Managing Client Care: Delegating
The nurse has delegated several nursing tasks to staff members. Which is the nurse's primary responsibility after the delegation of tasks?
✅Perform follow-up with each staff member regarding the performance and outcome of the task. 📢Rationale: The ultimate responsibility for a task lies with the person who delegated it. Therefore, it is the nurse's primary responsibility to follow-up with each staff member regarding the performance of the task and the outcomes related to implementing the task. Not all staff members have the education, knowledge, and ability to make judgments about tasks being performed. The nurse documents that the task has been completed, but this would not be done until follow-up was implemented and outcomes were identified. It is not appropriate to assign the tasks that were not completed to the next nursing shift.
The nurse is planning the client assignments for the day. The assignment that the nurse communicates to the unlicensed assistive personnel (UAP) includes which clients? Select all that apply.
✅A 9-year-old client with cystic fibrosis who requires assistance with toileting. ✅A 12-month-old client admitted 3 days ago with respiratory syncytial virus (RSV) who requires a bath. ✅A 10-month-old admitted for spasmodic laryngitis croup who is scheduled for discharge the following day who requires feedin. 📢Rationale: The unlicensed assistive personnel (UAP) should be assigned clients who require basic care needs and are in stable condition. Therefore, the UAP should be assigned the 9-year-old client with cystic fibrosis who needs toileting assistance, the 12-month-old child with RSV who requires a bath, and the 10-month-old admitted for spasmodic laryngitis who requires feeding and is set to be discharged the following day and thus is stable. These clients are appropriate assignments because they are all stable with basic care needs. The client admitted with diarrhea and dehydration who requires IV fluids and the child just 2 hours post-tonsillectomy both require the licensed nurse because they are unstable clients who require care with nursing judgment.
The nurse in charge of a rehabilitation center is planning the client assignments for the day. Which client should the nurse assign to the unlicensed assistive personnel (UAP)?
✅A client on strict bed rest and a 24-hour urine collection. 📢Rationale: The nurse is legally responsible for client assignments and must assign tasks based on the guidelines of nurse practice acts and the job description of the employing agency. A newly admitted client who had a below-the-knee amputation will require physiological and psychosocial care and initiation of rehabilitation. A client scheduled to be discharged home will require reinforcement of home care management. A client scheduled for a cardiac catheterization requires physiological needs. The UAP has been trained to care for a client on bed rest and on urine collections. The nurse should provide instructions to the UAP regarding the tasks, but the task required for this client is within the role description of a UAP.
The nurse is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)? A client requiring twice daily dry dressing changes A client requiring frequent ambulation with a walker A client on a bowel management program requiring rectal suppositories and a daily enema A client with diabetes mellitus requiring daily insulin and reinforcement of dietary measures
✅A client requiring frequent ambulation with a walker. 📢Rationale: Assignment of tasks needs to be implemented based on the job description of the UAP, the level of clinical competence, and state law. Options 1, 3, and 4 involve care that requires the skill of a licensed nurse. Although a UAP may be trained to administer an enema (depending on the state practice act and agency policies), a rectal suppository needs to be administered by a licensed nurse. Option 2 is the most appropriate assignment for the UAP.
The nurse is planning the client assignments for the day. Which is an appropriate assignment for the unlicensed assistive personnel (UAP)?
✅A client who requires a 24-hour urine collection. 📢Rationale: The nurse must determine the most appropriate assignment based on the skills of the staff member and the needs of the client. In this case, the appropriate assignment for a UAP would be to care for the client who requires urine collection. The client who has difficulty swallowing food and fluids is at risk for aspiration. Colostomy irrigations and tube feedings are not performed by unlicensed personnel.
The nurse employed in a long-term care facility is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)?
✅A client who requires a 24-hour urine collection. 📢Rationale: The nurse must determine the most appropriate assignment on the basis of the skills of the staff member and the needs of the client. The assignment of tasks needs to be implemented on the basis of the job description of the individual, the individual's level of clinical competence, and state law. Options 2, 3, and 4 involve care that requires the skill of a licensed nurse. A UAP is not licensed.
