recorded on the residents Kardex and care plan and documented in the medical record and flow sheets. The change-of-shift report should focus on new information about residents.

DIF: Cognitive Level: Knowledge REF: pp. 282-284 OBJ: 6

TOP: Change-of-shift report KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

5. The LPN/LVN charge nurse at the long-term care facility has assigned a newly licensed LPN/LVN to care for a resident needing a colostomy irrigation. The new LPN/LVN voices concern, because he has never performed a colostomy irrigation. What would be the best course of action for the LPN/LVN charge nurse?

a.

State, A colostomy irrigation is just like giving an enema. Youll be fine.

b.

Tell the new LPN/LVN, Ill do the irrigation while you care for your other assigned residents.

c.

Delegate the procedure to a willing nursing assistant.

d.

Arrange to supervise the new LPN/LVN as he performs the irrigation.

ANS: D

This action provides the supervision the new employee needs, and the new LPN/LVN probably will be capable of performing the task independently in the future. Stating, A colostomy irrigation is just like giving an enema. Youll be fine does not recognize the need for supervision. Telling the new employee that the charge nurse will do the irrigation while the LPN/LVN cares for other assigned residents increases the workload of the charge nurse with no change in the employees capabilities. Delegating the procedure to a willing nursing assistant would be inappropriate. The delegate should be competent, and the delegation should be acceptable according to state and agency policy.

DIF: Cognitive Level: Application REF: pp. 281-282 OBJ: 7

TOP: Assignment/delegation KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

6. The priority step the LPN/LVN charge nurse should take before delegating one of the charges to another LPN/LVN on staff is to

a.

determine whether the other LPN/LVN is competent to perform the task to be delegated.

b.

check the Nurse Practice Act of the state to learn whether an LPN/LVN charge nurse is allowed to delegate duties.

c.

delegate both the task and the responsibility that goes with the task.

d.

determine the directions that will be provided to the person to whom the task is delegated.

ANS: B

Charge nurse duties are part of an expanded LPN/LVN role. The charge nurse can delegate duties that are part of the ordinary role of the LPN/LVN to another LPN/LVN but may not be able to delegate duties that are part of the expanded role unless specifically permitted to do so by the Nurse Practice Act of the state. Determining whether the other LPN/LVN is competent to perform the task to be delegated is relevant but not the priority step to take. Delegating both the task and the responsibility that goes with the task is not the priority step to take. Determining the directions that will be provided to the person to whom the task is delegated is relevant but not the priority step to take.

DIF: Cognitive Level: Analysis REF: p. 279|pp. 281-282

OBJ: 1 TOP: Delegation KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

7. When the Nurse Practice Act of the state permits delegation as part of the LPN/LVN charge nurse duties, which task could be delegated to experienced, unlicensed assistive personnel who have been trained to perform the task?

a.

Calling the physician when a residents condition deteriorates

b.

Providing a performance evaluation for another nursing assistant

c.

Taking the vital signs of a resident whose condition is not critical

d.

Handling a grievance brought by a nursing assistant

ANS: C

This duty is one that can be safely and appropriately delegated. The other options are duties that are reserved for charge nurses or higher level management. Duties that may be delegated to nursing assistants usually involve identified resident goals rather than goals relating to personnel management.

DIF: Cognitive Level: Analysis REF: p. 279 OBJ: 1

TOP: Delegation vs. Assignment/delegation KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

8. When the LPN/LVN charge nurse makes rounds with the physician, which information should be called to the physicians attention?

a.

The resident demonstrates a weight increase or decrease of 1 lb.

b.

The resident demonstrates a temperature elevation over 99 F.

c.

The resident demonstrates a reduced level of consciousness.

d.

The resident demonstrates a blood pressure over 120/80.

ANS: C

A reduced level of consciousness is a significant change. The other options are not considered significant.

DIF: Cognitive Level: Analysis REF: p. 276|pp. 282-283

OBJ: 4 TOP: Reporting change of condition of resident to physician

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. Assuming all the following are staff members on the unit, to whom should the LPN/LVN charge nurse assign a newly admitted 65-year-old resident with left hemiplegia and a large sacral decubitus requiring a sterile dressing change?

a.

