Delegation in Nursing (Pearson Review)
A nurse plans to delegate some responsibilities of client care to a licensed practical nurse (LPN). Which task should the nurse delegate to the LPN? 1. Assessment of a newly admitted client. 2. Admission of a postoperative client. 3. Dressing changes for a client with wounds. 4. Assist a client with ambulation and AM care.
3. Dressing changes for a client with wounds. Rationale: The best choice is to assign the LPN to change the client's dressing. The registered nurse should perform all assessments. The registered nurse is skilled in assessment and in providing care to those with unpredictable outcomes. The nursing assistant may ambulate the client and provide AM care.
A nurse is delegating care of clients to the certified nursing assistant (CNA) and licensed practical nurse (LPN). Which tasks should the nurse give the CNA and LPN? 1. CNA: Measure vital signs; LPN: Give oral medications on assigned clients. 2. CNA: Change a non-infected dressing; LPN: Administer IV piggyback medications. 3. CNA: Ambulate a client who had a CVA; LPN: Assess two clients. 4. CNA: Measure vital signs; LPN: Complete a head-to-toe assessment on a newly admitted client.
1. CNA: Measure vital signs; LPN: Give oral medications on assigned clients. Rationale: The scope of practice and most job descriptions for CNAs include vital signs. It is within the scope of practice for the LPN to administer oral medications. In some facilities, CNAs are allowed to change dressings; however, the scope of practice for LPNs does not allow them to administer IV medications. CNAs are allowed to ambulate clients; however, LPNs should not assess clients. CNAs are able to measure vital signs but LPNs do not complete admissions because it involves assessment.
The registered nurse (RN) must delegate care of an assigned client to an unlicensed assistive person (UAP) for the shift. Which client would be best to delegate to the UAP? 1. A client who would benefit from talking about the recent death of her husband. 2. A client with a urinary drainage catheter and nasogastric feedings who is on bedrest. 3. A client with an ostomy who has persistent problems with leakage. 4. A client who was transferred from the critical care unit 3 days ago and is ambulatory.
4. A client who was transferred from the critical care unit 3 days ago and is ambulatory. Rationale: Factors to consider when delegating care include complexity of task, problem-solving innovation required, unpredictability, and level of client interaction. The ambulatory client is best to delegate because this client is likely to be stable with a low level of unpredictability. The client who recently lost her husband would benefit from pro- fessional communication with the RN and requires a high level of client interaction. The client receiving enteral feedings and is immobilized represents a more complex client, who is better assigned to a licensed nurse. The client with a leaking ostomy would benefit from problem-solving innovation and is best cared for by the RN.
A nurse is preparing for the shift, and makes a list of delegated tasks for the unlicensed assistive person (UAP). Which task should the nurse delegate to the UAP? 1. Feeding a client who was admitted with dysphagia from cerebrovascular accident. 2. Monitoring drainage from a chest tube on a client with a hemothorax. 3. Rechecking vital signs on a client whose blood pressure is 190/102. 4. Repositioning a client with severe weakness caused by multiple sclerosis.
4. Repositioning a client with severe weakness caused by multiple sclerosis. Rationale: The UAP is qualified to reposition a client with multiple sclerosis who has severe weakness. Due to the risk for aspiration, the nurse should feed the client with dysphagia. The nurse should monitor drainage from a chest tube for characteristics of exudate being removed from the client's thoracic cavity. When a client has an elevated or low blood pressure, the nurse should recheck and assess the client for validity of information and changes in status.
A nurse has delegated a venipuncture to an unlicensed assistant (UA) who has been off orientation for five days. The UA reports, "This client has a large, raised red area where the needle was inserted." The nurse's subsequent assessment reveals a hematoma in the venipuncture area. What elements of delegation have been breached? Select all that apply. 1. Task 2. Circumstance 3. Communication 4. Supervision 5. Skill
1. Task 4. Supervision 5. Skill Rationale: The nurse assigned a task at which the UA evidently was weak, and did not provide supervision. The nurse has delegated a venipuncture to a UA who may or may not be comfortable providing the skill. Though the task is permissible in general, venipuncture is not the right task for this UA.
