Prioritization, delegation and organ location

Question 1

Which part of the phrase is the most important when prioritizing patient?

Answer 1

The modifying phrase is the most important. When there are 2 answers that work, the tie should be broken based on the modifying phrase NOT the diagnosis

Question 2

What are the 3 rules for prioritization?

Answer 2

1. Acute vs. Chronic - acute ALWAYS over chronic
2. Fresh post-op <12 hours beats medical or other surgical
3. Unstable beats stable

Question 3

What word descriptions indicate that a patient is stable?

Answer 3

Stable
Chronic illness
Post op >12 hours
Local or regional anesthesia
Lab abnormalities in A/B (creatinine, BUN, hemoglobin 8-11, elevated HCT, elevated BNP, elevated Na, RBCs off)
Ready for discharge, to be discharged and admitted longer that 24 hours ago
Unchanged assessment
Experiencing typical expected s/s of the disease they were diagnosed

Question 4

What word descriptions indicate that a patient is unstable?

Answer 4

Unstable
Acute illness
Post op >12 hours
General anesthesia <12 hours
Lab abnormalities in C/D (INR over 4, K in 6s, pH in 6s, CO2 in 50s, low O2 sat, high WBC, low ANC, low CD4, low platelets)
Newly diagnosed, newly admitted, not ready for discharge admitted less than 24 hours ago
Changing or changed assessment
Experiencing unexpected S/S

Question 5

What 4 things ALWAYS make a patient unstable

Answer 5

Hemorrhage
High fevers over 105 b/c seizures
Hypoglycemia
Pulseless or breathless (V. fib, Asystole, at scene of unwhitnessed accident pulseless and breathless are a low priority)

Question 6

In a mass casualty what 3 things result in a black tag?

Answer 6

Pulseless
Breathless
Fixed and dilation pupils

Question 7

If the 3 rules of prioritization result in a tie then what should you do?

Answer 7

the more vital the organ, the high the priority

1. Brain
2. Lungs
3. Heart
4. Liver
5. Kidneys
6. Pancreas

Question 8

What can an LPN NOT do?

Answer 8

Cannot start an IV
Cannot hang/mix IV meds
Cannot push IV meds
Cannot administer blood or deal with central lines including flushing and dressing
Cannot make the care plan
Cannot preform or develop teaching
Cannot take care of unstable patients
Cannot preform the FIRST of anything
Cannot assess so no admission, discharge, transfer or first assess after a change

Question 9

What CAN an LPN do?

Answer 9

Can maintain and flush an IV
Can implement the care plan made by RN
Can reinforce teaching
Can do things such as tube feeding, post-op dressing changes, feed stroke pt, ambulate post-op patient, get VS on post-op pt AFTER the RN has done it FIRST

Question 10

What should NOT be delegated to an UAP?

Answer 10

Cannot chart - they can chart what they did such as “side rail is up” but cant chart about pt “pt less anxious”
Cannot give medication unless it is a topical over the counter barrier cream like A&D ointment
Cannot do assessments expect vitals and accucheck for DM
Cannot give treatments expect enemas

Question 11

What can the RN delegate to the UAP?

Answer 11

ADL unless it is the first time then the RN must do it and the the UAP can take over from there

Question 12

What should NOT be delegated to the family?

Answer 12

Never delegate any safety responsibilities to the family

Example: keeping the rail down on a crib, keeping restraints off while family is there

Question 13

How do you intervene with inappropriate behavior from staff?

Answer 13

If ask, is it illegal? If yes then tell supervisor

If it is not allege then ask if anyone including patient, co-worker, other staff is in immediate physical/psychological harm? If yes then confront immediately and take over

If no one is in harms way then ask if the behavior is simply inappropriate. If yes, then talk to that staff member at a different time about the incident

Question 14

What is a good way to remember when to auscultate heart valves?

Answer 14

A (aortic) P (pulmonic)
E (Erb point)
T (tricuspid)
M (mitral)

This is how they present on chest

Question 15

Where is the aortic valve?

Answer 15

2nd intercostal space, right sternal boarder

Question 16

Where is the pulmonic valve?

Answer 16

2nd intercostal space, left sternal border

Question 17

Where is the Erb point?

Answer 17

3rd intercostal space, left sternal border

Question 18

Where is the tricuspid valve?

Answer 18

4th intercostal space, left sternal border

Question 19

Where is the metal valve?

Answer 19

5th intercostal space at the midclavicular line

Apical pulse is in the same location as metal valve

Question 20

Guessing strategy for psych?

Answer 20

Pick answer that says “I will examine my feelings” OR “Establish a trust relationship”

Question 21

Guessing strategy for nutrition questions for adults?

Answer 21

Go with baked, not fried
Go with chicken
If no chicken, go with fish but avoid shellfish b/c high in cholesterol

Question 22

Guessing strategy for nutrition questions for kids? Preschoolers? Toddlers?

Answer 22

Never pick a casserole, stew or any dish that is slowly cooked in over
DONT mix meds in kids food - always ask permission before doing so

Preschooler - leave them alone, they will eat if they are hungry and one meal is okay for them

Toddlers - pick finger foods like hot dogs, French fries, tofu

Question 23

Guessing strategy for pharm questions

Answer 23

If you don’t know the SE for the drug but you know what they drug does then pick the SE in the same body system that the drug is working

If you do not know the drug at all and the drug is PO then pick a GI SE

Question 24

What should you never tell a kids about medication?

Answer 24

That it is candy

Question 25

Guessing strategy for OB?

Answer 25

Check the fetal HR

Question 26

Guessing strategy for Med/Surg

Answer 26

First thing to assess - check for LOC (if you found patient on the floor, you would say Sir, Sir are you okay?)

Firs thing to do - establish an airway

Question 27

Guessing strategy for pediatric questions?

Answer 27

When in doubt.. call it normal. Example: “This is normal. Everyone is on their own pace, GIVE IT MORE TIME”

When in doubt, pick the “older age” Example: when can a child pick? 12 or 14 months? Pick 14 months to give child more time

When in doubt, pick the easier task. Example: At 6 months a baby can roll over or sit with support? Pick roll over because it is easier

Question 28

What are general guessing strategies?

Answer 28

Rule out absolutes

Avoid answer choices that say the same thing because neither is correct

If tow answers are opposites, one is probably correct

Use the umbrella strategy - if all answers seem correct then pick the answer that includes all of them. Example: use safety and good body mechanics

Question 29

How do you prioritize the needs of patients?

Answer 29

The need that would have the WORST outcome is the higher priority

Example: Which is highest priority for suicidal patient? (a) Don’t give tranquilizer. (b)
Don’t orient to unit? (c) Don’t put him on suicide precautions? And (d) Don’t introduce him to staff?
If you did not put the patient on suicide precautions the patient would be dead

Question 30

What is the sesame street rule?

Answer 30

ONLY USE IF NOTHING ELSE WORKS

Look at all the answer choices and pick the answer that look different than the rest. There is only one right answer and 3 wrong so pick the odd ball out

Question 31

Use common knowledge/fundamental knowledge

Answer 31

If you don’t know the answer try to pull it out of the question

For example: if you are hanging piggyback Amikacin what do you need to do? If you know nothing about the medication, you do know how to hang a piggyback med and you need to use a pump for it