LPN/LVN orientee with 1 week of experience

b.

LPN/LVN with 2 years of experience

c.

Nursing assistant with 3 years of experience

d.

Nursing assistant who is a nursing student at a local college

ANS: B

The resident will require data collection by an experienced person to assist the RN with care planning. The assigned caregiver will need to be able to implement relatively complex care, including use of surgical aseptic technique and nursing judgment. The care required might be more than the orientee can provide. A nursing assistant should not be assigned to care for a new resident requiring careful data collection and use of nursing judgment.

DIF: Cognitive Level: Analysis REF: pp. 280-281 OBJ: 7

TOP: Assignment/delegation KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

10. The new nursing assistant arrived 1 hour late for duty on the second day of employment, giving the excuse of car trouble. The LPN/LVN charge nurse should

a.

note the incident of tardiness in the charge nurses personal file.

b.

send a letter of reprimand to the nursing assistant.

c.

give an oral reprimand to the nursing assistant.

d.

arrange to terminate the nursing assistant before a pattern develops.

ANS: A

Documenting the incident in the charge nurses personal file will allow the charge nurse to later determine whether a pattern develops. If no pattern develops, no harm has been done to the employees work record. A first instance of tardiness does not require reprimand or termination, but rather an explanation that the expectation for all employees is to be at work on time.

DIF: Cognitive Level: Analysis REF: pp. 277-278 OBJ: 5

TOP: When nursing assistants bring problems from home

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

11. The LPN/LVN charge nurse notices that a new nursing assistant has offensive body odor. The LPN/LVN charge nurse should

a.

report this finding to the RN supervisor.

b.

send the person to the locker room to shower and put on clean clothes.

c.

terminate the nursing assistant.

d.

meet with the person to inform her of the problem and reinforce agency expectations.

ANS: D

This action encourages the nursing assistant to take personal responsibility for her hygiene and appearance. The other actions do not permit the nursing assistant the opportunity to take personal responsibility.

DIF: Cognitive Level: Analysis REF: p. 278 OBJ: 5

TOP: Encouraging personal responsibility in nursing assistants

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

12. A resident has not voided in 6 hours. Which instruction to a nursing assistant would likely ensure getting the information needed by the LPN/LVN charge nurse?

a.

Watch the residents output closely today.

b.

I need to know if the resident is voiding sufficiently.

c.

The resident should void at least twice during the shift in quantities of 200 ml or more.

d.

Report to me immediately if the resident voids between now and 10 AM, and tell me the amount he voids. If he has not voided by 10 AM, please report this to me.

ANS: D

This is an example of specific, complete communication. It should be followed by giving the nursing assistant an opportunity to repeat what is expected. The other instructions are vague and could leave the nursing assistant wondering what to do.

DIF: Cognitive Level: Application REF: p. 288 OBJ: 7

TOP: Right direction/communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

13. The LPN/LVN charge nurse has assigned tasks to the nursing assistant staff and the LPN/LVN orienting to the unit. On which statement about responsibility for outcomes should the LPN/LVN charge nurse base her or his actions?

a.

The LPN/LVN charge nurse has no further responsibility, because the staff members have accepted the assignments and are responsible for completing all tasks.

b.

The LPN/LVN charge nurse is responsible for checking the outcomes of care of the LPN/LVN orientee only because he is not an official member of the staff.

c.

The LPN/LVN charge nurse is responsible for checking the outcomes of care of the nursing assistants only, because the nursing assistants are unlicensed, whereas the LPN/LVN orientee is a licensed employee.

d.

The LPN/LVN charge nurse is legally responsible for checking the outcomes of all assignments made.

ANS: D

The LPN/LVN charge nurse is responsible for ensuring that all assigned tasks and delegated duties have been performed and for noting the outcomes.

