Exemplar 39.3 Delegation

The nurse is planning the client assignments for the day. Which clients can be safely assigned to the unlicensed assistive personnel (UAP)? Select all that apply. 1. The client receiving a heparin infusion 2. The client receiving a blood transfusion 3. The client receiving continuous oxygen at 2 L/min 4. The client recovering from Guillain-Barré syndrome 5. The client who just returned from surgery for a hip repair 6. The client on isolation for methicillin-resistant Staphylococcus aureus

3.The client receiving continuous oxygen at 2 L/min 4.The client recovering from Guillain-Barré syndrome 6.The client on isolation for methicillin-resistant Staphylococcus aureus UAPs cannot be assigned to a client requiring care that is more than basic. UAPs do not have the education to safely care for clients requiring more than basic care. Assigning a UAP to these clients presents an unsafe situation. The client receiving a heparin infusion requires licensed personnel to monitor progress and for possible adverse reactions. The client receiving a blood transfusion requires monitoring for possible adverse reactions; licensed personnel are necessary. The client receiving a heparin infusion requires licensed personnel to monitor progress and for possible adverse reactions. Unlicensed personnel cannot be assigned to a client who needs immediate postoperative assessment. These clients need to be cared for by a registered nurse (RN).

The nurse is delegating the morning hygienic care of a man to the unlicensed assistive personnel (UAP). In reviewing the assigned tasks, the nurse should instruct the UAP to use an electric razor for which client? 1. The client with severe pain related to osteoporosis 2. The client with hypokalemia related to diuretic therapy 3. The client with thrombocytopenia related to chemotherapy 4. The client with an elevated white blood cell count related to infection

3.The client with thrombocytopenia related to chemotherapy The client with thrombocytopenia has a low platelet count. Using a straight razor increases the risk of abrasion and bleeding caused by ineffective clotting capability. The client with hypokalemia has a low potassium level. Shaving the client has no relationship to the client's potassium level. The client with severe pain is not affected by the different choices in shaving tools. Likewise, the client with an elevated white blood cell count will not be affected by the different choices in shaving tools.

The nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? Select all that apply. 1. The nurse who never had roseola 2. The nurse who never had mumps 3. The nurse who never had chickenpox 4. The nurse who never had German measles 5. The nurse who never received the varicella-zoster vaccine

3.The nurse who never had chickenpox 5.The nurse who never received the varicella-zoster vaccine The nurses who have not had chickenpox or did not receive the varicella-zoster vaccine are susceptible to the herpes zoster virus and should not be assigned to care for the client with herpes zoster. Nurses who have not contracted roseola, mumps, or rubella are not necessarily susceptible to herpes zoster. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus, the causative virus of chickenpox. Individuals who have not been exposed to the varicella-zoster virus or who did not receive the varicella-zoster vaccine are susceptible to chickenpox. Health care workers who are unsure of their immune status should have varicella titers done before exposure to a person with herpes zoster.

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 (vocational) nurse and 3 unlicensed assistive personnel (UAPs) on a nursing team. Which client would the nurse most appropriately assign to the licensed practical (vocational) nurse? 1. A client who requires a bed bath 2. An older client requiring frequent ambulation 3. A client who requires hourly vital sign measurements 4. A client requiring abdominal wound irrigations and dressing changes every 3 hours

4. A client requiring abdominal wound irrigations and dressing changes every 3 hours When delegating nursing assignments, the nurse needs to consider the skills and educational level of the nursing staff. Giving a bed bath, assisting with frequent ambulation, and taking vital signs can be provided most appropriately by UAP. The licensed practical (vocational) nurse is skilled in wound irrigations and dressing changes and most appropriately would be assigned to the client who needs this care.

The registered nurse is creating the plan for client assignments for the day. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? 1. A client scheduled to receive a blood transfusion 2. A client with bladder cancer who will be receiving chemotherapy 3. A client newly diagnosed with diabetes mellitus scheduled for discharge 4. A client on bed rest who requires range-of-motion (ROM) exercises every 4 hours

4.A client on bed rest who requires range-of-motion (ROM) exercises every 4 hours 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 the UAP would be to care for the client on bed rest who requires ROM exercises. The UAP is trained in this procedure. The client receiving chemotherapy and the client receiving a blood transfusion require assessment skills that only a licensed nurse can perform. The client with diabetes mellitus who is being discharged will require predischarge review of diabetic management instructions and coordination of necessary home care services.

