Delegation in Nursing
The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an assistive personnel (AP)? a) A client requiring a colostomy irrigation b) A client receiving continuous tube feedings c) A client who requires urine specimen collections d) A client with difficulty swallowing foods and fluids
c) A client who requires urine specimen collections The AP is trained in this routine procedure.
As the RN, you are making the patient assignments for the next shift. Which patient would you assign to the LPN? a) A 68-year-old male patient experiencing atrial fibrillation and is receiving a Diltiazem drip. b) A 25-year-old female patient newly admitted with diabetic ketoacidosis. c) An 85-year-old female patient with Alzheimer's disease who has a colostomy and scheduled tube feedings. d) A 45-year-old male patient who is ordered to receive 2 units of pack red blood cells.
c) An 85-year-old female patient with Alzheimer's disease who has a colostomy and scheduled tube feedings
The nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The nurse needs to assign four clients and has a licensed practical nurse and 3 assistive personnel (APs) on a nursing team. Which client would the nurse most appropriately assign to the licensed practical nurse (LPN)? a) A client who requires a bed bath b) An older client requiring frequent ambulation c) A client who requires hourly vital sign measurements d) A client requiring abdominal wound irrigations and dressing changes every 3 hours
d) A client requiring abdominal wound irrigations and dressing changes every 3 hours The LPN is skilled in wound irrigations and dressing changes.
You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP? a) Assisting the patient with oral hygiene b) Evaluating the patient's response to feedings c) Educating the patient about oral care d) Assessing lung sounds
A
True or False? An RN can delegate the following task to an experienced LPN: Evaluating a patient's understanding of how to administer subQ injections of enoxaparin sodium (Lovenox)
False
True or False? An RN should NOT delegate the following task to an LPN: Providing wound care to a stage 3 pressure injury
False
A client requiring a platelet transfusion. Who should this be delegated to? (Choose one) - RN - LPN - UAP
RN
A client with respiratory failure on a mechanical ventilator. Who should this be delegated to? (Choose one) - RN - LPN - UAP
RN
Give preoperative teaching to a client about a patient-controlled analgesia (PCA). Who should this task be delegated to? (Choose one) - RN - LPN - UAP
RN
Perform admission assessments on a client admitted for chest pain and shortness of breath. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
RN
Check color and temperature for a client with a forearm cast. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
LPN
True or False? An RN can delegate the following task to an experienced LPN: Performing an assessment on a new admission
False
True or False? An RN can delegate the following task to an experienced LPN: Administering an influenza vaccine
True
True or False? An RN can delegate the following task to an experienced LPN: Auscultating lung and bowel sounds
True
True or False? An RN can delegate the following task to an experienced LPN: Collecting a urine sample from an indwelling Foley catheter
True
True or False? An RN should NOT delegate the following task to an LPN: Starting a blood transfusion
True
On our unit there are two RNs: one is a new RN and the other is an experienced RN. In addition, there are three LPNs and two nursing assistants. Which tasks delegated to one of the nursing assistants by the new RN needs to be reevaluated? (SATA) a) Apply hydrocortisone cream to eczema on skin after giving the patient a bath b) Assist the patient with administering a Fleet Enema c) Emptying an ostomy bag d) Collecting and recording patient's blood pressure, heart rate, temperature, oxygen saturation, respirations, and pain rating e) Assist a patient with ambulating
A & B
Which patients below are best assigned to the LPN? a) A 30-year-old male patient with active GI bleeding that requires multiple blood transfusions. b) A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker. c) A 29-year-old male patient who is post-op day 6 from a colostomy placement that is on a clear liquid diet. d) A 55-year-old male patient who reports chest pain and has ST segment elevation on his EKG.
B & C Rationale: LPNs should be assigned STABLE patients with predicable outcomes and cases that don't require critical thinking or complex analysis. The patients in options A and D are unstable and require constant care with decisions being based on how to interpret patient findings.
You're making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs? Select all that apply: a) A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy. b) A 25 year-old female patient newly admitted with diabetic ketoacidosis. c) A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings. d) A 65 year-old female patient who has an order to remove the Foley catheter.
