Delegation
Which of the following tasks would the charge nurse on a surgical unit assign to the experienced unlicensed assistive personnel (UAP)? 1. Assisting a client in ambulating to the bathroom for the first time following surgery(9%) 2. Explaining why using the incentive spirometer is important to a client with postoperative pneumonia(0%) 3. Feeding a client with dementia who has a blood sugar of 70 mg/dL (3.9 mmol/L)(79%) 4. Taking vital signs every 15 minutes on a client who was just transferred from the post- anesthesia recovery unit(10%)
The charge nurse must know the UAP's level of knowledge and competency in relation to the task and be familiar with institutional policy and procedures before delegating the task. Routine tasks, such as taking vital signs, supervising ambulation, bed making, assisting with hygiene, and activities of daily living, can be delegated to an experienced UAP. The charge nurse appropriately delegates the routine task of feeding to the UAP. The general procedure and safety principles associated with feeding (positioning, observations about swallowing, recording intake) do not change because of the client's diagnosis of dementia. Normal fasting blood glucose levels are 70-110 mg/dL (3.9-6.1 mmol/L). (Option 1) It is not appropriate for the UAP to independently assist a client in ambulating for the first time following surgery as it requires assessment of potential postoperative complications and evaluation of ability to ambulate. (Option 2) Initial teaching/explaining about the use of incentive spirometer is the sole responsibility of the registered nurse (RN). (Option 4) Taking vital signs in an unstable newly postoperative client requires assessment of potential postoperative complications and is not appropriate to delegate to the UAP.
The clinical coordinator registered nurse (RN) on a surgical unit makes assignments for the staff of RN, licensed practical nurse, and graduate nurse. Which assignment is most appropriate for a new graduate nurse? 1. A 36-year-old client with postoperative venous thromboembolism who is to be started on the institution's intravenous heparin therapy protocol this morning (39%) 2. A 56-year-old client with newly diagnosed cancer, scheduled for a total laryngectomy this morning, who is now refusing surgery(9%) 3. A 68-year-old client with multiple sclerosis, 2 days postoperative open cholecystectomy with recurrent mucous plugs, who is scheduled for a bronchoscopy this morning(43%) 4. An 80-year-old client, 3 days postoperative colectomy with peritonitis, who was mentally alert before and develops new-onset confusion this morning(7%)
To prepare a client for a bronchoscopy, the nurse must be able to perform basic assessment skills, such as assessing vital signs, lung sounds, ability to swallow, and gag reflex; maintain nothing-by-mouth status; prepare a checklist before the procedure; and monitor for respiratory difficulty after the procedure. Because these are skills a graduate nurse possesses, this is an appropriate assignment. (Option 1) Initiating a heparin infusion according to institution protocol involves collecting baseline serum specimens (eg, partial thromboplastin time [aPTT], International Normalized Ratio [INR], prothrombin time, platelets, hemoglobin, hematocrit), calculating weight-based dosages, (eg, bolus dose, infusion rate in units/hr), and calculating intravenous infusion pump hourly rate. Serum aPTT and INR levels are monitored every 6 hours or according to protocol. Frequent changes in rate or dose based on these levels may be necessary to maintain a therapeutic level of heparin. For these reasons, this is not an appropriate assignment for a new graduate nurse. (Option 2) A client with newly diagnosed cancer who is refusing radical surgery that will result in the loss of speech and inability to communicate normally is demonstrating fear and anxiety. This client needs preoperative teaching about the surgical procedure, what to expect immediately after surgery, methods for speech restoration, and general preoperative teaching (eg, deep breathing, suctioning, pain management). Emotional support, education, and advanced therapeutic communication skills are necessary to help allay fear and anxiety. For these reasons, this is not an appropriate assignment for a new graduate nurse. (Option 4) The elderly client with new-onset confusion is at risk for developing hospital-induced delirium related to advanced age, surgery, hypoxia, fluid and electrolyte disturbances, immobility, pain, and/or drugs. The nurse must perform neurological assessments to determine the cause and intervene appropriately. For these reasons, it is not an appropriate assignment for a new graduate nurse.
