Management of Care – LPN Flashcards

Thirty rapid-review flashcards for Management of Care at licensed practical or vocational nurse depth. Cover the answer, recall it, then check. Pair these with the LPN practice questions. Scope of practice varies by state; these cards reflect the nationally common standards tested on the NCLEX-PN.

Scope of Practice

What document defines the LPN scope of practice

The nurse practice act of the state in which the nurse is licensed, interpreted by that state's board of nursing. Facility policy may narrow a scope but can never widen it, and a provider's order can never authorize practice outside the legal scope.

What is the LPN's role in assessment and in teaching

The LPN collects focused data and reports findings to the registered nurse, and reinforces teaching the RN has already initiated. The initial comprehensive assessment, the care plan, initial teaching, and evaluation of outcomes belong to the RN.

What kind of client is appropriate for LPN assignment

A stable client with a predictable outcome and an established plan of care.

Name eight skills commonly within LPN scope

Administering oral, topical, subcutaneous, and intramuscular medications; sterile dressing changes and complex wound care; urinary catheterization; nasogastric tube insertion, feeding, and maintenance; tracheostomy care and suctioning; ostomy care; capillary blood glucose testing; and monitoring a client who has already been stabilized.

Name six activities generally outside LPN scope

The initial comprehensive assessment, nursing diagnosis and care plan development, initial client teaching, evaluation of care outcomes, administration of blood products, and intravenous push medications in most jurisdictions.

What should the LPN do about an assignment that exceeds the LPN scope or the LPN's training

Clarify it with the supervising registered nurse or charge nurse before acting, naming the specific task involved, and request orientation, supervision, or reassignment of that task. Do not silently perform it, and do not walk off the assignment, which can constitute abandonment.

Receiving and Giving Delegation

What are the Five Rights of Delegation

Right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Which tasks may an LPN delegate to assistive personnel

Standard, unvarying tasks on stable clients that require no nursing judgment, such as bathing and hygiene, feeding a client with no swallowing impairment, ambulating and transferring, positioning, bed making, vital signs on a stable client, intake and output, weights, and specimen collection.

What may assistive personnel never do

Assess, teach, evaluate, interpret findings, or exercise nursing judgment. An assistive personnel may report that a client's sacrum looks red, but may not stage it as a pressure injury.

What makes a delegation instruction complete

It states the specific client, the specific task, the frequency and time frame, the expected outcome, and exactly what to report back and when.

Who is accountable when a task an LPN delegated to an assistive personnel is done incorrectly

The LPN remains accountable for the decision to delegate and for supervising it, and the supervising registered nurse remains accountable for the overall assignment. The assistive personnel is responsible for the performance of the task itself.

Reporting and the Chain of Command

What are the components of SBAR

Situation, background, assessment, and recommendation. State clearly what is being asked for, not just what was observed.

Trace the nursing chain of command from the LPN upward

LPN to registered nurse to charge nurse to nurse manager to house supervisor or director to chief nursing officer, with risk management and the ethics committee as parallel resources.

What does the LPN do when a reported concern is not acted on

Escalate promptly to the next level of the chain of command, one level at a time, and document each step. Reporting once does not discharge the duty to the client.

Name six changes that must be reported to the registered nurse immediately

A new or worsening change in level of consciousness, new or worsening respiratory difficulty, a significant change in vital signs, new or changed chest pain, urine output under about 30 mL per hour, and any finding that is unexpected for that client's diagnosis.

What is the rule about carrying out an order the LPN believes is unsafe

Do not carry it out. Clarify with the registered nurse and the prescriber, and escalate if unresolved. A nurse who follows an order known or suspected to be wrong shares liability for the harm.

Prioritization

What is the first prioritization filter

Airway, then breathing, then circulation. An airway problem outranks everything else.

State the prioritization rules after ABC

Safety and risk of harm, then unstable over stable, then acute over chronic, then sudden and unexpected over gradual and expected, then actual problems over potential problems, then Maslow's hierarchy.

What does the LPN do first for a client with new dyspnea

Stay with the client, raise the head of the bed, apply oxygen if ordered, obtain vital signs and oxygen saturation, and notify the registered nurse immediately.

Consent, Directives, and Rights

Who obtains informed consent, and what is the nurse's part in it

The provider who will perform the procedure discloses the nature, risks, benefits, and alternatives and obtains consent. The nurse may witness the signature and verify that it is voluntary and that the client appears to understand.

What does the nurse do when a client asks about the risks of a procedure after signing the consent

Stop, and notify the registered nurse and the provider so the provider can complete the disclosure. Consent may be withdrawn at any time, including after the form is signed.

Can a competent adult refuse treatment

Yes, for any reason or no reason, including life-sustaining treatment. Document the refusal, ensure the client understood the consequences, and notify the registered nurse and the provider.

What does a DNR order mean, and what does the LPN do if such a client is found apneic and pulseless

It means cardiopulmonary resuscitation will not be performed, while all other indicated care continues unless separately limited. Withhold resuscitation, remain with the client, support the family, notify the registered nurse and provider, and document the findings and the time.

When does an advance directive take effect

Only when the client loses decision-making capacity. A competent client's currently expressed wish always overrides the document, and the client may revoke it at any time.

Confidentiality

Who may receive information about a client, and what are four everyday breaches

Information goes only to those with a legitimate need to know for treatment, payment, or health care operations, and only the minimum necessary; employers, neighbors, media, and curious coworkers do not qualify. Four common breaches are accessing the record of a client not in your care including a coworker, discussing clients in elevators or hallways or the cafeteria, leaving a workstation logged in and unattended, and posting anything client-related on social media including images that appear de-identified.

Legal, Documentation, and Ethics

Name the four elements required to prove malpractice

Duty, breach of duty, causation, and damages. All four are required.

What are the rules for documentation, and how is an error corrected

Entries must be factual, objective, accurate, complete, timely, legible, and signed; chart what was observed, what was done, and how the client responded. Correct an error by drawing a single line through it, labeling it as an error, and adding the date, time, and initials. Never erase, use correction fluid, delete, or remove pages, and never record in the chart that an incident report was completed.

What are the restraint rules the LPN must know

A time-limited provider order is required and as-needed orders are prohibited; use the least restrictive effective device; secure it to the movable bed frame and never to a side rail; use a quick-release knot; monitor circulation, sensation, and skin; and release periodically for range of motion, toileting, and fluids.

What is the LPN's duty when abuse is suspected

Nurses are mandatory reporters. Reasonable suspicion is enough and proof is not required. Document objectively what was observed, report to the registered nurse immediately, and interview the client privately rather than in the presence of the suspected abuser.

Define the six core ethical principles

Autonomy is self-determination, beneficence is doing good, nonmaleficence is avoiding harm, justice is fairness, fidelity is keeping commitments, and veracity is truthfulness.

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