NACE Nursing Acceleration Challenge Exam I PN-RN Coordinated Care and Delegation 5 — Questions and Answers
Question 1: A nurse manager notices that a UAP frequently skips reporting changes in patient condition. Which is the MOST appropriate initial action?
- File a formal disciplinary report immediately
- Privately counsel the UAP on reporting expectations and document the conversation (Correct answer)
- Reassign all of the UAP's patients to licensed staff
- Ignore the behavior unless a patient outcome is negatively affected
Correct answer: Privately counsel the UAP on reporting expectations and document the conversation
The initial response should be direct, private counseling to clarify expectations and correct the behavior, with documentation for accountability.
Question 2: Which situation represents a violation of the five rights of delegation?
- Asking a UAP to take vital signs on a stable medical patient
- Directing a UAP to perform a focused neurological assessment on a new stroke patient (Correct answer)
- Assigning a UAP to assist a patient with bathing after confirming the UAP's competency
- Delegating meal assistance to a UAP for a patient on a regular diet
Correct answer: Directing a UAP to perform a focused neurological assessment on a new stroke patient
A neurological assessment requires clinical judgment and is outside the UAP's scope of practice, violating the 'right task' component of delegation.
Question 3: A nurse is preparing to discharge a patient. Which member of the healthcare team is MOST appropriate to involve for concerns about the patient's ability to afford medications?
- Registered dietitian
- Physical therapist
- Social worker or case manager (Correct answer)
- Respiratory therapist
Correct answer: Social worker or case manager
Social workers and case managers specialize in connecting patients with financial assistance programs and community resources for medication affordability.
Question 4: A PN receives a verbal telephone order from a physician for a medication. What is the correct process for handling this order?
- Administer the medication immediately based on the verbal order alone
- Write down the order, read it back to the physician for verification, and document it per facility policy (Correct answer)
- Refuse all verbal orders and insist on written orders only
- Have a UAP transcribe the order to free up the nurse's time
Correct answer: Write down the order, read it back to the physician for verification, and document it per facility policy
The read-back process for verbal orders is a Joint Commission-required safety practice to verify accuracy before implementation.
Question 5: Which action by the PN BEST demonstrates effective coordination of care during a patient's hospitalization?
- Completing all tasks independently without involving other disciplines
- Communicating relevant patient updates to all members of the care team at each shift change (Correct answer)
- Documenting only abnormal findings to save time
- Limiting patient family involvement to protect privacy
Correct answer: Communicating relevant patient updates to all members of the care team at each shift change
Consistent and thorough communication across all disciplines at each transition ensures continuity and prevents errors in coordinated care.
Question 6: A nurse is preparing to delegate morning care tasks. The UAP states, 'I don't know how to do that.' What is the correct nursing action?
- Document the refusal and reassign the patient to another UAP
- Accept the statement and assign a different task without further inquiry
- Assess the UAP's knowledge gap and provide education or choose not to delegate that task (Correct answer)
- Insist the UAP perform the task anyway since it is within their job description
Correct answer: Assess the UAP's knowledge gap and provide education or choose not to delegate that task
The delegating nurse must verify competency; if the UAP lacks the skill, the nurse must either provide education or retain the task rather than risk patient safety.
Question 7: A nurse discovers that a patient's advance directive specifies no resuscitation, but the physician has entered a full-code order. What is the nurse's BEST action?
- Follow the physician's order because it is the most recent
- Administer care based on whichever order seems most reasonable
- Notify the physician of the discrepancy and escalate to the charge nurse or supervisor if unresolved (Correct answer)
- Ignore the advance directive since it was created before admission
Correct answer: Notify the physician of the discrepancy and escalate to the charge nurse or supervisor if unresolved
A conflict between an advance directive and a physician order requires immediate clarification through the chain of command to protect the patient's legal rights.
NACE Nursing Acceleration Challenge Exam I PN-RN Coordinated Care and Delegation 5
A nurse manager notices that a UAP frequently skips reporting changes in patient condition.
Which is the MOST appropriate initial action?