The registered nurse (RN) and practical nurse (PN) are caring for a client who was admitted to the medical unit last night with a moderate asthma exacerbation and an upper respiratory infection. Which tasks are appropriate for the RN to delegate to the PN? Select all that apply. 1. Administering albuterol metered-dose inhaler medication 2. Auscultating lung sounds to determine the response to a bronchodilator 3. Checking oxygen saturation with the pulse oximeter 4. Measuring morning peak expiratory flow with the client's peak flow meter 5. Teaching the client about a newly prescribed inhaled corticosteroid
When delegating tasks, the registered nurse (RN) should consider the 5 rights of delegation along with the scope of practice. The scope of practice for a practical nurse (PN) includes administering medications, although regulations related to narcotics and IV medications vary by state (Option 1). Based on staff member availability, it can also be appropriate to perform or delegate tasks below the scope of a given staff member (eg, delegating vital signs to a PN, an RN performing ostomy care) (Option 3). Measuring peak expiratory flow with a peak flow meter is also within the scope of practice for a PN (Option 4). (Option 2) The PN can collect data (eg, auscultating breath sounds, observing for accessory muscle use). However, evaluation of the collected data (ie, determining the client's response to a bronchodilator medication) is the responsibility of the RN, as it requires use of the nursing process. (Option 5) PNs are able to reinforce education initiated by the RN. However, providing teaching on new topics may not be delegated to the PN.
The registered nurse (RN) on a medical-surgical unit is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which tasks are most appropriate to assign to the LPN? Select all that apply. 1. Administering a scheduled analgesic to a client with chronic back pain currently rated 8/10 2. Assessing fluid volume status of a client with heart failure who is scheduled for discharge 3. Assisting with bathing, feeding, and dressing a client with multiple sclerosis 4. Performing wound care and sterile dressing change for a client with a stasis ulcer 5. Providing incontinence care and linen change for a client with diarrhea
Wound care and routine medication administration are the most appropriate tasks to assign to the LPN. The LPN can perform sterile procedures and cleanse and dress wounds for which there is an established prescription plan (Option 4). Pain rated at 8/10 is an expected finding in a client with chronic back pain, and the oral analgesic may be administered as scheduled by the LPN (Option 1). If this client were experiencing new-onset, unexplained pain requiring intravenous analgesic administration, the client would need assessment by the RN. (Option 2) The LPN may perform specific assessments, but evaluating the fluid volume status of a heart failure client is a comprehensive assessment involving multiple body systems (eg, heart and lung sounds, peripheral edema, adequacy of urine output). This client will also require discharge education on home management of heart failure, which is the responsibility of the RN. (Options 3 and 5) UAP have the appropriate skills and knowledge to meet clients' elimination, hygiene, and comfort needs. Although these tasks could be safely carried out by an LPN, underutilizing UAP would be an ineffective use of resources.
A float nurse from labor and delivery is assigned to the cardiac care unit. Which client is most appropriate for the charge nurse to assign to the float nurse? 1. Client 3 days following a myocardial infarction who is on 6 L of oxygen and reports nausea(12%) 2. Client admitted for hypertensive crisis with blood pressure of 154/92 mm Hg on amlodipine PO(30%) 3. Client with a demand pacemaker set at 70/min who has a ventricular rate of 65/min(5%) 4. Client with angina at rest who has normal troponin levels and normal sinus rhythm on ECG(51%)
A hypertensive crisis is an elevation in blood pressure (BP) >180 mm Hg systolic and/or >120 mm Hg diastolic with evidence of organ damage (eg, kidney damage, retinopathy). The goal of treatment is to slowly lower BP using IV antihypertensive medications (eg, vasodilators) to limit end-organ damage. Once the client's condition is stabilized, oral antihypertensives are prescribed and IV medications are titrated off. Float nurse assignments should be made on the basis of what is within the knowledge and skill of the generalist nurse. The float nurse can safely care for the client whose BP is controlled by oral medication, and has the knowledge and skill to assess vital signs (Option 2). (Option 1) The client with a history of myocardial infarction showing signs of reinfarction (eg, nausea, increased oxygen demands) may be unstable and should not be assigned to the float nurse. (Option 3) A ventricular rate of 65/min observed in a client with a demand pacemaker rate of 70/min indicates a malfunction in sensing or capturing the client's heart rate. An experienced cardiac nurse should care for this client. (Option 4) Unstable angina (angina at rest) is a medical emergency that requires specialist-level monitoring and intervention.
