Ch. 13-Delegation of Nursing Tasks
Who is accountable for ensuring that the registered nurse (RN) has access to documented competency information for staff to whom the RN is delegating tasks? A. The organization/agency B. The nurse leader C. The nurse supervisor D. The safety office
A. The organization/agency
Heidenthal and Marthaler (2005) state that what to delegate depends on all of the following factors except: A. Your state's nurse practice act B. Hospital policies and procedures C. What shift you are working D. The clinical situation
C. What shift you are working
Barriers to delegation can arise for which of the following health care workers? A. Registered nurse (RN) delegator B. RN delegate C. Licensed practical nurse (LPN) D. All of the above
D. All of the above
The nursing team consists of the nurse, two LPNs, and two UAPs. It is most appropriate for the nurse to care for which client? a. A client with ride-sided weakness requiring assistance with morning care. b. A client requiring administration of digoxin and furosimide via an NG tube. c. A client whose adult child is upset because the client is diagnosed with terminal cancer. d. A client who is 24 hours after a laminectomy with spinal fusion and is having difficulty voiding.
d. A client who is 24 hours after a laminectomy with spinal fusion and is having difficulty voiding. This is the most unstable client and requires the skills of an RN
Many long-term care facilities assign ________________as charge nurses. A. Registered nurses (RNs) B. Licensed practical nurses (LPNs) C. Nursing supervisors D. Nurse externs
B. Licensed practical nurses (LPNs)
What are the five rights of delegation per the National Council of State Boards of Nursing (1997)? A. Right task, right circumstance, right person, right direction/communication, right unit B. Right task, right circumstance, right medication, right direction/communication, right supervision C. Right task, right circumstance, right person, right direction/communication, right supervision D. Right task, right time, right person, right direction/communication, right supervision
C. Right task, right circumstance, right person, right direction/communication, right supervision
An RN from the maternity floor is reassigned to the emergency department. Which assignment is MOST appropriate for the maternity nurse? 1. The client at 20 weeks gestation reporting a small amount of vaginal bleeding 2. The client being admitted for suicidal thoughts 3. The client reporting numbness and tingling on the right side 4. The client being admitted for chest pain
1. The client at 20 weeks gestation reporting a small amount of vaginal bleeding The maternity nurse has knowledge and abilities to care for this client
When accepting a delegated assignment, what does the nurse use per the State of New Jersey Nurse Practice Act, 1999? A. A nursing matrix B. A decision-making algorithm C. Facility policy D. Facility procedure
B. A decision-making algorithm
When delegating, the requirement of the right _________ means that you must know the competency level, job description, individual level of skill, and education of the individual to whom you are delegating. A. Direction/communication B. Person C. Task D. Circumstance
B. Person
Some activities may not be delegated. All of the following may be delegated except: A. Performing an initial patient assessment B. Updating the patient's plan of care C. Providing direct nursing care D. Giving a registered nurse (RN) a needle and syringe, unlabeled, and telling her to administer the medication even though the RN did not see the medication prepared
D. Giving a registered nurse (RN) a needle and syringe, unlabeled, and telling her to administer the medication even though the RN did not see the medication prepared
The _________nurse no longer relies on rules to understand a situation or to act appropriately; focuses quickly on viable solutions; is able to lead a team efficiently; can organize others' work and supervise them effectively. A. Novice B. Expert C. Competent D. Proficient
D. Proficient
Which of the following is not a principle of delegation? A. The nursing profession determines the scope and standards of nursing practice. B. The registered nurse (RN) takes responsibility and accountability for the provision of nursing practice. C. The RN directs care and determines the appropriate use of resources when providing care. D. The licensed practical nurse (LPN) can delegate tasks to the nursing assistant.
D. The licensed practical nurse (LPN) can delegate tasks to the nursing assistant.
The charge nurse is having difficulty making an assignment for the nursing team. Which assessment by the supervisor helps the charge nurse make the assignment for the day shift? a. "Describe the knowledge and skill level of each member of your team." b. "Do you know which assignment each staff member prefers?" c. How long has each staff member been employed on the unit?" d. "Do you know if any staff members are working OT today?"
a. "Describe the knowledge and skill level of each member of your team." Five rights of delegation: Task, Circumstances, Person, Direction, and Supervision
When delegating, it is important that the RN know the knowledge and skills of the person to whom they are delegating a task. Which of the following delegations would require an immediate intervention by the RN? a. A UAP changes a dressing on a patient prior to discharge. b. An LPN changes a dressing on a patient prior to discharge. c. An RN changes a dressing on a patient prior to discharge. d. A senior student nurse changes a dressing on a patient prior to discharge.
a. A UAP changes a dressing on a patient prior to discharge. Option A is correct because according to the nurse practice acts of most states, the UAP is not authorized to change dressings because it requires an assessment, which they are not allowed to do and would require an intervention. Each individual institution may authorize enhanced practices to UAP, but NCLEX does not recognize this as appropriate. The other options are appropriate interventions and do not require an intervention.