An obstetric nurse is floated to a medical unit to care for a group of acutely ill clients. The charge nurse should assign which group of clients to the float nurse? 1. A client with a three-day-old total knee replacement, a client who is postoperative for colectomy, and a client who is post-operative for hysterectomy. 2. An older adult client with dehydration, a client with atrial fibrillation, and a client just admitted with hip fracture. 3. A client with an old cerebrovascular accident, a client with a three-day-old hip replacement, and a client with diabetic ketoacidosis. 4. An older adult client with pneumonia, a client with an exacerbation of asthma, and a client who has below knee amputation.
1. A client with a three-day-old total knee replacement, a client who is postoperative for colectomy, and a client who is post-operative for hysterectomy. Rationale: The float nurse from the obstetrics unit can be assigned clients who have abdominal surgery, since the nurse likely has experience working with clients having cesarean section. The nurse can also be assigned clients whose conditions are relatively stable. Clients who have acute conditions compounded by chronic health problems are more complicated, and are better assigned to nurses with experience on the medical-surgical unit. Also, older adult clients can have fluctuations in status, placing them at higher risk for complications, which is not an ideal situation for the float nurse.
Which task would not be appropriate for the registered nurse (RN) to delegate to a licensed practical nurse (LPN) or unlicensed assistive personnel (UAP)? 1. Instructing the LPN to reinforce teaching of the RN's assigned clients prior to discharge. 2. Assigning UAPs to complete vital signs and document and report changes to the RN. 3. Asking the UAP to assess and evaluate the client response to IV pain medication. 4. Instructing the LPN to remove a dressing from a postoperative client's abdominal wound.
3. Asking the UAP to assess and evaluate the client response to IV pain medication. Rationale: The decision to delegate should be consistent with the nursing process (appropriate assessment, planning, implementation, and evaluation). The person responsible for client assessment, diagnosis, care planning, and evaluation is the registered nurse. The LPN can reinforce teaching previously performed by the RN. Assistive personnel may perform simple nursing interventions, but the RN remains responsible for analyzing the data and the client outcome. The LPN can change a dressing.
A registered nurse (RN) who is the charge nurse for the shift is making assignments for the day. Which client should be assigned to the licensed practical nurse (LPN)? 1. A client with sickle-cell anemia requiring pain medications every three hours. 2. A three-day postoperative client who will be discharged tomorrow morning. 3. A 76-year-old client newly admitted with pneumonia and type 2 diabetes mellitus. 4. A client who received chemotherapy for leukemia and has a hemoglobin of 6.4 grams/dL.
2. A three-day postoperative client who will be discharged tomorrow morning. Rationale: The three-day postoperative client who will be discharged tomorrow is stable. The client's outcomes are almost met. The LPN could provide the care for this client. A client with sickle-cell anemia who requires pain medications every three hours needs frequent observations and assessments. Because of the RN's ability to problem-solve and think critically, this client should be assigned to a registered nurse. A 76-year-old client with a newly admitted with a chronic condition, type 2 diabetes, exacerbated by an acute condition, pneumonia, is at risk for changes in status and require frequent assessment. A client with leukemia who has a hemoglobin of 6.4 grams/dL might need a blood transfusion, and has unpredictable outcomes. The RN should care for clients with unpredictable outcomes.
The delivery of care system on a medical floor is team nursing. On wing A, there is a registered nurse (RN), licensed practical/vocational nurse (LPN/LVN), and an unlicensed assistant person (UAP) to care for eight clients. Which tasks would be best delegated to the LPN? 1. Vital signs and assessment of a newly postoperative client. 2. Wound care and oral medications for all clients. 3. Vital signs and bed baths on all eight clients. 4. Physical assessments on two young, stable clients.
2. Wound care and oral medications for all clients. Rationale: The LPN may check vitals and give bed baths, but the skill set of the LPN is better utilized in providing wound care and medications for the clients. Due to scope of practice the RN should check vital signs and perform assessment of the postoperative client. The scope of practice of a UAP involves completion of tasks, so the UAP should check vital signs and complete bed baths on the clients. Physical assessment is within the scope of practice of the RN.