When creating an assignment for a team consisting of a registered nurse (RN), 1 licensed practical nurse (LPN), and 2 unlicensed assistive personnel (UAP), which is the best client for the LPN? 1. A client requiring frequent temperature checks 2. A client requiring assistance with ambulation every 4 hours 3. A client on a mechanical ventilator requiring frequent assessment and suctioning 4. A client with a spinal cord injury requiring urinary catheterization every 6 hours

4.A client with a spinal cord injury requiring urinary catheterization every 6 hours When creating nursing assignments, the nurse needs to consider the skills and educational level of the nursing staff. Frequent temperature checks and ambulation can most appropriately be provided by the UAP, considering the clients identified in each option. The client on the mechanical ventilator requiring frequent assessment and suctioning should most appropriately be cared for by the RN. The LPN is skilled in urinary catheterization, so the client in option 4 would be assigned to this staff member.

The nurse is planning the client assignments for a group of clients and has a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) on the nursing team. Which client would the nurse most appropriately assign to the LPN? 1. A client with stable heart failure who has early-stage Alzheimer's disease 2. A client who is scheduled for an electrocardiogram and a chest x-ray examination 3. A client who was treated for dehydration, is weak, and needs assistance with bathing 4. A client with emphysema who is receiving oxygen at 2 L/min by nasal cannula and becomes dyspneic on exertion

4.A client with emphysema who is receiving oxygen at 2 L/min by nasal cannula and becomes dyspneic on exertion The nurse would most appropriately assign the client with emphysema to the LPN. This client has an airway problem and has the highest priority needs among the clients presented in the options. The clients described in options 1, 2, and 3 can appropriately be cared for by the UAP.

A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team-based model of nursing practice? 1. Each staff member is assigned a specific task for a group of clients. 2. A staff member is assigned to determine the client's needs at home and begin discharge planning. 3. A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an unlicensed assistive personnel (UAP). 4. An RN leads 2 licensed practical nurses (LPNs) and 3 UAPs in providing care to a group of 12 clients.

4.An RN leads 2 licensed practical nurses (LPNs) and 3 UAPs in providing care to a group of 12 clients. In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option 1 identifies functional nursing. Option 2 identifies a component of case management. Option 3 identifies primary nursing (relationship-based practice).

The nurse is planning client assignments for the day. Which clients can be safely assigned to unlicensed assistive personnel (UAPs)? Select all that apply. 1. Client who is receiving chemotherapy and is in isolation 2. Client with anemia who is receiving a second unit of blood and needs assessment of vital signs 3. Client newly diagnosed with hyperthyroidism who is in need of teaching regarding medication therapy 4. Client who is 72 hours postoperative recovering from a total knee replacement and needs assistance with bathing and dressing 5. Client who is 48 hours postoperative recovering from an open reduction and fixation of the right forearm and needs assistance with feeding 6. Client who is newly admitted with shortness of breath, circumoral cyanosis, and a respiratory rate of 30 breaths per minute who requires an admission assessment

4.Client who is 72 hours postoperative recovering from a total knee replacement and needs assistance with bathing and dressing 5.Client who is 48 hours postoperative recovering from an open reduction and fixation of the right forearm and needs assistance with feeding The scope of practice of UAPs includes measurement of vital signs and assistance with feeding, bathing, and dressing. Clients who need assessment, are receiving chemotherapy, are receiving blood, or require education need the more advanced skills of a licensed nurse.

