Delegation (ATI Chapter 6)
A nurse manager of a medical‑surgical unit is assigning care responsibilities for the oncoming shift. a client is awaiting transfer back to the unit from the paCu following thoracic surgery. to which of the following staff members should the nurse assign this client? A. Charge nurse B. rn C.practical nurse D.assistive personnel
A. although the charge nurse can provide all the care this client requires in the immediate postoperative period, administrative responsibilities might prevent the close monitoring and assessment this client needs B. CORRECT: a client returning from surgery requires an rn's assessment and establishment of a plan of care, especially if the client is potentially unstable. C. although pns can perform some of the tasks crucial in the immediate postoperative period, they cannot provide the comprehensive care this client needs at this time. D. although aps can perform some of the tasks crucial in the immediate postoperative period, they cannot provide the comprehensive care this client needs at this time, particularly assessment.
An rn is making assignments for a practical nurse (pn) at the beginning of the shift. Which of the following assignments should the pn question? A. assisting a client who is 24‑hr postoperative to use an incentive spirometer B. Collecting a clean‑catch urine specimen from a client who has a wound infection C. providing nasopharyngeal suctioning for a client who has pneumonia D. teaching a client who has asthma to use a metered‑dose inhaler
A. assisting a client to use an incentive spirometer is within the scope of practice of the pn. B. Collecting a clean‑catch urine specimen is within the scope of practice of the pn. C. providing nasopharyngeal suctioning is within the scope of practice of the pn. D. CORRECT: the rn is responsible for primary teaching. the pn may only reinforce teaching
A nurse on a medical‑surgical unit has received change‑of‑shift report and will care for four clients. Which of the following client's needs should the nurse assign to an assistive personnel. A.Feeding a client who was admitted 24 hr ago with aspiration pneumonia B.reinforcing teaching with a client who is learning to walk using a quad cane C.reapplying a condom catheter for a client who has urinary incontinence D.applying a sterile dressing to a pressure ulcer
A. it would be inappropriate to delegate the feeding of a client who has aspiration pneumonia to an ap because the client is at risk for further aspiration. B. either an rn or an pn, not an ap, may reinforce teaching. C. CORRECT: the application of a condom catheter is a noninvasive, routine procedure that the nurse may delegate to an ap. D. either an rn or an pn, not an ap, may apply a sterile dressing.
A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an ap. Which of the following information should the nurse share with the ap? (Select all that apply.) A. the roommate ambulates independently. B. the client ambulates with his slippers on over his antiembolic stockings. C. the client uses a front‑wheeled walker when ambulating. D. the client had pain medication 30 min ago. E. The client is allergic to codeine. F. The client ate 50% of his breakfast this morning.
A. the ap does not need to know the status of the client's roommate to complete this assignment. B. CORRECT: to complete this assignment safely, the ap should make sure the client wears stockings and slippers. C. CORRECT: to complete this assignment safely, the ap should make sure the client uses a front‑wheeled walker D. CORRECT: to complete this assignment safely, the ap should know that the client should be feeling the effects of the pain medication. E. the ap does not need to know the client's allergy status to complete this assignment. F. The ap does not need to know the client's food intake to complete this assignment
A nurse is preparing an in‑service program about delegation. Which of the following elements should she identify when presenting the five rights of delegation? (Select all that apply.) A. right client B. right supervision and evaluation C. right direction and communication D. right time E. right circumstances
A. the right client is one of the rights of medication administration, not of delegation. B. CORRECT: the right supervision and evaluation is one of the five rights of delegation. they also include the right task and the right person. C. CORRECT: right direction and communication is one of the five rights of delegation. they also include the right task and the right person. D. although the delegatee needs to know whether there is a time frame or a specific time to perform the task, the right time is not one of the five rights of delegation. it is one of the rights of medication administration. E. CORRECT: the right circumstances is one of the five rights of delegation. they also include the right task and the right person
A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)? A. Assisting the patient to sit up on the side of the bed B. Instructing the patient to cough effectively C. Teaching the patient to use incentive spirometry D. Auscultation of breath sounds every 4 hours
Answer: A. Assisting the patient to sit up on the side of the bed Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse.
The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? A. Observe how well the patient performs pursed-lip breathing B. Plan a nursing care regimen that gradually increases activity intolerance C. Assist the patient with basic activities of daily living D. Consult with the physical therapy department about reconditioning exercises
Answer: A. Observe how well the patient performs pursed-lip breathing Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Assisting patients with ADLs is more appropriately delegated to a nursing assistant. Planning and consulting require additional education and skills, appropriate to an RN.
The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit? A. A 58-year old on airborne precautions for tuberculosis (TB) B. A 68-year old just returned from bronchoscopy and biopsy C. A 72-year old who needs teaching about the use of incentive spirometry D. A 69-year old with COPD who is ventilator dependent
Answer: C. A 72-year old who needs teaching about the use of incentive spirometry Many surgical patients are taught about coughing, deep breathing, and use of incentive spirometry preoperatively. To care for the patient with TB in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. The bronchoscopy patient needs specialized procedure, and the ventilator-dependent patient needs a nurse who is familiar with ventilator care. Both of these patients need experienced nurses.