The staff nurse who is in charge of the medical-surgical unit for the shift is receiving four admissions. The emergency department is sending a client with hypertension and an exacerbation of heart failure, and a client who has pneumonia and a history of diabetes mellitus. The post-anesthesia care unit (PACU) is transferring a client who had a total abdominal hysterectomy and a client who underwent hip replacement. If the staff consists of two RNs (one on orientation) and two LPNs, what assignment would be appropriate? 1. The RN on orientation will be assigned the postoperative client who underwent hip replacement. 2. The experienced RN will be assigned the postoperative client who underwent hip replacement. 3. An LPN will be assigned the client with pneumonia and history of diabetes. 4. An LPN will be assigned the client with the abdominal hysterectomy.
2. The experienced RN will be assigned the postoperative client who underwent hip replacement. Rationale: Of the answer options, the best option is that the skilled RN should get the postoperative client with the hip replacement and the abdominal hysterectomy. Postoperative clients are critical clients due to the risk for hypovolemia and shock. The experienced nurse should receive the surgical clients. The RN on orientation should care for the clients with medical conditions such as CHF, hypertension, and diabetes. In this case, the LPNs should assume duties such as vital signs and assisting with ADLs.
The registered nurse (RN) is assigned to five clients for the shift. Which tasks are best delegated to the licensed practical/vocational nurse (LPN/LVN)? Select all that apply. 1. Repositioning a nasogastric tube on a client who has had a small bowel resection. 2. Irrigating a urinary catheter on a client admitted from a skilled nursing facility. 3. Rechecking vital signs on a 40-year-old asymptomatic client with a BP of 100/64. 4. Changing a dressing on a client with a diabetic foot ulcer in the metatarsal area. 5. Administering red blood cells to a client with a hemoglobin of 10.2 grams/dL.
2. Irrigating a urinary catheter on a client admitted from a skilled nursing facility. 4. Changing a dressing on a client with a diabetic foot ulcer in the metatarsal area. Rationale: The scope of practice for LPNs allows them to irrigate urinary catheters and change dressings on diabetic ulcers. While LPNs are allowed to irrigate nasogastric tubes, the RN should reposition the tube if it is necessary. The routine measurement of client with a BP of 100/64 does not require the skills of an LPN; a UAP could do this instead. Blood administration should not be delegated to an LPN due to the complications that could arise during the transfusion; rather, it is within the scope of practice of the RN.
A client is experiencing respiratory distress. Respirations are 32 breaths/min and shallow. The client is positioned in an orthopneic position, with a heart rate of 118/min and a blood pressure of 90/40 mm Hg. The client is pale and confused. Which task should the nurse delegate to the charge nurse? 1. Head-to-toe assessment 2. Placement of a second IV site 3. Application of oxygen 4. Overhead page the respiratory therapist (RT)
2. Placement of a second IV site. Rationale: The charge nurse should be used to complete a task within the RN's scope of practice, such as starting an intravenous line, while leaving client assessment to the assigned nurse. The assigned nurse should complete a head-to-toe assessment. The nurse assigned to the client knows more about the client than other nurses on the unit do, and can determine a change in the client's status. The application of oxygen is a task for the nurse assigned to the client. Given the information provided in the scenario, the nurse should apply the oxygen immediately to rectify low oxygen levels. The unit secretary could page RT to the room stat for assistance.
After receiving the intershift report, the registered nurse (RN) has many tasks to complete during the next 12 hours. Which tasks would the nurse delegate to an unlicensed assistant person (UAP)? Select all that apply. 1. Flushing a nasogastric tube on a client who has had a colectomy. 2. Irrigating a clogged urinary catheter on an older adult client. 3. Rechecking vital signs on a 30-year-old client with a BP of 100/60. 4. Changing a dressing on a client with an infected diabetic foot ulcer. 5. Measuring and recording hourly urine output for a client who underwent nephrectomy.
3. Rechecking vital signs on a 30-year-old client with a BP of 100/60. 5. Measuring and recording hourly urine output for a client who underwent nephrectomy. Rationale: The UAP can measure vital signs and report the findings to the RN. The UAP can measure and record the urine output, although the RN would need to make further assessments about the client's status. The RN should irrigate the nasogastric tube and irrigate the urinary catheter as these are not in the UAP's scope of practice and job description. A client with an infected wound should have the dressing changed by the RN for assessment of effectiveness of wound therapy and complications.