The registered nurse is caring for multiple clients on a medical-surgical unit and has finished the morning assessment. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel? 1. Apply a collagenase dressing to a client's pressure ulcer for wound debridement(2%) 2. Assist a client 1 day postoperative hip fracture repair to the bathroom(42%) 3. Feed a client through a gastrostomy tube after elevating the head of the bed(10%) 4. Offer orange juice to a client if the blood glucose level is <70 mg/dL (<3.9 mmol/L)(43%)
Delegation is the process of transferring responsibility of performing a task while maintaining the ultimate responsibility for the action and its outcome. The registered nurse (RN) should take into account the five rights of delegation (right task, right person, right circumstances, right communication/direction, and right supervision/evaluation) and the scope of practice when deciding which tasks to delegate. The unlicensed assistive personnel (UAP) can assist clients out of bedor to the bathroom, assist with activities of daily living, and position clients. The RN is responsible for assessing the client and adhering to the nursing process. (Option 1) Debridement of a wound involves removing debris or dead tissue to convert contaminated wounds into clean wounds so that normal healing can take place. Dressing (eg, collagenase) changes for debridement require sterile technique; UAP can change dressings only for chronic wounds using clean technique. (Option 3) The UAP can elevate the head of the bed when a client receives enteral nutrition to prevent aspiration. However, feeding through a gastrostomy tube cannot be delegated to the UAP as it requires assessment of tube placement and aspiration of gastric residual volume. (Option 4) Offering orange juice is an intervention for treating hypoglycemia that is outside the UAP's scope of practice. The UAP should report the blood glucose level to the RN so that the RN can first reassess the client for accompanying symptoms of hypoglycemia; these would require RN assessment and interpretation before intervention.
The nurse is caring for a client who needs an indwelling urinary catheter inserted for urinary retention. Which tasks would be appropriate to delegate to the unlicensed assistive personnel? Select all that apply. May include LPN jobs! 1. Document output from the urinary collection bag 2. Hold adipose tissue out of the way during catheter insertion 3. Monitor color of the urine after the nurse has assessed it 4. Reinforce education about the purpose of the urinary catheter 5. Secure the catheter to the client's thigh with an anchor
It is within the unlicensed assistive personnel (UAP) scope of practice to document output from a urinary collection bag (Option 1). The UAP can assist the nurse during a procedure by helping to position a client or holding part of the client's body (Option 2). The UAP may also perform routine tasks, such as securing a catheter to the client's thigh with an anchor device (Option 5). (Option 3) A licensed practical nurse (LPN) may monitor for changes after an initial assessment has been performed by a registered nurse (RN), but this is not within the UAP scope of practice. (Option 4) Education should be provided by the RN. Reinforcement of education may be performed by the LPN, but it is not within the UAP scope of practice.
The nurse is making assignments for the next shift. Which client should the nurse assign to the new nurse coming out of orientation? 1. Client diagnosed with chronic anemia receiving iron via IV route(53%) 2. Client newly admitted for uncontrolled diabetes mellitus type 2 with blood glucose >600 mg/dL (33.3 mmol/L)(3%) 3. Client undergoing ultrafiltration for congestive heart failure(3%) 4. Client with a prescription for routine hemodialysis who has chronic renal failure(40%)
The nurse is looking for the most stable client to assign to the new nurse. The client who is scheduled for hemodialysis has a chronic disorder and receives this therapy on a regular basis. There is no indication that this client might be unstable. (Option 1) There is a high incidence of IV iron causing hypersensitivity reactions, including anaphylaxis. Therefore, a test dose needs to be given first. This client should be assigned to a more experienced nurse. (Option 2) The client with hyperglycemia is at high risk for diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic coma. Both are associated with acute and chronic complications and require careful assessment and prompt nursing intervention. This client should also be assigned to a more experienced nurse. (Option 3) Ultrafiltration (removal of excess fluid) is a complex task that requires extra training to perform. It is performed for clients who are not responding to IV diuretics. In addition, clients receiving ultrafiltration are more likely to be hemodynamically unstable due to their advanced heart failure; therefore, it is better for these clients to receive care from an experienced nurse.
