Level: Advanced
Difficulty: Hard
Subtopic: Pain basics
NCLEX: An 82-year-old client on a medical-surgical unit is being evaluated for nursing care related to pain basics. Asse…
Nursing fundamentals Basic Care and Comfort Safety and Infection Prevention and Control
Case Study
An 82-year-old client on a medical-surgical unit is being evaluated for nursing care related to pain basics. Assessment data include pressure injury stage 2 noted on the coccyx with unchanged dressing. Which action is appropriate within the RN scope of practice?
Question
A. Independently diagnose the medical disease and prescribe treatment.
B. Prescribe new medications without a provider order.
C. Assess, analyze cues, implement nursing interventions per orders, teach, evaluate outcomes, and question unsafe orders.
D. Delegate nursing assessment and evaluation on an unstable client.
B. Prescribe new medications without a provider order.
C. Assess, analyze cues, implement nursing interventions per orders, teach, evaluate outcomes, and question unsafe orders.
D. Delegate nursing assessment and evaluation on an unstable client.
Rationale
Correct answer: C. Assess, analyze cues, implement nursing interventions per orders, teach, evaluate outcomes, and question unsafe orders.
Rationale: RNs assess, coordinate care, teach, and evaluate. Diagnosis and prescribing are provider responsibilities.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: RNs assess, coordinate care, teach, and evaluate. Diagnosis and prescribing are provider responsibilities.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.