The nurse is giving a report to an unlicensed assistive personnel (UAP) who will be caring for a client who has hand restraints (safety devices). The nurse instructs the UAP to check the skin integrity of the restrained hands how frequently? 1. Every 2 hours 2. Every 3 hours 3. Every 4 hours 4. Every 30 minutes

4.Every 30 minutes The nurse should instruct the UAP to check safety devices and skin integrity every 30 minutes. The neurovascular and circulatory status of the extremity should also be checked every 30 minutes. In addition, the safety device should be removed at least every 2 hours to permit muscle exercise and to promote circulation. Agency guidelines regarding the use of safety devices should always be followed.

A postoperative client has been transferred to the medical-surgical unit from the intensive care unit (ICU). The client asks the assigned nurse why unlicensed assistive personnel (UAP) help with range-of-motion exercises. Which is the best response by the nurse? A) "Your condition has improved so I delegated that part of your care to the UAP." B) "You do not need me to ambulate you." C) "The charge nurse made the decision to have the UAP assist you when walking." D) "I assigned all of your care to the UAP."

A) An assignment of care is made to a qualified individual (the RN), who then may delegate parts of that care to a UAP. The nurse would not assign care to the UAP, but rather, delegate certain tasks to the UAP. Saying that the client does not need the nurse is not the best approach; it is better to explain that the client has improved to the point where the UAP can assist with certain tasks. The UAP may be delegated tasks by a nurse assigned to care for the client. The charge nurse does not make the assessment to delegate to the UAP; the RN assigned to the care of the client is the decision maker.

The nurse delegated unlicensed assistive personnel (UAP) to assist a client with performing a simple dressing change. The client was formerly able to do the procedure, but because of painful arthritis is now unable to perform the redressing. The UAP has done this procedure before. Which of the following must the nurse emphasize to the UAP? A) Report to the nurse immediately anything unusual, such as bleeding or infection. B) The nurse should demonstrate the steps of the procedure. C) Make the client do most of the procedure and report the expected output. D) The UAP should do health teaching while performing the procedure.

A) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's ability. The nurse established the particular parameters outside of which immediate notification is requested. If in pain, the client should not have to do any of the procedure. If the UAP has done the procedure before, the nurse should not need to demonstrate it. Health teaching is outside of the scope of practice for the UAP.

The nurse is working on a medical-surgical unit that is short staffed due to a callout. The manager of the unit was unable to replace the nurse, so the extra clients were assigned to the remaining nurses. The manager was able to get the help of unlicensed assistive personnel (UAP) from the house pool to help on the unit. In order for effective care to be given to the clients, the nurses would do which of the following? A) Delegate vital signs and a.m. care to the UAP. B) Explain to the manager that care may be compromised if another nurse does not work the shift. C) Tell the clients their care will be sparse. D) Assign wound care to the UAP.

A) The nurses would delegate to the UAP tasks such as taking and recording vital signs, performing a.m. care, and ambulating clients to ensure that all clients receive appropriate care. UAPs are not assigned care, they are delegated tasks. The goal for the unit is to meet the needs of the clients; complaining to the manager will not accomplish this. Telling the clients their care will be sparse is inappropriate. UAPs can be very helpful because they are trained to complete tasks that the nurses would not have time to complete, thus accomplishing the goal of care for all clients on the unit. To alleviate clients' anxiety, the nurse may tell them that extra help is coming for the shift. Nurses delegate tasks directly to the UAPs rather than telling the manager what needs to be done.

A nurse-supervisor is encouraging nurses to delegate responsibilities whenever possible. What are some of the criteria for deciding which tasks might be delegated? Select all that apply. A) How complex is the task? B) How busy are you? C) Is the client frequently complaining? D) Is training or education required? E) Is the task unpleasant?

A, D) Highly technical tasks and complex client care tasks that require specific levels of licensure, certification, or training should not be delegated. The nurse's busyness may point out the need for delegation but it does not define which tasks may be delegated. The behavior of the client and the unpleasant nature of the task are not criteria for delegation.

An experienced delegator is mentoring a newly appointed nurse in her hospital. The new nurse says that she is hesitant to delegate tasks to unlicensed assistive personnel (UAP) because she is afraid they will not be done correctly. How can the delegator respond to the nurse's concerns? A) Tell her not to delegate any tasks unless she is completely confident. B) Tell her to clearly identify the task and expectations and then to monitor the delegate's progress. C) Tell her that delegation often results in a decrease in job satisfaction. D) Tell her that her job responsibility requires that she do everything herself.

