Delegation

LPN's role

-assists with implementation of care -performs procedures -recognized abnormalities -**cares for stable pt's with predictable outcomes -gives meds -has knowledge of aspesis

UAP's role

-direct pt care -ADL's -vital signs -I&O -feeding

A nurse delegates care of clients to the certified nursing assistant (CNA) and licensed practical/vocational nurse (LPN/LVN). Which tasks should the nurse assign to the CNA and LPN/LVN? 1. CNA - check vital signs; LPN - give oral meds to assigned clients 2. CNA - change noninfected dressing; LPN - administer intravenous piggyback (IVPB) medications 3. CNA - ambulate a client who had a stroke; LPN - assess two clients 4. CNA - take vital signs; LPN - complete all admission paperwork

1

After receiving intershift report on a medical nursing unit, the registered nurse (RN) prepares for the work of the day. Which of the following activities can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? Select all that apply. 1. Irrigating a nasogastric tube on a client receiving tube feedings 2. Irrigating a clogged urinary drainage catheter on an older adult client 3. Rechecking vital signs on a post-surgical client with a previous BP of 98/60 mm Hg 4. Changing a dressing on a client admitted with an infected diabetic foot ulcer the previous day 5. Administering a unit packed red blood cells (RBCs) to a client with a hemoglobin of 10.2 grams

1,2

The registered nurse (RN) has completed making client assignments for the shift and is preparing to delegate appropriate nursing care activities to the staff. Which tasks may the RN delegate to the certified nursing assistant (CNA)? Select all that apply. 1. Ambulating a client in the hallway 2. Recording intake and output from meal trays 3. Measuring and recording vital signs 4. Completing a skin risk assessment using the Braden scale 5. Recording a client's oxygen saturation measurements

1,2,3,5

5 rights of delegation

1. right task 2. right circumstance/time 3.right person 4. right direction/communication 5. right supervision/evaluation

A nurse assists a client in room A with lunch. The charge nurse calls the nurse and reports the client in room C reports pain and is requesting pain medication. What is the nurse's best action? 1. Finish feeding client in room A, then medicate client in room C for pain. 2. Stop feeding client in room A and medicate client in room C for pain. 3. Finish feeding client in room A and ask charge nurse to medicate client in room C. 4. Ask charge nurse to feed client in room A while nurse medicates client in room C for pain.

2

Which of the following tasks is it appropriate for the nurse to delegate to an experienced nursing assistant? 1. Obtain a 24 hr. diet recall from a pt. recently admitted with anorexia nervosa. 2. Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection 3. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a patient after a transurethral resection 4. Observe a pt. newly diagnosed with diabetes mellitus practice injection techniques using an orange

2

A client experiences respiratory distress with shallow respirations at a rate of 32/minute. The client has assumed an orthopneic position and is pale and confused. Heart rate is 118 bpm and blood pressure is 90/40 mm Hg. Which task should the nurse delegate to the charge nurse? 1.Completion of a head-to-toe assessment 2. Insertion of a second IV line 3. Application of oxygen per protocol order 4. Paging of the respiratory therapist

2, you need to prepare for STAT meds

A nurse leader reinforces the healthcare agency's vision of client-centered care. The manager supports the clinical environment by doing which of the following? Select all that apply. 1.Putting the nurses' needs first 2.Putting clients' needs first 3.Enhancing quality care 4.Focusing on early client discharge 5.Focusing on safety

2,3,5

A registered nurse (RN) delegates complicated wound care to a licensed practical/vocational nurse (LPN/LVN). The LPN/LVN has only changed this type of dressing once. Which component of delegation has the RN neglected? 1. Authority 2. Competency 3. Communication 4. Responsibility

2. competency

The care delivery system on a medical nursing unit is team nursing. On wing A, there is a registered nurse (RN) and licensed practical/vocational nurse (LPN/LVN) team to care for eight clients. Which tasks should the RN delegate to the LPN/LVN? 1. Vital signs and assessment on a postoperative client 2. Wound care and oral and intravenous (IV) medications for all clients 3. Vital signs and hygiene care on all eight clients 4. Assessments on two young, stable clients

3

The Nursing Team includes 1 LPN and 3 RN's. Select the appropriate patient assignment for the LPN. a. a two year old newly admitted with Rotovirus b. a 10 year old who had a spika cast applied today c. a 5 year old who had an appendectomy 3 days ago d. a 2 month old with RSV,hx. of 26 weeks preemie, BPD, and a feeding tube requiring 24 hr. special care

C

STOP

Story Thing of the answer/option Options Pick and dont change

ABC plus V level of priority

airway, breathing, cardiac status and circulation, and vital signs

LPN and IV's

can only monitor IVs.

LPN nursing process

data collection, planning, implementing and evluating NP ASSESSMENT OR ANALYZING DATA

Prioritization

deciding which needs or problems require immediate action and which can be delayed

What do you do if you feel unprepared or intrained to complete a task?

decline to perform it

second level of priority setting

mental status changes, untreated medical issues, ACUTE PAIN*, acute elimination problems, abnomral laboratory results and risk

third level of priority

more long term issues such as health education, rest, and coping

Can LPN's start IV's?

no they can not start IV's, hang IV's or give IV meds

change of status in pt what do you do first?

notify physician and stay with the pt

according to maslows needs... which comes first physiological or psychological?

physiological!!!

A 5 year old asthmatic client , in acute respiratory distress is in the Emergency Room. You note a large bruise on his back: 1. provide client and patient admission kit 2. Administer oxygen 3. Call Social worker 4. Obtain an O2 saturation

prioritize in this order, 2, 3, 1

A 6 year old post operative tonsillectomy client with old, dried blood in his mouth: 1. Fix leaking IV tubing 2. Assess client's mouth for further frank bleeding 3. Help client clean/rinse mouth 4. Offer a cherry popsicle

prioritize in this order: 2, 1, 3

A 2 year old girl crying for her mother in her crib with a bloody nose: 1. Check/change client's diaper 2. Assist client to stop bloody nose by applying pressure to her nose 3. Hand client her favorite stuffed animal to calm her down 4. Instruct child to blow her nose

prioritize in this order: 2, 3, 1

Supervision

provision, guidance, direction, oversight, evaluation and follow up by the RN of the task delegeated to the UAP

R.N. Practice guide

questions used as guidelines....not legal advice

Code of ethics

states that the nurse is responsible and accountable for individual nursing practice and determines delegation

can LPN's educate?

they can only reinforce patient education it must be initially taught by the RN

can LPN's assess?

they can only update the initial assessment of the RN

true or false... it is the nurses responsibility to know the knowledge level of the person she is delegating to ?

true