The registered nurse (RN) is working with unlicensed assistive personnel (UAP). Which task can the RN safely delegate to the UAP? 1. Assisting a 2-day postoperative hip arthroplasty client with morning care(74%) 2. Collecting a urine specimen for culture and sensitivity from a client with a Foley catheter(21%) 3. Initial change of colostomy bag for a client who is 1-day postoperative colostomy(0%) 4. Refilling the empty enteral feeding container with tube feeding(3%)
The RN should always observe the 5 rights of delegation when considering appropriate task assignments. Bathing along with mouth and skin care are standardized, routine procedures. Therefore, the RN can delegate to the UAP the task of assisting the 2-day postoperative client with morning care. A client who is 2-days postoperative hip arthroplasty is usually stable, but the nurse can reassess the delegated tasks if the client's condition changes. (Option 2) Specimen collection from a Foley catheter is considered a sterile procedure. It involves accessing a sterile collection port, but there is a risk of introducing bacteria into the closed drainage system if done improperly. However, the UAP or even the client may collect a clean-catch or midstream urine specimen when appropriate instructions are given. (Option 3) Changing the colostomy bag for a client with an established stoma (not fresh) can be delegated by the RN to the UAP. However, the RN must first assess the appearance and function of the new colostomy stoma during the initial bag change. This requires nursing knowledge and judgment. The RN is also responsible for providing both initial client education regarding the new colostomy and emotional support as many clients have difficulty adjusting to the change in body image. (Option 4) The RN does not delegate care related to enteral feedings to the UAP as this requires professional nursing skills regarding abdominal and placement assessment, aspiration of residual volumes, and irrigation.
Which client is most appropriate for the charge nurse in the postpartum unit to assign to the float nurse from the intensive care unit? 1. Client experiencing fever and pain with mastitis(36%) 2. Client preparing for discharge after cesarean birth(9%) 3. Client showing disinterest in caring for the newborn(5%) 4. Client with hysterectomy after postpartum hemorrhage(48%)
The client with blood loss leading to a hysterectomy would require close observation of hemodynamic status. Signs could be subtle, and the nurse floating from the intensive care unit would have the assessment skills needed to recognize any changes. (Option 1) Mastitis is a very painful infection. A postpartum nurse would be most familiar with the comfort measures associated with mastitis. (Option 2) A client preparing for discharge after cesarean birth would require an experienced postpartum nurse as discharge instructions would involve teaching related to both the newborn and the client. (Option 3) Psychosocial adjustment after giving birth can be complex. An experienced postpartum nurse would be trained to assess for signs of adjustment issues.
The nurse is preparing to administer a unit of packed red blood cells to a client whose hemoglobin is 7 g/dL (70 g/L). What tasks can the nurse delegate to unlicensed assistive personnel? Select all that apply. 1. Assist with checking identification of the client and the blood product 2. Measure vital signs at the end of the transfusion 3. Measure vital signs prior to starting the transfusion 4. Measure vital signs within the first 10 minutes of starting the transfusion 5. Pick up blood from the blood bank
The registered nurse (RN) is responsible for most of the care rendered to a client during a blood transfusion as this is considered a high-acuity procedure requiring a high level of nursing assessment and judgment. Based on the individual state or provincial practice act and institutional policy, the RN may have assistance from a licensed practical nurse with checking blood products, verifying client identification, and monitoring the blood transfusion rate. Unlicensed assistive personnel (UAP) can obtain the blood product from the blood bank and courier it to the floor where the RN will verify the blood product with another nurse (Option 5). UAP can also take vital signs before the transfusion begins and any time after the first 15 minutes of infusion (Options 2 and 3). (Option 1) Only nurses are able to verify blood product and client identification for blood transfusion procedures. (Option 4) It is the responsibility of the RN to stay with the client during the first 15 minutes of the transfusion, monitor client response, and measure vital signs. A transfusion reaction is most likely to occur during this time. However, the RN may delegate measurement of vital signs after the first 15 minutes.