DIF: Cognitive Level: Application REF: p. 290 OBJ: 7

TOP: Evaluation KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Safe, Effective Care Environment

14. The plan of care for a resident in the rehabilitation unit requires the resident to receive teaching about how to monitor blood glucose as part of discharge teaching. The RN is working with a resident whose condition is deteriorating. The LPN/LVN charge nurse has performed blood glucose monitoring many times but is new and has not received facility certification. The nursing assistant assigned to the patient is a diabetic and monitors blood glucose several times a day. Who should perform the teaching?

a.

RN

b.

LPN/LVN charge nurse

c.

Nursing assistant

d.

Physician

ANS: A

The RN is required to initiate teaching. The LPN/LVN can follow up, review, and reinforce.

DIF: Cognitive Level: Application REF: p. 279 OBJ: 1

TOP: Scope of practice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

15. When a residents family complains that their mother is receiving inferior care in the extended care facility, which action should the LPN/LVN charge nurse initially take?

a.

Gently explain that Continuous Quality Improvement (CQI) would not permit giving inferior care.

b.

Mention that the staff is overworked and would be glad for the familys assistance.

c.

Ask the family to be specific and give examples of inferior care the mother has received.

d.

Tell the family that their reaction is based on guilt because of their need to place their mother in an extended care facility.

ANS: C

Data collection is necessary to clarify the problem needing to be resolved. The other options display various levels of defensiveness.

DIF: Cognitive Level: Analysis REF: p. 278 OBJ: 5

TOP: Dealing with demanding/complaining families

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

16. In the following scenario, who owns the problem?

Before the shift starts, the nursing assistants sympathetically tell the LPN/LVN charge nurse about nursing assistant Jennys latest child care and car problems, which make it difficult for Jenny to get to work on time.

The problem is owned by

a.

the nursing assistants.

b.

the LPN/LVN charge nurse.

c.

Jenny.

d.

Jenny and the nursing assistants.

e.

Jenny and the LPN/LVN charge nurse.

f.

the entire staff.

ANS: C

The individual with the problem is Jenny. She must take responsibility for it (own it) and resolve it. The other options suggest that team members should solve problems for peers, which is an incorrect idea.

DIF: Cognitive Level: Analysis REF: pp. 277-278 OBJ: 5

TOP: Nursing assistant problems KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

17. How should the following scenario be evaluated with respect to the goal of encouraging the nursing assistant to be accountable for learning skills?

Nursing assistant: I do not know how to use the new lifting device to get Mrs. Jackson out of bed. I missed the demonstration the other day.

LPN/LVN charge nurse: I will ask Kay if she has time to get Mrs. Jackson out of bed with the new device while you assist. How can you prepare yourself to use the new device?

Nursing assistant: I could watch closely when I assist Kay and ask questions. Then, I guess I could watch the videotape that came from the company and practice with a couple of the aides when they have time.

LPN/LVN charge nurse: Good plan. I will plan to observe and evaluate your competency tomorrow afternoon.

The scenario should be evaluated as

a.

a good example of encouraging the nursing assistant to be accountable for learning.

b.

too pushy on the part of the LPN/LVN charge nurse.

c.

placing too much responsibility on the nursing assistant.

d.

placing too much responsibility on the LPN/LVN charge nurse.

e.

condescending to the nursing assistant.

ANS: A

When nursing assistants cant perform tasks that are in their job description, it is their responsibility to learn the skill. This option reminds the nursing assistant of that fact and asks for a plan for remediation, which the nursing assistant provides.

DIF: Cognitive Level: Evaluation REF: p. 278 OBJ: 5

TOP: Encouraging personal responsibility in nursing assistants KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

18. To which goal should the LPN/LVN give priority?

a.

Resident X who has been experiencing a medication reaction will have no rash and uncompromised respirations.

b.

Resident Y who is obese and has had a recent knee replacement will ambulate using a walker with the assistance of a staff member.

c.

Resident Z will receive blood glucose monitoring and insulin as ordered.

d.

All residents will be weighed before breakfast.