The RN is working on a medical unit with an LPN and a UAP as the team members. Which tasks should the charge nurse complete? a. Assignments of new admissions to staff b. IV medications for all patients c. Regulation of heparin drip based on the heparin nomogram d. Discharge instructions for a patient going home
a. Assignments of new admissions to staff Option A is correct because the charge nurse is responsible for management of the shift and therefore assignments of new admissions. Options B, C, and D are incorrect because these would be assigned to the RN.
The nursing team consists of two nurses, two LPNS/LVNS, and two UAPs. Which task does the nurse assign to a UAP? a. Assist an older adult client with lunch b. Administer famotidine to a client at 0800. c. change a dressing for a postoperative client. d. Instruct a client about signs and symptoms of lithium toxicity.
a. Assist an older adult client with lunch Stable client with standard, unchanging procedures
The nursing team consists of two nurses, two LPNs, and two UAPs. The nurse considers the assignment appropriate if an LPN is required to complete which of the following tasks? a. Perform a sterile dressing b. Obtain vital signs c. Stock supplies of syringes and dressings d. Transfer a stable client to x-ray.
a. Perform a sterile dressing LPNs assist with implementation of care, perform procedures, differentiate normal from abnormal, care for stable clients with predictable outcomes, have knowledge of asepsis and dressing changes, and may administer meds depending on educational background and state nurse practice acts.
A client diagnosed with a stroke is admitted. The nurse notes the client has difficulty swallowing and requires assistance with bathing, toileting, and feeding. The delegation is appropriate if the nurse delegates the tasks of bathing and toileting to which staff member? a. The UAP b. The LPN c. The speech therapist d. The respiratory therapist
a. The UAP UAPs can assist with direct client care activities and ADLs in stable patients.
The nursing team caring for clients on the pediatric unit consists of one nurse, two LPNs, and three UAPs. Which client does the nurse assign to the UAP? a. The client who needs help socializing with other children. b. The client requiring an 0800 insulin injection. c. The client reporting abdominal tenderness in the
a. The client who needs help socializing with other children. The other options require a med pass, or assessment to assist the client
The nurse discusses delegation with a new nurse. Which statement by the new nurse indicates an understanding of the meaning of delegation? a. "Delegation means that the nurse is able to accept responsibility for the nursing actions and results." b. "Delegation occurs when the nurse assigns a specific function or aspect of client care to an LPN or UAP." c. "Delegation occurs when the nurse assigns a task the nurse does not have time to complete to another staff member." d. "Delegation means being obligated to accomplish the assigned work."
b. "Delegation occurs when the nurse assigns a specific function or aspect of client care to an LPN or UAP." Delegation is the reassignment of responsibility for the performance of a specific job from one person to another. Staff member's skills and abilities must be assessed prior to delegation.
The nurse is working on a surgical unit with an LPN and a UAP as the team members. Which tasks should the LPN complete? a. Take vital signs on a newly transferred patient from the PACU. b. Change dressing on a patient 4 days after a BKA. c. Reposition a patient 4 days after a BKA. d. Notify the physician of a BP change in a postoperative patient.
b. Change dressing on a patient 4 days after a BKA. Option B is correct because LPNs are authorized to change dressings and make stable assessments. Option C can be accomplished by the UAP. Options A and D are incorrect because they would require the RN because it is a change in patient stability.
When working in an ICU, which of the following actions by the UAP requires immediate intervention by the RN? (Select all that apply.) a. Replacing a colostomy bag after cleansing the stoma b. Changing the IV drip rate as ordered by the physician c. Applying an antifungal powder to a patient's groin d. Administering saline nasal spray to a patient complaining of dry nasal passages e. Emptying the urinary draining device
b. Changing the IV drip rate as ordered by the physician c. Applying an antifungal powder to a patient's groin d. Administering saline nasal spray to a patient complaining of dry nasal passages Options B, C, and D are correct because medication administration is only allowed by the RN even in the ICU setting. Options A and E are allowed by the UAP because it does not require an assessment.
The nurse is working on a surgical unit with an LPN and a UAP as the team members. Which tasks should the RN complete? a. Change dressing on a patient 4 days after a below-knee amputation (BKA). b. Feed a patient who had a cardiovascular accident (CVA) 3 days ago. c. Turn a patient who had a CVA 4 days ago. d. Record the intake and output (I&O) on a patient on strict fluid restrictions.
b. Feed a patient who had a cardiovascular accident (CVA) 3 days ago. Option B is correct because of the potential of aspiration in CVA patients when eating, the RN is the only staff member authorized to feed this patient. Option A is incorrect because this can be accomplished by the LPN because it is a stable assessment. Options C and D are incorrect because these are allowed by the UAP.