The registered nurse, licensed practical nurse (LPN), and unlicensed assistive personnel are assigned a client who is being transferred from the post-anesthesia care unit (PACU). Which tasks are the most appropriate to delegate to the LPN? Select all that apply. 1. Assess the client on admission 2. Measure vital signs and pulse oximetry 3. Monitor pain level and administer pain medications 4. Receive verbal report from the PACU nurse 5. Reposition client every 2 hours 6. Titrate oxygen based on unit protocols
The registered nurse (RN) should consider the 5 rights of delegation prior to delegating a task. Tasks such as monitoring pain, administering medications, and titrating oxygen may be delegated by the RN to the licensed practical nurse (LPN) (Options 3 and 6). (Options 1 and 4) The RN receives report from the post-anesthesia care unit nurse, performs initial assessments, and performs other tasks requiring critical judgment (eg, initial teaching, care planning). (Options 2 and 5) Client positioning and measurement of vital signs and pulse oximetry may be delegated to unlicensed assistive personnel (UAP). Although LPNs can carry out these tasks, their time is better spent performing more complex client care (eg, medication administration) if UAP is available.
Which tasks can the registered nurse appropriately delegate to unlicensed assistive personnel? Select all that apply. 1. Assist the registered nurse with ambulating a client 1-day post chest tube placement 2. Measure wound drainage from a bulb drain and document it on the output flow sheet 3. Monitor for redness and swelling at the IV insertion site and report back to the nurse 4. Return an unused unit of packed red blood cells to the blood bank 5. Take family members to the waiting room after the client goes into surgery
Unlicensed assistive personnel (UAP) may perform routine tasks for stable clients under the direction of the registered nurse (RN). Tasks related to the nursing process (eg, assessment, planning, evaluation) require trained knowledge, critical thinking, and individualized application by the RN and cannot be delegated. A client 1-day post chest tube placement must be assessed by the RN to establish safety and readiness for ambulation. However, the UAP can assist the RN in ambulating if appropriate (Option 1). UAP can empty, measure, and record output from a surgical drain. However, the RN is responsible for assessing the drainage (eg, type, amount, odor, color) and maintaining the wound drainage device (Option 2). As directed by the RN, UAP can courier blood products to and from the blood bank (Option 4). However, verification of any blood products must be performed by 2 RNs prior to transfusion. UAP can carry out comfort measures such as escorting family members to the waiting area (Option 5). (Option 3) Although UAP may report observations of abnormal physical signs to the nurse, it is the RN's responsibility to assess the client's ongoing condition. Monitoring of RN findings can be delegated to a licensed practical nurse but not to a UAP.
The nurse is caring for a mechanically ventilated client with a tracheostomy tube in the intensive care unit. What client care tasks can the nurse safely delegate to the unlicensed assistive personnel? Select all that apply. 1. Applying moisturizing solution to the oral mucosa and lips 2. Cleaning the area around tracheostomy stoma with normal saline 3. Educating the family to maintain the head of the bed at least 30 degrees 4. Obtaining and documenting respiratory rate and pulse oximetry readings 5. Performing passive and active range-of-motion exercises
Clients requiring mechanical ventilation receive care from many members of the health care team. Nurses must often delegate tasks to ensure that care is provided in a timely manner. When delegating, nurses must consider the stability of the client and the experience level of unlicensed assistive personnel (UAP). In accordance with the five rights of delegation, nurses may delegate the following client care tasks to the UAP: Performing routine oral care, which will not affect medical stability in a client with a tracheostomy tube (Option 1) Measuring and obtaining vital signs (Option 4) Testing blood glucose (per hospital policy) Performing personal hygiene and skin care (eg, bathing) Performing passive and/or active range-of-motion exercises (Option 5) Measuring output (eg, urinary, drainage) (Option 2) The tracheostomy is a surgically created airway with a high risk of infection. Only licensed individuals (eg, registered nurse, licensed practical nurse) should perform tracheostomy care. (Option 3) Although an elevated head of bed (HOB) is necessary to prevent ventilator-acquired pneumonia and improve chest expansion, teaching is not within the scope of the UAP and should be performed only by nurses. However, after nurses provide teaching, the UAP may remind the family to keep the HOB elevated.