ANS: A

The goal for the resident who has been experiencing a medication reaction that states he will have no rash and uncompromised respirations reflects a level 1 priority, a life-threatening situation. The goal for an obese resident who has had a recent knee replacement that states she will ambulate using a walker with the assistance of a staff member is level 2, essential to safety. The remaining options are level 3 priorities, essential to the medical/nursing plan of care.

DIF: Cognitive Level: Analysis REF: pp. 283-284 OBJ: 8

TOP: Priorities KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment

19. An LPN/LVN is working in a health care facility that allows delegation of nursing duties to nursing assistants by the LPN/LVN. Which of the following duties could be delegated to the nursing assistant?

a.

Weighing a patient

b.

Initial patient education

c.

Assessing a patients pain

d.

Changing a sterile dressing

ANS: A

Weighing a patient is within a nursing assistants scope of practice. The remaining options are not within a nursing assistants scope of practice. Examples of duties not to delegate to a nursing assistant include sterile technique procedures, crisis situations, initial patient education, and interpretation of data.

DIF: Cognitive Level: Analysis REF: pp. 279-281 OBJ: 7

TOP: Delegation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. Which principles of delegation should the LPN/LVN charge nurse follow when delegating a duty to a nursing assistant? (Select all that apply.)

a.

Choose a nursing assistant who is competent to perform the delegated duty.

b.

Determine the nursing assistants willingness to accept the delegated duty.

c.

Transfer responsibility for the duty to the nursing assistant accepting the delegation.

d.

Permit the nursing assistant to perform the duty without guidance or monitoring.

e.

Plan to delegate duties the LPN/LVN charge nurse enjoys least.

ANS: A, B

Choosing a nursing assistant who is competent to perform the delegated duty fulfills the Right Person criteria. Delegation is complete only when the nursing assistant accepts the delegated duty. Responsibility for a delegated duty cannot be transferred. The LPN/LVN charge nurse is responsible for supervision and evaluation. Delegated duties should not necessarily be those that the nurse does not enjoy.

DIF: Cognitive Level: Comprehension REF: p. 279 OBJ: 7

TOP: Delegation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

2. Examples of tasks the LPN/LVN charge nurse of the extended care unit might assign to a nursing assistant (NA) include which of the following? (Select all that apply.)

a.

Bathing a resident who is in stable condition

b.

Administering a nasogastric tube feeding

c.

Assisting a resident with Parkinson disease to ambulate

d.

Transferring a resident from bed to chair with the assistance of another NA

ANS: A, C, D

These tasks have predictable outcomes. Additionally, the NA has been taught to safely perform these tasks. Administering a nasogastric tube feeding is an invasive procedure, beyond the scope of the NA because it requires nursing judgment.

DIF: Cognitive Level: Comprehension REF: p. 284 OBJ: 7

TOP: Right task KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

3. Select the examples of LPN/LVN charge nurse directions that meet the criteria for Right Direction/Communication. (Select all that apply.)

a.

Please bathe Mrs. Duffy today, cut her nails, and shampoo her hair. The beautician will set her hair at 11 AM.

b.

Mr. Hovde needs to have fluids pushed today. His skin seemed dry to me when I made rounds, and we certainly dont want him to become dehydrated.

c.

Mrs. Neidert needs to walk from her room to the nurses station with the assistance of two this morning and again after lunch. Please report whether she does this easily or with difficulty.

d.

Offer Mr. Jones the urinal before breakfast and before his shower. Report to me immediately if he voids and the amount he voids. If he does not void by 10 AM, notify me, as I will need to catheterize him.

e.

Mrs. Snyder must be showered, dressed in street clothes, and groomed by 10 AM. Have her hat, coat, and mittens ready. The Medi-van is picking her up at 10:30 for a doctors appointment.

ANS: A, C, D, E

The directions offered in these options are clear, specific, as detailed as necessary and given at the nursing assistants level of understanding. The resident goal has been identified in each case or a rationale has been given. When results are needed at a specific time, an explanation is given. When reporting is required, it is stated. These criteria are not met in the option with Mr. Hovde.

DIF: Cognitive Level: Analysis REF: p. 288 OBJ: 7

TOP: Right Direction/Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

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