The nurse is planning the client assignments for the day. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? A client who requires wound irrigation A client who requires frequent ambulation A client who is receiving continuous tube feedings A client who requires frequent vital signs after a cardiac catheterization
✅A client who requires frequent ambulation. 📢Rationale: The nurse must determine the most appropriate assignment on the basis of the skills of the staff member and the needs of the client. In this case the most appropriate assignment for the UAP would be to care for the client who requires frequent ambulation. The UAP is skilled in this task. The client who had a cardiac catheterization will require specific monitoring in addition to that of the vital signs. Wound irrigations and tube feedings are not performed by unlicensed personnel.
A nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The nurse must assign four clients and has a licensed practical nurse (LPN) and three unlicensed assistive personnel (UAP) on a nursing team. To which client should the nurse assign the LPN?
✅A client with an abdominal wound requiring wound irrigations and dressing changes every 3 hours. 📢Rationale: When delegating nursing assignments, the nurse needs to consider the skills and educational level of the nursing staff. Collecting a 24-hour urine, assisting with frequent ambulation, and giving a bed bath can be done by a UAP. The LPN is skilled in wound irrigations and dressing changes, and this client should be assigned to this staff member.
A client will be undergoing a colonoscopy in the morning. Which task is appropriate to delegate to the unlicensed assistive personnel (UAP)?
✅Answering the call light promptly after the enema has been given. 📢Rationale: Clients frequently have strong urges to defecate after receiving enemas and laxatives to prepare for the colonoscopy. It is not appropriate to provide a soft diet the evening before the exam; clear liquids only are provided. It is also inappropriate to delegate to the UAP the responsibility to determine if the client understood instructions or to sign the procedure consent form. The UAP is trained to answer call lights.
The nurse is planning the client assignments. Which is the least appropriate assignment for the unlicensed assistive personnel (UAP)?
✅Assisting a child who is profoundly developmentally disabled to eat lunch. 📢Rationale: The nurse must determine the most appropriate assignment based on the skills of the staff member and the needs of the client. In this case, the least appropriate assignment for the UAP would be assisting a profoundly developmentally disabled child with feeding. The child is likely to have difficulty eating and therefore has a higher potential for complications, such as choking and aspiration. The remaining options do not include data indicating that these tasks carry any unforeseen risk.
The nurse is assisting in planning client assignments. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? Caring for a client with a new colostomy Caring for a client newly diagnosed with diabetes Assisting a client to ambulate after an appendectomy Assisting a client to perform a self-dressing change on a wound before discharge
✅Assisting a client to ambulate after an appendectomy. 📢Rationale: The nurse must determine the most appropriate assignment based on the skills of the staff member and the needs of the client. In this case, the most appropriate assignment for a UAP would be assisting a client to ambulate after an appendectomy. Options 1, 2, and 4 would require assessment and teaching, so they cannot be delegated to a UAP.
A client experiences cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style? Autocratic Situational Democratic Laissez-faire
✅Autocratic 📢Rationale: Autocratic leadership is an approach in which the leader retains all authority and is primarily concerned with task accomplishment. It is an effective leadership style to implement in an emergency or crisis situation. The leader assigns clearly defined tasks and establishes one-way communication with the work group, and he or she makes all decisions independently. Situational leadership is a comprehensive approach that incorporates the leader's style, the maturity of the work group, and the situation at hand. Democratic leadership is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff. Laissez-faire leadership is a permissive style in which the leader gives up control and delegates all decision making to the work group.
An unlicensed assistive personnel (UAP) tells the nurse that she is becoming very frustrated trying to communicate with an older client who is severely hard of hearing and does not have his hearing aid. Which instructions should the nurse recommend to improve communication between the UAP and the client? Select all that apply.
✅Make sure the environment is well lit. ✅Face the client and speak slowly and clearly. ✅Ask the client to restate what has been said. ✅Turn the television volume down while communicating. 📢Rationale: Words spoken slowly and clearly are more easily understood by the hearing-impaired client. Using other senses promotes communication. Facing the client in optimum light adds sight to the communication process. Asking for feedback verifies that the client has heard what was communicated. Eliminating background noise from the television decreases distraction. Asking questions that can be answered yes or no does not address the client's ability to understand. It only limits communication. Loud speech is often more difficult to be understood and repetition may cause the client to disengage from communication.
The nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which describes the team-based model of nursing practice?
✅Nursing staff are led by the nurse when providing care to a group of clients. 📢Rationale: In team nursing, nursing personnel are led by the nurse when providing care to a group of clients. Option 1 identifies functional nursing. Option 2 identifies a component of case management. Option 4 identifies primary nursing.