B) Although this is a typical concern of inexperienced and insecure delegators, following the delegation guidelines can increase her confidence in the process. The key to retaining control is to clearly identify the task and expectations and then to monitor the delegate's progress and provide feedback. If one is able to delegate some routine tasks to others, then job satisfaction should increase because of increased opportunities. An appropriate environment supports delegation

The nurse is working on a unit with unlicensed assistive personnel (UAP). One nurse refuses to utilize the UAP and is consistently leaving nursing tasks for the next shift that have yet to be completed. The nurse is jeopardizing effective care because of: A) Avoidance of responsibility. B) Overdependence on others. C) The belief that no one else can perform a task as well as the nurse can. D) The state nurse practice act.

C) One barrier to delegation is the belief that nobody else is capable of getting the job done for the client. The state nurse practice act would be considered an environmental barrier. The nurse who refuses to delegate care is not being overly dependent. The nurse is accepting too much responsibility rather than too little.

The nurse is caring for several medical-surgical clients. The nurse has delegated skin care of an incontinent client to new unlicensed assistive personnel (UAP) on the unit. In order to improve effectiveness of the care given, the nurse plans to do which of the following? A) Ask the client if the care was appropriate. B) Ask the UAP if the care was given. C) Demonstrate the appropriate care needed, then delegate the task for the remainder of the shift. D) Closely observe the UAP each time the care is given.

C) The nurse would show the UAP the exact procedure the first time to avoid any confusion. The nurse would reassess the client's skin later rather than asking the UAP if the task was done. The nurse could possibly alarm the client by asking the client if care was appropriate. Closely observing the UAP defeats the purpose of delegation.

The nurse has assigned the vital signs and daily weights of her clients to the unlicensed assistive personnel (UAP) on duty. It is still important for the nurse to reassess each client throughout the shift for which reason? A) The UAP cannot report to the next shift. B) The UAP is not trustworthy. C) The nurse maintains the authority to care for the clients. D) The nurse remains accountable for the clients' care.

D) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP may be untrustworthy, but the reason the nurse checks on the clients is because the accountability belongs to the nurse. The nurse could take a report from the UAP and report that to the next shift. The nurse transfers the authority for the delegated care to the UAP.

A registered nurse (RN) who is working with a nursing student assigns the student to care for a client with a diagnosis of Cushing's syndrome. The RN asks the student questions about this disorder. Which statement made by the student indicates understanding of Cushing's syndrome? 1. "Cushing's syndrome is caused by excessive amounts of cortisol." 2. "Cushing's syndrome is caused by decreased amounts of aldosterone." 3. "Cushing's syndrome is caused by excessive amounts of antidiuretic hormone." 4. "Cushing's syndrome is caused by decreased amounts of parathyroid hormone."

1."Cushing's syndrome is caused by excessive amounts of cortisol." Cushing's syndrome is a condition caused by excessive amounts of cortisol. Options 2, 3, and 4 are inaccurate descriptions of this disorder.

The nurse is planning the client assignments for the day. Which clients can be safely assigned to the unlicensed assistive personnel (UAP)? Select all that apply. 1. A client needing a bed bath 2. A client needing to ambulate 3. A client needing packed red blood cells 4. A client requiring assistance with feeding 5. A client needing to have vital signs checked 6. A client needing to use the bedside commode

1.A client needing a bed bath 2.A client needing to ambulate 4.A client requiring assistance with feeding 5.A client needing to have vital signs checked 6.A client needing to use the bedside commode UAPs can perform tasks that are noninvasive. Therefore, options 1, 2, 4, 5, and 6 are tasks that the UAP can perform. The client in option 3 must be cared for by the registered nurse.