Which of these tasks are appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? Select all that apply. 1. Assign lunch times to the other UAP on the unit 2. Assist a client with a new ostomy with bathing and changing pouches 3. Collect vital signs on a client 4 hours after laparoscopic appendectomy 4. Pick up an intravenous antibiotic from the pharmacy 5. Record intake and output for a client with metabolic alkalosis
The UAP can be delegated tasks that do not require nursing judgment. Any task that involves the nursing process (assessment, diagnosis, planning, implementation, evaluation) requires the attention of the RN. The UAP may gather information (eg, vital signs, intake and output) about stable clients, assist stable clients with activities of daily living, and retrieve necessary supplies, but the RN retains accountability for all of the delegated actions and outcomes (Options 3, 4, and 5). The RN is also responsible for determining the competency level of the UAP prior to delegating tasks. (Option 1) Making staff lunch assignments is part of the management of the unit; therefore, the RN cannot delegate this task. The RN must ensure that there is adequate staff coverage to meet client needs during the assigned lunch times. (Option 2) UAPs can give bed baths to stable, appropriate clients. The client with a new ostomy requires assessment and teaching about cleaning and caring for the ostomy; therefore, an RN must perform this task.
While caring for a client in skeletal traction, which tasks can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) to help prevent immobility hazards? Select all that apply. 1. Assist with active and passive range of motion (ROM) exercises 2. Change bed linens while logrolling the client from side to side 3. Check the color and temperature of the affected extremity 4. Remind the client to use the incentive spirometer 5. Reapply pneumatic compression device after bathing the client
The UAP has the skills and knowledge to perform standard procedures to prevent immobility hazards for a client in traction (eg, pneumonia, pressure ulcers, foot drop, thromboembolism). When providing care for a stable client, the RN can safely delegate these tasks to the UAP: Assist with active and passive ROM exercises after the client has been taught how to perform them by the RN or physical therapist (Option 1) Notify the RN of client reports of pain, tingling, or decreased sensation in the affected extremity Remind the client to use the incentive spirometer after the client has been taught proper use by the RN or respiratory therapist (Option 4) Maintain proper use of pneumatic compression devices (Option 5) Remind the client to move frequently using the overhead trapeze (Option 2) The UAP changes the linens from the top to the bottom of the bed with assistance; clients are instructed to lift themselves using the overhead trapeze. This approach maintains immobilization of the injured extremity. Logrolling the client will require multiple staff members, including one person to stabilize weights. (Option 3) The RN is responsible for peripheral circulation, neurovascular, and skin assessments.
Which client assignment is most appropriate for the nurse on an orthopedic unit to assign to a float nurse from a general medical unit? 1. Client 1-day postoperative with external fixators to stabilize a complex fracture of the wrist(5%) 2. Client 3-days post knee replacement surgery awaiting discharge(28%) 3. Client who is scheduled for an above-the-knee amputation today(12%) 4. Client with a long leg cast applied yesterday morning to treat a fractured ankle(53%)
The client with the cast applied 24-hours ago is stable and is the most appropriate assignment for the float nurse. This client requires the nurse to perform basic pain, peripheral vascular (eg, color, temperature, capillary refill, peripheral pulses, edema), and peripheral neurologic (eg, sensation and motor function) assessments, which should be familiar to a nurse who works on a general medical unit. (Option 1) This client is unstable and requires frequent assessments to identify signs and symptoms of infection and changes in neurovascular status (for compartment syndrome). Pin care is needed as well. (Option 2) The client waiting to be discharged requires extensive discharge teaching about using a continuous passive motion device, weight-bearing restrictions and assistive devices, anticoagulation prophylaxis, and rehabilitation. (Option 3) The client scheduled for an amputation requires preoperative teaching and psychological support specific to this type of surgery (eg, phantom pain, change in body image). Therefore, this client should be assigned to a nurse who is familiar with preparing clients for orthopedic surgery.
