Walkthrough: Safety and Infection Control Q1 – NCLEX-RN®

00:00 The nurse is delegating vital signs of newborn infants to an unlicensed assistive personnel. Which infant's vital signs will the nurse delegate to the UAP? Select all that apply. Okay, so we're going to stop right there with the stem of the question, the words before the answer choices. We know our rules, always to break that down to make sure we are laser focused so we know what we're looking for before we look at the answer choices particularly important with the select-all-that-apply.

00:29 So the first sentence. The nurse is delegating vital signs of newborn infants to an unlicensed assistive personnel. Now, anytime you see different descriptions of nursing staff and personnel, you got to ask yourself this thing, "Who am I? Who else is in the question? Do I delegate or supervise that person?" Okay, so let's talk about that for a second. Who am I in this question? I'm the nurse. Who's the other person? A UAP, an unlicensed assistive personnel. So I ask myself, what's the 3rd question, "Do I delegate or supervise this individual?" In this case, the answer is yes. If it said the nurse, that's me, is discussing something with another nurse, I say I'm a nurse, they're a nurse. Do I delegate or supervise them? No, I do not. Unless I'm the charged nurse, I don't supervise my peer on the same level. So, keep that in mind when you're answering questions like management of care. You have to know who are the players in the question and who supervises who so you can see what's appropriate. UAPs cannot delegate to someone else, right, in NCLEX world.

01:42 I know in real life they might trade things with our UAPs but that's not how it's supposed to be done in NCLEX world. Now if there's an LPN in the question, yes.

01:51 The nurse in this question when you're taking NCLEX questions is considered an RN. Okay, so in NCLEX questions if it says "the nurse", that means an RN. Now, we recognize that RNs and LPNs are both nurses, but I'm just telling you the lingo when you're taking an NCLEX question you see "the nurse", that means RN. So the nurse is delegating and we know that is appropriate for them to do it, vital signs of newborn infants to a UAP. Is that possible? Yeah. A UAP can take vital signs, who has been trained in that unit to take vital signs of newborn infants. It needs to be an appropriate assignment because it says "Which infant's vital signs will the nurse delegate to the UAP?" So essentially what they're asking me is if a patient is unstable, that needs to be a nurse. No question, an RN, not the UAP. So, RNs are the ones who are within their scope of practice to do detailed assessment. So, I'm only going to ask a UAP to take the vital signs on any age patient of a patient that's stable. Okay, whether they're a neonate or an old person, they need to be stable, hemodynamically stable. Otherwise, I'm not going to assign a UAP to do that. The patient's unstable, the RN needs to be in the room doing that. Okay, so ready to go? Now you're going to see 5 options here, pause the video, make sure you have on your sheet ready to go, the numbers only 1, 2, 3, 4, and 5. Use those numbers as you think through these answer choices when you say yes or no and make yourself say why you're leaving an answer in or eliminating it. I'll see you back in however long it takes you to work through this question and feel confident about your process. You may feel wonky on some of the answers, that's okay. Just feel confident that "Yes, I did my best to be consistent. I treated this as 5 separate answer choices. I decide if I'm going to leave them in or out and I gave my rationale, I said why I did it. Now I'm ready to come back and hear the walk through with Rhonda." Okay, see you in a few minutes.

04:09 Hey, welcome back. So, first let's talk about some cool things you learned from the stem of the question that you can apply to other questions. I know, we haven't done the answer choices yet, but here's something I want you to see. This is why practice is so valuable to your success. So we learned here when it comes to delegating or a question where there is different staff involved I always have to ask "Who I am? Who the other players are? And do I delegate or supervise them?" If I'm an RN delegating to an LPN or to UAP, I'm only going to delegate stable patients. Now, this isn't giving over patient care, this is just asking them to check vital signs which is a part of patient care. So I'm looking for only stable patients to do this. So thinking hemodynamics or anything else that tells us they're unstable, they're out, we'll not give them to the UAP. So look at answer choice number 3. I know, I just like to start in the middle sometimes, keep you guys guessing. You are welcome to do the same thing if that helps keep your brain in there and makes it the tiniest bit more fun because I know studying is hard, makes me feel like Cinderella when everybody else is at the ball but it's going to pay off. So, an infant with nasal flaring and grunting, that is not a good sign. Right? Is that a stable patient? No, the baby is not snoring like an old grandpa. What the baby is doing is like they are working really hard to try to breathe. They're in eminent respiratory problems. Would I send a UAP in? Absolutely not. That's got to be an RN. Since it's asking me would I delegate vital signs of this child to the UAP? No. Number 3 is out and that's because they are not stable, they're showing me really nasty signs of respiratory problems. So 3, you're out of there. Who else seems like I would throw them out? When you look through those, remember you'd go in to order or random as long as you use your sheet to keep track of what you've done. Number 5, an infant who is jittery shortly after delivery. Is that normal? No. So there's another rule that you can take with you.