A patient turns his call light on and states his "abdominal wound dressing needs changing." Which team member is most appropriately delegated to respond to this call light? a. RN b. LPN c. Senior student nurse d. UAP
b. LPN Option B is correct although the RN or student nurse could change the dressing, the best use of staff is to delegate the change to the LPN. Options A and C are not the best answer. Option D is inappropriate because the task requires an assessment.
The nurse delegates care to be provided during the shift to the team members. Which duty can the nurse safely and appropriately delegate to the LPN? a. Perform a venipuncture and start and IV drip. b. Perform a dressing change with sterile procedure. c. Hang a unit of packed red blood cells (PRBCs) d. Perform a urethral catheterization on a post-TURP client
b. Perform a dressing change with sterile procedure. Sterile dressing changes are within the scope of practice for LPNs in all states.
The nursing team consists of one nurse, one LPN, and two UAPs. Which is the most appropriate delegation of client care activities? a. The UAP should perform suctioning. b. The LPN should perform sterile wound care and dressing changes. c. The UAP should administer subcutaneous medications. d. The nurse should perform bed baths and record intake and output.
b. The LPN should perform sterile wound care and dressing changes. LPNs can perform some invasive tasks such as dressing changes, catheterization, and suctioning. They cannot administer blood, but may take vitals.
The charge nurse supervises care of clients on the Med-Surg unit. The charge nurse determines care is apporpriate if which task is delegated to the UAP? a. The client diagnosed with a peptic ulcer requiring the morning dose of famotidine b. The client diagnosed with COPD needing vital signs taken c. The client diagnosed with Diabetes Type II requiring discharge instructions d. The client on the day of surgery requiring a sterile dressing change
b. The client diagnosed with COPD needing vital signs taken Standard and routine task. RN can delegate, but is still responsible for the action and the results.
The RN assesses clients for the day shift. The nursing team includes one RN, two LPNs, and four NAP. THe nurse determines assignments are appropriate if which client is assigned to the NAP? a. The client diagnosed with Crohn's disease requiring a sterile dressing change. b. The client diagnosed with chronic kidney failure requiring intake and output. c. The client diagnosed with full thickness burns requiring IV morphine prior to a dressing change. d. The client diagnosed with cancer of the lung reporting a headache.
b. The client diagnosed with chronic kidney failure requiring intake and output. NAPs can assist with direct client care activities. Responsibility of task is transferred, but the accountability for the process is still with the delegator.
The nursing team caring for clients on the pediatric unit consists of two nurses, two LPNs, and two UAPs. Which client does the nurse assign to the LPN? a. The client admitted with asthma b. The client in a balanced suspension traction for a fractured left femur. c. The client admitted with intestinal bleeding d. The client admitted for ingesting a grandparents anti-hypertensive medication.
b. The client in a balanced suspension traction for a fractured left femur. The nurse will ensure the weights hang freely, and frequently inspect the skin for areas of breakdown. The LPN can care for the client with balanced suspension traction.
The nursing team consists of two nurses, two LPNs, and two UAPs. Which client assigned to the LPN does the LPN question? a. The infant client requiring a bath prior to discharge b. The infant client with a palpable olive-shaped mass in the epigastrium and frequent vomiting c. The infant client requiring eye drops instilled d. The client requiring a rectal temp every 6 hours.
b. The infant client with a palpable olive-shaped mass in the epigastrium and frequent vomiting This indicates pyloric stenosis. The client is not stable and requires further assessment from the RN
Which would require an immediate intervention by the RN? a. An LPN administers oral pain medications to a patient. b. An RN administers oral pain medications to a patient. c. A UAP administers oral pain medications to a patient. d. A senior student nurse administers oral pain medications to a patient.
c. A UAP administers oral pain medications to a patient. Option C is correct because UAPs are not authorized by the state nursing practice acts to administer medications and would require an intervention. The other options are incorrect because this staff member is allowed to administer medications and does not require an intervention.
The nurse from the psychiatric unit is reassigned to the pediatric unit. Which client assignment is most appropriate for this nurse? a. A preschool-age client diagnosed with type 1 diabetes admitted with a blood glucose of 370 mg/dL and reporting thirst and frequent urination. b. A school age client diagnosed with hemophilia requiring discharge instructions about appropriate and safe sports. c. A toddler client with a superficial partial thickness burn to the right thigh who cries and screams whenever the parent tries to leave the room. d. An adolescent client with a newly diagnosed brain tumor reporting headaches and left sided weakness.
c. A toddler client with a superficial partial thickness burn to the right thigh who cries and screams whenever the parent tries to leave the room. A toddler experiencing separation anxiety is stable at this time and would be appropriate.
