Management of Care – RN Flashcards

Thirty rapid-review flashcards for Management of Care at registered nurse depth. Cover the answer, recall it, then check. Pair these with the RN practice questions.

Delegation and Supervision

What are the Five Rights of Delegation

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

Who retains accountability for a delegated task

The delegating registered nurse. The delegatee is responsible for performing the task correctly, but accountability for the decision to delegate and for supervising the outcome is never transferred.

What four nursing functions are never delegated

Assessment, teaching, evaluation, and any activity requiring nursing judgment. Add a fifth practical rule, which is that the care of an unstable or unpredictable client is not delegated.

What does the right direction and communication require

Clear, concise, correct, and complete instruction that states the specific task, the time frame, any limits, the expected outcome, and exactly what to report back and when. "Keep an eye on him" is not a delegation.

Which clients should the RN keep rather than assign to an LPN

Newly admitted clients, clients who are unstable or whose status is changing, clients requiring initial teaching or care planning, and clients receiving high-risk therapies such as intravenous push medications, blood products, titrated vasoactive drips, or total parenteral nutrition.

Which clients should be assigned to a float or agency nurse

The most stable clients with the most predictable needs, because the nurse's orientation to the unit and its population is limited. The charge nurse remains accountable for the appropriateness of the assignment.

What does an assistive personnel do with abnormal data

Reports it. Assistive personnel may measure and observe, but may not interpret findings, evaluate outcomes, or make care decisions.

Prioritization

State the priority frameworks in the order they are applied

Airway, breathing, circulation first; then safety and risk of harm; then unstable over stable; then acute over chronic; then actual problems over potential problems; then Maslow's hierarchy for the remainder.

When does CAB replace ABC

During cardiopulmonary resuscitation of a pulseless client, where compressions come before airway and breathing. ABC remains the framework for prioritizing among multiple clients.

Assess or intervene first

Assess first, unless the situation is an immediate life threat with an obvious remedy, such as manually ventilating a cyanotic client whose ventilator has failed.

How does prioritization change in a mass casualty event

The goal shifts from doing the most for each individual to achieving the greatest good for the greatest number, so resources go to survivable life threats rather than to the most severely injured.

What do the disaster triage tags mean

Red or immediate marks a survivable life threat needing rapid intervention; yellow or delayed marks a serious injury that can wait briefly; green or minimal marks the walking wounded; black or expectant marks injuries not survivable with the resources available.

Continuity of Care

What are the components of SBAR

Situation, background, assessment, and recommendation. The recommendation states what the nurse is asking the recipient to do and is not optional.

What is required for verbal and telephone orders and critical values

They are written down and read back to the sender for verification, are limited to situations where the provider cannot access the record, and must be authenticated by the provider within the time frame set by policy.

When does discharge planning begin

On admission. It is interdisciplinary and considers expected functional level, support system, home environment, finances, and health literacy.

What is the minimum necessary standard

Protected health information may be disclosed only to those with a legitimate need to know for treatment, payment, or health care operations, and only the least amount required for that purpose.

Consent, Directives, and Rights

Who is responsible for obtaining informed consent and what is the nurse's role

The provider performing the procedure discloses the nature, risks, benefits, and alternatives and obtains consent. The nurse witnesses the signature, verifies that it is voluntary and that the client is competent, and confirms understanding.

What does the nurse do if the client cannot describe the planned procedure

Stop the process and notify the provider to return and complete the disclosure. The nurse does not explain the procedure in the provider's place and does not obtain the signature first.

Compare a living will and a durable power of attorney for health care

A living will states which treatments the person does or does not want. A durable power of attorney for health care names a person to decide, which is generally more flexible because a named agent can respond to situations the document never anticipated.

What does a DNR order limit

Cardiopulmonary resuscitation only. Pain control, oxygen, antibiotics, nutrition, positioning, suctioning, and all other indicated treatments continue unless separately limited.

When does an advance directive take effect

Only when the client loses decision-making capacity. A competent client's currently expressed wish always governs, and the client may revoke or change the directive at any time.

What does the Patient Self-Determination Act require

Facilities receiving Medicare or Medicaid funds must ask on admission whether the client has an advance directive, provide written information about the right to create one, document its existence, and not discriminate based on whether one exists.

Legal and Ethical

Name the four elements required to prove malpractice

Duty, breach of duty, causation, and damages. All four must be present; if any element fails, the claim fails.

Distinguish negligence from malpractice

Negligence is failure to act as a reasonably prudent person would in similar circumstances and can be committed by anyone. Malpractice is professional negligence, measured against the standard of a reasonably prudent nurse with similar education and experience.

Distinguish assault from battery

Assault is a threat that creates a reasonable fear of harmful contact, with no touching required. Battery is the actual harmful or offensive contact without consent, such as treating over a refusal.

State the restraint order rules tested on licensure examinations

A time-limited provider order is required, as-needed orders are prohibited, a face-to-face evaluation is required within 1 hour for violent or self-destructive behavior, and renewal intervals are 4 hours for adults 18 and older, 2 hours for ages 9 through 17, and 1 hour for children under 9.

How is a restraint applied safely

Use the least restrictive effective device, secure it to the movable portion of the bed frame and never to a side rail, use a quick-release knot, monitor circulation and skin, and release periodically for range of motion, toileting, and fluids.

How is a charting error corrected, and what is the rule about incident reports

Correct an error by drawing a single line through the entry so it remains readable, labeling it as an error, and adding the date, time, and initials; never erase, use correction fluid, or delete. The clinical event, the client's condition, and the treatment given are documented in the record, but the fact that an incident report was completed is not, and the report itself is not filed in the chart.

What should a nurse do with an order believed to be unsafe, and what is the chain of command

Do not carry it out; clarify directly with the prescriber and escalate if unresolved. The nursing chain runs from assistive personnel to LPN to RN to charge nurse to nurse manager to house supervisor to chief nursing officer, with risk management and the ethics committee as parallel resources.

Define the six core ethical principles

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

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