06:22 I don't want to give a patient who is unstable or showing abnormal assessment information to an LPN or UAP in NCLEX world. Let me go over that again. As an RN, I don't want to delegate to an LPN or a UAP a patient who has abnormal assessment information. Is it normal for an infant to be jittery shortly after delivery? No. So that client is not going to the UAP or an LPN. That client needs to be assessed by an RN. Okay, so we got to rid number 3 and number 5. Now I'm going to start back up on top and see if we can go through it right. Okay, so an infant with hip dysplasia, are they unstable? Well, a hip dysplasia, that's going to be like a bone thing. Yeah, I can have a UAP do that. There are no signs that they're hemodynamically unstable or respiratory unstable. We're going there.

07:16 So number 1, leaving you in. Number 2, an infant with a diagnosis of neonatal abstinent syndrome with increased muscle tone. Okay. If you've not seen a baby with this diagnosis, it will break your heart. I called students in their nursery rotation in town and it is just heartbreaking. These babies are so hard to soothe and it's not their choice. Right? Their mother was taking drugs while they're in the womb. Now, when they're no longer in the womb, they're cut off from drug access that's why it's abstinence syndrome. They're withdrawing and they are just, almost impossible to soothe and they want to eat, eat, eat, eat, eat. It really takes a special nurse who can be calm and patient and emotionally intelligent to deal with these types of situations. So, could a UAP take the blood pressure? Yeah. The vital signs they could. The baby isn't hemodynamically unstable, it's just their central nervous system is screaming for some of these drugs again. That's what's going on. So while it is very difficult, I have a really hard time seeing these babies. That's a very difficult diagnosis, they are not unstable hemodynamically so a UAP could take their vital signs. Now, we know we got rid of number 3, right, because there are signs of respiratory trouble. Number 4, an infant with, okay this is just a fun word to say. Right? Say it with me, hyperbilirubinemia. I mean, it's just fun, try it.

08:52 Hyperbilirubinemia. Like if you want to impress your family at dinner the next time or your friends, just say "Oh yeah, I was just reading about hyperbilirubinemia. Yeah, it's a cool one." Anyway, hyper means high, bilirubin now that's what a waste product we're trying to get rid of, and emia means in your blood. So these are the little guys who, it's fairly common diagnosis. Their little livers just can't keep up with what it needs to process and help you get it out of your body. So, an infant with hyperbilirubinemia is not likely to be unstable and if they were, they'd have to give you more information in this answer choice. So, we can assume they are stable. So, a UAP could take the vital signs. Number 5, we already threw out. So, correct answers "Who I would delegate as a nurse to a UAP?" The stable patients of these 5 options would be an infant with hip dysplasia because that's an orthopedic thing. An infant with NAS, neonatal abstinence syndrome because well it's miserable, they're not, anything else in the question tells us that they're hemodynamically unstable and an infant with, right, hyperbilirubinemia. That's it. 3 and 5, no. I would not delegate to a UAP. Those 2 clients need to be assessed directly by an RN. Okay, time to reflect. Lots of things from this question. This one I like it when I get a question like there is more than just content and knowledge. There are lots of strategies here where you're looking who you are, looking who the other people are. Do you delegate and supervise them? You only delegate stable patients to an LPN or UAP in NCLEX world. Not a bad idea in real life, but you should never delegate an unstable patient, that's what you're looking for. Gave you a little bit of information about some of those diagnosis. So what needs to be added to your notebook? So you can refer to it over time as you're building up those skills in test taking. Okay, come back and join us for another question.