A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Rationale:

A. Institutional policies and procedures: While helpful in guiding facility-specific protocols, policies do not override state regulations. An institution may allow tasks that exceed or fall short of legal scope, so this should not be the primary reference.

B. Written prescription from the provider: A provider’s order does not define or expand a nurse’s legal scope of practice. Even with a valid order, the nurse must independently verify whether they are legally permitted to carry out the task.

C. State Nurse Practice Act: The Nurse Practice Act (NPA) is the legal authority that defines what licensed nurses are permitted to do in their state. It is the most authoritative resource to determine whether a task is within the nurse’s legal scope of practice.

D. Verbal direction from the nurse manager: Even when given by a superior, verbal instructions must still comply with state law. A nurse manager’s guidance cannot authorize a task that lies outside the nurse’s legal scope.

Rationale:

A. Document assessment findings and interventions after providing care for a group of clients: Delaying documentation can lead to inaccuracies or omissions due to forgetfulness. Real-time or immediate documentation ensures completeness and supports continuity of care.

B. Gather supplies for a client's dressing change after removing the old dressing: Supplies should be gathered in advance to minimize delays and reduce the risk of contamination or client exposure. Doing so afterward is inefficient and interrupts workflow.

C. Complete activities for one client before moving to the next client: Focusing on one client at a time improves efficiency, reduces errors, and supports prioritization. It allows for full attention on care tasks and appropriate time management across the shift.

D. Delay cleaning personal work area until the end of the shift: Maintaining a clean and organized workspace throughout the shift helps prevent errors, improves efficiency, and supports infection control, especially in high-traffic care areas.