The nurse is planning the client assignments for the day. Which clients can be safely assigned to the unlicensed assistive personnel (UAP)? Select all that apply. 1. A confused older client who requires feeding 2. A client who requires turning every 2 hours 3. A client admitted with dehydration who is on strict intake and output 4. A client on 3 L of oxygen by nasal cannula and a pulse oximetry reading of 89% 5. A client who experienced a 10-beat run of ventricular tachycardia and hypotension on the previous shift 6. A client 4 days postoperative after exploratory laparotomy who requires ambulation in the hallway 4 times a day

1.A confused older client who requires feeding 2.A client who requires turning every 2 hours 3.A client admitted with dehydration who is on strict intake and output 6.A client 4 days postoperative after exploratory laparotomy who requires ambulation in the hallway 4 times a day Activities such as turning, ambulation, maintenance of intake and output, and feeding can be delegated to the UAP. Therefore, clients 1, 2, 3, and 6 can be assigned to the UAP. The clients in options 4 and 5 are or have demonstrated recent instability and should be assigned to the registered nurse for comprehensive assessment.

The nurse is rearranging the client assignments after several discharges and admissions occurred. Which tasks should be assigned to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Cleaning a client's dentures 2. Ambulating a postoperative client 3. Taking 4:00 p.m. vital signs on clients 4. Giving medications left by the nurse for the client to take 5. Assisting a client with a urinary drainage catheter into a chair 6. Obtaining a catheterized urinalysis and taking it to the laboratory

1.Cleaning a client's dentures 2.Ambulating a postoperative client 3.Taking 4:00 p.m. vital signs on clients 5.Assisting a client with a urinary drainage catheter into a chair Medication administration and invasive procedures, such as urinary catheterization for specimen collection, cannot be done by the UAP; therefore, these options are incorrect. The remaining options identify activities that can be performed by the UAP.

A registered nurse is delegating activities to the nursing staff. Which activities are most appropriate for the unlicensed assistive personnel (UAP)? Select all that apply. 1. Collecting a urine specimen from a client 2. Obtaining frequent oral temperatures on a client 3. Accompanying a client being discharged to his transportation to home 4. Assisting a postcardiac catheterization client who needs to lie flat to eat lunch 5. Monitoring the amounts of fluid remaining in intravenous (IV) solution bags for a client receiving IV fluids

1.Collecting a urine specimen from a client 2.Obtaining frequent oral temperatures on a client 3.Accompanying a client being discharged to his transportation to home Work that is delegated to others must be done consistent with the individual's level of expertise and licensure or lack of licensure. Based on the options provided, the most appropriate activities for a UAP are noted in options 1, 2, and 3. These options do not include situations to indicate that these activities carry any risk. Because the client needs to eat lying flat, the client is at risk for aspiration. Care related to IV therapy needs to be done by a licensed nurse.

The nurse is developing a client care assignment for a group of unlicensed assistive personnel (UAPs). What is the nurse's first step in planning and assigning clients? 1. Determine what skills can be delegated. 2. Determine the years of experience of each UAP. 3. Determine how much supervision is required for each client assigned. 4. Determine how many clients the agency allows to be delegated to each UAP.

1.Determine what skills can be delegated. Knowing what skills can be delegated is essential when nurses assign client care to other health care personnel. Nurses must be familiar with their state's Nurse Practice Act, institutional policies and procedures, and the institution's job description for UAPs. Information from these sources is necessary to define the level of competency of UAPs. Determining how many clients to delegate is not the first step, and in fact most agencies do not state a specific number of clients that may be assigned. Determining years of experience is also not a first step, although a UAP's experience could affect the type of client assigned. How much supervision will be required is also important but, again, not the first step the nurse takes when delegating client assignment to the UAPs.

The registered nurse (RN) is planning her client assignments for the day. She has a licensed practical nurse and an unlicensed assistive personnel (UAP) on her team. Which task should the RN delegate to the UAP? 1. Empty a client's urinary catheter bag. 2. Instruct a client on his new diabetic diet. 3. Teach a client how to check her blood glucose. 4. Evaluate a newly admitted client's home medications.

1.Empty a client's urinary catheter bag. The nurse must delegate tasks according to the educational level of staff members. Unlicensed personnel such as a UAP can perform tasks that are noninvasive, such as emptying a urinary catheter bag. Additionally, UAPs are not trained to teach or evaluate. Only an RN can teach, evaluate, and instruct.