The nursing team consists of two RNs, one LPNs, and two UAPs. The nurse considers the assignment appropriate if the LPN is required to complete which task? a. Obtain vital signs for the client immediately and ECT. b. Assist the client with bathing and feeding c. Administer a tube feeding for the client with dysphagia. d. Discharge the client with multiple sclerosis.
c. Administer a tube feeding for the client with dysphagia. Stable patient with expected outcomes
Which delegations would require an immediate intervention by the RN? a. A senior student nurse makes a telephone call to a physician. b. A senior student nurse discusses a patient's condition with a physician. c. A senior student nurse calls a physician to report lab data on a patient. d. A senior student nurse takes an order from the physician.
d. A senior student nurse takes an order from the physician. Option D is correct because student nurses at any level are not licensed and therefore are not authorized to take orders from physicians or other health care providers and thus would require an intervention. The other options are appropriate actions of a student nurse as long as orders are not received and does not require an intervention.
The RN has received and assignment for the night shift. Which task is appropriate for the nurse to delegate to a UAP with 20 years experience? a. Assess the breathing pattern of an asthmatic client. b. <onitor a client who is expectorating rust-colored sputum. c. Administer codeine to a post-op client d. Bathe a client prior to the scheduled 0600 surgery.
d. Bathe a client prior to the scheduled 0600 surgery. This is a standard unchanging procedure that can be done by the UAP
The nurse is working on a surgical unit with an LPN and a UAP as the team members. Which tasks should the UAP complete? a. Ambulate a patient 1 day after a thoracotomy. b. Adjust the oxygen level on a patient complaining of shortness of breath. c. Replace the nasal cannula on a patient who has pulled it out of her nose after becoming confused. d. Record the output from a Pleur-Evac.
d. Record the output from a Pleur-Evac. Option D is correct as the UAP can record I&O because it does not require an assessment. The other options are incorrect because those actions are only allowed by the RN because it requires an assessment.
The nurse receives the assignment for the day shift. Which client is appropriate for the nurse to delegate to the LPN with 30 years of experience? a. The adult client reporting chest pain and dyspnea. b. the pediatric client with an abdominal mass that is firm and deep and confined to one side c. the pediatric client reporting polyuria and polydipsia. d. The adult client three days post-op requiring a dressing change.
d. The adult client three days post-op requiring a dressing change. Stable client with a predictable outcome. LPNs are licensed and trained to perform wound care.
The nurse receives a report and assesses assigned client on the unit. It is most appropriate for the nurse to assign which client to the care of the LPN? a. The client newly admitted with a diagnosis of MI, recovering from a heart catheterization. b. The client with a diagnosis of heart failure who also expresses frequent suicidal thoughts. The client diagnosed with full-thickness burns covering 40% of the body. d. The client diagnosed with COPD who requires ambulation twice during the evening.
d. The client diagnosed with COPD who requires ambulation twice during the evening. Client is stable with a predictable outcome. The RN may reinforce COPD teaching to the LPN and will be required to reassess the client status throughout the shift.
The nursing team on the pediatric unit consists of one RN, one LPN, and two UAPs. Which client does the nurse assign to the UAP? a. The client admitted with vomiting, weight loss, and abdominal pain b. The client admitted with decreased hemoglobin and hematocrit reporting fatigue c. The client diagnosed with a UTI who requires discharge instructions. d. The infant client requiring antibiotic ointment on the circumcision site.
d. The infant client requiring antibiotic ointment on the circumcision site. The client is stable with a predictable outcome. -Other answers require an assessment from the RN
A patient turns his call light on and requests assistance to the bathroom. Which team member is most appropriately delegated to respond to this patient? a. RN b. LPN c. Student nurse d. UAP
d. UAP Option D is correct because all of the choices could accomplish this task, but it is most appropriately delegated to the UAP. Option A is incorrect because an RN may provide the patient-requested urinal, but it is not good utilization of staff. Option B is incorrect because an LPN may provide the patient-requested urinal, but it is not good utilization of staff. Option C is incorrect because the student nurse may provide the patient-requested urinal, but it is not good utilization of staff.
The LPN from the Med-Surg unit is sent to the ED to help. To which client can the LPN be assigned? a. An infant client experiencing seizures. b. A pregnant client having vaginal bleeding c. The client with chest pain d. the client with an infected surgical wound.
d. the client with an infected surgical wound. This client has a condition the LPN has likely dealt with on the Med-Surg floor. The client is stable with a more predictable outcome.