prioritization/delegation

Question 1

question format for priority question

Answer 1

age, gender, modifying phrase
- dx and modifying phrase are important but the modifying phrase is more important

Question 2

prioritization

Answer 2

• acute > chronic
• 1st 12 hours post op beats medical or other surgical
• unstable > stable

Question 3

stable pt

Answer 3

• greater than 12 hours post op
• local or regional anesthesia
• unchanged assessment
• lab abnormalities of A or B level
• admitted longer than 24 hours ago

Question 4

unstable pt

Answer 4

• general anesthesia
• changing assessment
• post op less than 12 hours
  -lab abnormalities of C or D
• admitted less than 24 hours

Question 5

always unstable regardless if its expected or not

Answer 5

• hemorrhage
• high fevers (105 +)
• hypoglycemia
• pulselessness or breathless: unless it was unwitnessed because they are dead already and not a priority

Question 6

black tags in an unwitnessed accident

Answer 6

• low priority!!!
• pulseless
• breathless
• fixed and dilated pupils (even if still breathing)

Question 7

if still stuck: tie breaker

Answer 7

• only use as a tie breaker
• the more vital the organ the higher the priority (the organ in the modifying phrase not dx)
  #1 = brain
  #2 = lungs
  #3 = heart
  #4 = liver
  #5 = kidney
  # 6 = pancreas

Question 8

what to not delegate

Answer 8

• what you eat
• Evaluate
• Assess
• Teach

Question 9

LPN do not delegate

Answer 9

• starting/hanging/mixing anything IV
• NO IVP meds
• blood administration
• messing with central lines
• plan or create the care plan But they can implement it
• cant perform or develop teaching but they can reinforce it
• unstable pt
• first anything
• admission/dc/transfer/first assessment after a change

Question 10

what you can delegate to a UAP

Answer 10

• topical OTC barrier creams
• vitals
• accucheck (glucose)
• enema
• ADLS (not the first one and only one stable pt)
  *catheterize if there is nothing else they can do

Question 11

what UAP cant do

Answer 11

• chart about the pt (besides what they did)
• give meds
• assess
• treat
  -delegate to the family of the patient

Question 12

sitters/caregivers

Answer 12

• can only do what you teach them to do and you must make sure you document that you taught them

Question 13

how do you handle inappropriate staff behavior

Answer 13

1. is the pt in immediate danger: if so, confront and interviene. if no, approach them later
2. is what they are doing illegal? if yes, always tell the supervisor

Question 14

if action is harmful or illegal

Answer 14

• confront now then tell the supervisor

Question 15

psych questions

Answer 15

• great answer is always establish a trusting relationship or the nurse will examine their ow feelings about…

Question 16

nutrition

Answer 16

• pick chicken (unless fried)
• pick fish (not shellfish) second
• never pick casseroles for children
• never mix meds in children food
• finger foods for toddlers

Question 17

drugs

Answer 17

• if you know what a drug does, pick a side effect in the same body system where the drug is working
• if PO pick GI side effect
• never tell child medicine is candy

Question 18

OB

Answer 18

• check fetal HR

Question 19

med surg

Answer 19

• LOC over airway on assessments but the first thing you should do is establish an airway

Question 20

pediatric growth and development

Answer 20

• always give the child more time dont rush their growth
  1. when in doubt call it normal
  2. when in doubt pick the older age (if there is two ages it could be pick the older one)
  3. when in doubt pick the easier task (roll over is easier than sitting up)

Question 21

generalized absolutes

Answer 21

• rule them out
• all, never, always, everyone

Question 22

if two answers are the same

Answer 22

• neither of them are right

Question 23

if two answers are opposite

Answer 23

• one of them is probably right

Question 24

umbrella strategy

Answer 24

• look for an answer that covers all the others without saying it

Question 25

never pick infection when

Answer 25

• in the first 72 hours of anything

Question 26

where do you find aortic

Answer 26

• 2nd intercostal space @ r sternal boarder

Question 27

pulmonic

Answer 27

• 3rd intercostal space @ L sternal boarder

Question 28

tricuspid

Answer 28

• 4th intercostal space @ L sternal boarder

Question 29

mitral

Answer 29

• 5th intercostal space @ midclavicular
• also called apical or point of maximal impulse