A patient with sleep apnea has a nursing diagnosis of Sleep Deprivation related to disrupted sleep cycle. Which action should you delegate to the nursing assistant (PCT)? A. Discuss weight-loss strategies such as diet and exercise with the patient B. Teach the patient how to set up the BiPAP machine before sleeping C. Remind the patient to sleep on his side instead of his back. D. Administer modafinil (Provigil) to promote daytime wakefulness
Answer: C. Remind the patient to sleep on his side instead of his back. The nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient's plan of care. Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The RN can delegate administration of medication to an LPN/LVN.
Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team? A. Evaluating the patient's complaint of chest pain B. Monitoring laboratory values for changes in oxygenation C. Assessing for symptoms of respiratory failure D. Auscultating the lungs for crackles
Answer: D. Auscultating the lungs for crackles. An LPN who has been trained to auscultate lungs sounds can gather data by routine assessment and observation, under supervision of an RN. Independently evaluating patients, assessing for symptoms of respiratory failure, and monitoring and interpreting laboratory values require additional education and skill, appropriate to the scope of practice of the RN.
After the respiratory therapist performs suctioning on a patient who is intubated, the nursing assistant measures vital signs for the patient. Which vital sign value should the nursing assistant report to the RN immediately? A. Heart rate of 98 beats/min B. Respiratory rate of 24 breaths/min C. Blood pressure of 168/90 mm Hg D. Tympanic temperature of 101.4 F (38.6 C)
Answer: D. Tympanic temperature of 101.4 F (38.6 C) Infections are always a threat for the patient receiving mechanical ventilation. The endotracheal tube bypasses the body's normal air-filtering mechanisms and provides a direct access route for bacteria or viruses to the lower part of the respiratory system.
You are acting as preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients? Select all that apply. A. A 38-year old with moderate persistent asthma awaiting discharge B. A 63-year old with a tracheostomy needing tracheostomy care every shift. C. A 56-year old with lung cancer who has just undergone left lower lobectomy D. A 49-year old just admitted with a new diagnosis of esophageal cancer.
Answers. A and B. The new RN is at an early point in her orientation. The most appropriate patients to assign to her are those in stable condition who require routine care. The patient with the lobectomy will require the care of a more experienced nurse, who will perform frequent assessments and monitoring for postoperative complications. The patient admitted with newly diagnosed esophageal cancer will also benefit from care by an experienced nurse. This patient may have questions and needs a comprehensive admission assessment. As the new nurse advances through her orientation, you will want to work with her in providing care for these patients with more complex needs.
An experienced LPN, under the supervision of the team leader RN, is providing nursing care for a patient with a respiratory problem. Which actions are appropriate to the scope of practice of an experienced LPN? Select all that apply. A. Auscultate breath sounds B. Administer medications via metered-dose inhaler (MDI) C. Complete in-depth admission assessment D. Initiate the nursing care plan E. Evaluate the patient's technique for using MDI's
Answers: A and B. The experienced LPN is capable of gathering data and making observations, including noting breath sounds and performing pulse oximetry. Administering medications, such as those delivered via MDIs, is within the scope of practice of the LPN. Independently completing the admission assessment, initiating the nursing care plan, and evaluating a patient's abilities require additional education and skills. These actions are within the scope of practice of the professional RN.
A patient with a pulmonary embolus is receiving anticoagulation with IV heparin. What instructions would you give the nursing assistant who will help the patient with activities of daily living? Select all that apply. A. Use a lift sheet when moving and positioning the patient in bed B. Use an electric razor when shaving the patient each day C. Use a soft-bristled toothbrush or tooth sponge for oral care D. Use a rectal thermometer to obtain a more accurate body temperature E. Be sure the patient's footwear has a firm sole when the patient ambulates
Answers: A, B, C, and E. While a patient is receiving anticoagulation therapy, it is important to avoid trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal thermometers and enemas). All of the other instructions are appropriate to the care of a patient receiving anticoagulants.
LPN delegation tasks
Monitoring client findings (as input to the RN's ongoing assessment of the client) • Reinforcing client teaching from a standard care plan • Performing tracheostomy care • Suctioning • Checking nasogastric tube patency • Administrating enteral feedings • Inserting a urinary catheter • Administrating medication (excluding intravenous medications in several states)
RN delegation
NEVER DELEGATE NURSING PROCESS
AP delegation tasks
• Activities of daily living (ADLs) • Bathing • Grooming • Dressing • Toileting • Ambulating • Feeding (without swallowing precautions) • Positioning • Bed making • Specimen collection • Intake and output (I&O) • Vital signs (for stable clients)