P and D study guide

Nursing Assistant - ADLs/Noninvasive - Assist - Remind/Reinforce: usually reminds pt. TO do something rather than HOW to do it (skills previously taught by other health care professional or precaution measures)*** ** Usually in regards to ADLs (hygiene, nutrition, ambulating, skin care), turning, repositioning, cough deep breathe ROM ** - Special positioning-- requires initial education by RN -- assistant will assist not teach - I/O , VS, Weight - They can detach suction and remove a foley but not connect or insert - Gather (equipment) LVN/LPN - Auscultate/Listen - Check(s) - Reinforce/remind - Administer (PO,SubQ,IM -- NO high alert meds, plasma, blood products-- these and IV are done by RN) - Observe - Collect (data, specimens) - Monitor - Set up (basic equipment) - Review/Teach-- Usually standard practices (hand washing/hygiene) or med administration (ie. eye drops) -- RN mostly teaches/educated and LPNs Reinforce - Routine/Standard - Wound care/Suction/Urinary Cath/Blood glucose readings ** Don't assign LVN/LPN to do a task an nurse assistant can complete** RN - Assess - Plan - Evaluate - Consult - Teach/Educate - Encourage - Develop - Review - Update - Counsel - Suggest - Initial/Comprehensive/Baseline (assessments) - Frequent/Ongoing assessments (unstable pts) Physician -Informed Consent -Medical diagnosis -Prescriptions

-Order procedures Avoid These Assignments for New/Float/LVN/LPN/Traveling -New onset/sudden/acute -New admission -Transfer -Newly diagnosed -Discharge -Require education/teaching (beyond basic skills -- tend to be complex and specific to patients on that particular unit) - Unstable (ie. High risk of sudden respiratory failure, or requires frequent assessments and changes in therapy(like electrolyte imbalances) Give - Chronic - Routine meds/procedures - Stable ALL HEALTHCARE WORKERS - Responsible for knowing about and implementing standard precautions + airborne/droplet/contact -> therefore all can teach about it or prepare a room for it

The HESI exit exam is one you have to pass to graduate from nursing school and it is not easy to prepare for or pass according to a lot of nursing students. There are different parts to the exams, I think the hardest part would be med surg , fundamentals etc and the easier parts are delegation, prioritization, professional, law and ethical issues. I think if you can pass as many of the 'easy" questions as you can, it will increase your chances of passing the hesi. So here are a few tips on answering delegation and prioritization questions.
Difficulty: Moderate

Instructions
1.
o

1
1. It is always safe to narrow down answers to those that give vital signs to the UAP. The UAP can also measure output from a foley catheter. The UAP can also transport patients between departments. So to review a UAP can Feed the client (observe the UAP feeding the client if there is any paralysis involved) Take vital signs Perform range of motion exercises Perform routine grooming and hygiene

Measure output from the foley bag Transport patients

o

2
2. The LPN can give medications, reinforce teaching and carry out ROUTINE care. The LPN cannot do anything invasive i.e IV insertion according to HESI and NCLEX! In review the LPN can do more than the UAP which includes the following Give medication plus injections Perform ROUTINE assessments (routine as in the hospital does this every so often without expecting to encounter problems because its just routine)dressing changes, catheter insertion and suctioning. Can assist the physician during procedures if the RN has to leave Cannot do anything in the nursing process

3
3. The RN must assess the patient, the RN must receive report about the patient and give report about a patient, the RN must perform patient teaching. Anything invasive and sterile is the job of the RN. The RN cannot delegate any of the above. So The RN cannot delegate pre op assessment or post op assessment Handling invasive line Sterile technique Patient education Triage Assessment, evaluation or monitoring Planning, care plans, interventions or nursing diagnosis

4
4. To answer prioritization questions on the HESI, think about the following 1 Time frames: if the patient is freshly post op, you must see that patient first. 2 Stability:If the patient is unstable or in a potentially life threatening situation you must see that patient first. Unsable patient may men their vitals are off from their baseline so they need monitoring 3 ABC: use airway breathing circulation, the patient with affected or potentially affected airway should be seen first 4 Maslow: always pick physiological integrity before safety and mental issues 5 Safety: if there is the possibility of the patient harming themselves or others see that patient first 6 The discharge patient can be last because they are stable 7 Always give the client who requires the least complex care to the new graduate nurse. Never give the new grad patients about to be discharged because they need teaching or patients newly diagnosed with a disease because they also need teaching

This article hopefully should help you answer questions on prioritization and delegation.There are lots of these questions on HESI so the more of them you get right the better for you!
References What can RN's delegate to LPN/NA's?. (n.d.). Nursing Community | Nurses | Nursing Students. Retrieved June 13, 2012, from http://allnurses.com/nclex-discussion-forum/what-canrns-302187.html Contributor, e. (n.d.). How to pass the HESI exit exam- answering delegation questions | eHow.com. eHow | How to Videos, Articles & More - Discover the expert in you. | eHow.com. Retrieved June 13, 2012, from http://www.ehow.com/print/how_5205237_pass-exam-answering-delegationquestions.html