C & D
Select all the task you could delegate to a nursing assistant as the RN: a) Wound dressing change b) IV flush c) Collecting vital signs d) Weighing a patient e) Mouth care f) Suctioning a patient g) Applying oxygen to a patient h) Connecting a patient to their IV fluids i) Assisting a patient with a bath j) Applying denture paste to dentures
C, D, E, I, J
True or False? An RN should NOT delegate the following task to an LPN: Performing an assessment on a new admission
True
The nurse is making assignments for the unlicensed assistive personnel. Which tasks can be safely assigned to the UAP? (SATA) a) Assisting an alert and oriented client with a chest tube during ambulation b) Feeding an alert and oriented client with aspiration PNA c) Teaching a stable client how to use a cane d) Bathing a client with Alzheimer's disease that is A+O x1 e) Turning a client who is poorly nourished f) Performing venipuncture on a client admitted for a PE two days ago
D, E, F
6. An RN has a critical patient that needs constant monitoring. However, the RN also has other patients in need of care. Which tasks below could the RN delegate to the LPN to help continue the process of patient care? a) Admitting and assessing the new admission b) Completing the discharge teaching to a patient going home c) Updating and evaluating the patient's plan of care d) Administering subcutaneous Heparin e) Obtaining a routine 12-lead EKG f) Collecting a stool specimen g) Flushing a central line with normal saline
D, E, F Rationale: These are all tasks an LPN can perform. They are routine procedures that usually have predictable outcomes. RNs are responsible for performing assessments on new admissions, teaching, evaluating, flushing and maintain central lines, and updating the patient's plan of care.
A client who requires a bed bath and range of motion exercises. Who should this be delegated to? (Choose one) - RN - LPN - UAP
UAP
A client who requires frequent ambulation and has a steady gait. Who should this be delegated to? (Choose one) - RN - LPN - UAP
UAP
A client who requires hourly pulse and blood pressure measurements. Who should this be delegated to? (Choose one) - RN - LPN - UAP
UAP
Assist a client to turn every 2 hours. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
UAP
Assist clients to ambulate in the hallway, as ordered by the Healthcare Provider (HCP). Who should this task be delegated to? (Choose one) - RN - LPN - UAP
UAP
Change linens for clients as needed. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
UAP
True or False? An RN can delegate the following task to an experienced LPN: Developing a plan of care for a patient who is admitted with Guillain-Barre Syndrome
False
True or False? An RN can delegate the following task to an experienced LPN: Educating a patient about how to monitor for side effects associated with Warfarin
False
True or False? An RN should NOT delegate the following task to an LPN: Auscultating lung and bowel sounds
False
True or False? An RN should NOT delegate the following task to an LPN: Collecting a urine sample from an indwelling Foley catheter
False
A client receiving continuous tube feedings. Who should this be delegated to? (Choose one) - RN - LPN - UAP
LPN
A client requiring abdominal wound irrigations and dressing changes every three hours. Who should this be delegated to? (Choose one) - RN - LPN - UAP
LPN
A client who requires a colostomy irrigation. Who should this be delegated to? (Choose one) - RN - LPN - UAP
LPN
Assess for pain on a client who has a kidney stone. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
LPN
True or False? An RN should NOT delegate the following task to an LPN: Administering IV Morphine 2 mg for pain
True
True or False? An RN should NOT delegate the following task to an LPN: Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome
True
True or False? An RN should NOT delegate the following task to an LPN: Educating a patient about how to monitor for side effects associated with Warfarin
True
The nurse in charge of a long-term care facility is planning the client assignments for the day. Which client should be assigned to the assistive personnel (AP)? a) A client on strict bed rest b) A client with dyspnea who is receiving oxygen therapy c) A client scheduled for transfer to the hospital for surgery d) A client with a gastrostomy tube who requires tube feedings every 4 hours
a) A client on strict bed rest All other responses require physiological and psychosocial needs that require care by a licensed nurse. The AP has been trained to care for a client on bed rest.
Assess relief of heat application for a client with lower back pain. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
LPN
Take vital signs every 4 hours as directed. Who should this task be delegated to? (Choose one) - RN - LPN - UAP
UAP
You're making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs? SATA a) A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy. b) A 25 year-old female patient newly admitted with diabetic ketoacidosis. c) A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings. d) A 65 year-old female patient who has an order to remove a Foley catheter.
C & D: These are standard routine procedures the LPN can perform and these patient cases are stable. ADDITIONAL RATIONALE: a) An RN is the best for this patient because the patient will need discharge teaching AND the nurse will need to teach the patient how to self-administer antibiotics. b) This is a new admission and the patient is UNSTABLE. Most patients with DKA (diabetic ketoacidosis) require insulin drips along with close monitoring of the blood glucose levels, which requires critical thinking and interpretation.