The newly appointed vice president for nursing operations has announced that the authority for decision making will be decentralized and distributed throughout the organization. Which term describing this organizational chart should the vice president employ while talking with the employees? 1. Flat 2. Vertical 3. Circular 4. Horizontal

1.Flat Organizational charts are drawings that show how the parts of an organization are linked. In "flat" organizations, authority and responsibility are delegated to the lowest operational level possible. Option 2 is incorrect because a vertical chart indicates a formal line of authority and communications. Traditionally, vertical charts indicate decision making at the upper levels of management. Option 3 indicates a concentric or circular chart, with the chief executive in the center and successive layers of authority. Option 4 refers to a horizontal, or left-to-right, chart that depicts the chief executive at the left, with lower layers of the authority to the right.

A client with diabetes mellitus is admitted to the hospital for eye surgery. Which task can be delegated to the unlicensed assistive personnel (UAP)? 1. Orient the client to the hospital surroundings. 2. Instruct the client on how to apply the eye drops. 3. Listen to the client express his frustration or loss. 4. Review hand washing and hygiene practices with the client.

1.Orient the client to the hospital surroundings. Orienting the client to the hospital room and surroundings is within the scope of the UAP's responsibilities. Instructing on the use of eye drops, reviewing hand washing, and therapeutically listening to the client's emotions require formative evaluation to gauge client readiness. These activities are the responsibilities of the registered nurse. Teaching and assessments cannot be delegated to UAPs.

The registered nurse (RN) directs the licensed practical nurse (LPN) to assist with the care of a client who has a sacral ulcer. Which is the most appropriate activity for the RN to delegate to the LPN? 1. Place the client in a side-lying position. 2. Initiate wound care protocol for standardized ulcer care. 3. Meet with the wound specialist to identify measures to improve healing. 4. Determine which treatments would best meet the healing needs of the client.

1.Place the client in a side-lying position. The best task for the LPN is to place the client in the side-lying position. Proper positioning requires nursing skills and is within the LPN's abilities and scope of practice. Initiating a wound care protocol, meeting with the wound specialist to identify measures to improve healing, and determining which treatments would best meet the healing needs of the client are outside the LPN's scope of practice, even though the LPN may assist the RN in determining the plan of care. These activities are the RN's responsibilities.

The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply. 1. The acuity level of the clients 2. Specific requests from the staff 3. The clustering of the rooms on the unit 4. The number of anticipated client discharges 5. Client needs and workers' needs and abilities

1.The acuity level of the clients 5.Client needs and workers' needs and abilities There are guidelines that the nurse should use when delegating and planning assignments. These include the following: ensure client safety; be aware of individual variations in work abilities; determine which tasks can be delegated and to whom; match the task to the delegatee on the basis of the nurse practice act and appropriate position descriptions; provide directions that are clear, concise, accurate, and complete; validate the delegatee's understanding of the directions; communicate a feeling of confidence to the delegatee and provide feedback promptly after the task is performed; and maintain continuity of care as much as possible when assigning client care. Staff requests, convenience as in clustering client rooms, and anticipated changes in unit census are not specific guidelines to use when delegating and planning assignments.

The graduate nurse is interviewed by the manager of a unit and is told that the manager's leadership style is laissez-faire or one of letting the staff nurses make the decisions about the unit's operations. Which question by the graduate nurse indicates the best understanding of the laissez-faire leadership style? 1. "As the manager, do you maintain control and make all decisions?" 2. "As the manager, do you assume a passive, nondirective approach?" 3. "As the manager, do you facilitate decision making within the group?" 4. "As the manager, do you change style according to the needs of the group?"

2."As the manager, do you assume a passive, nondirective approach?" A laissez-faire leader assumes a passive, nondirective approach. Option 1 describes an autocratic leader; this type of leader would make the decisions. Option 3 describes a democratic leader. This type of leader is a "talk with the members" type of leader who gains input and facilitates decision making by the group. Option 4 describes a situational leader; this is seen when a manager indicates that in some situations, the manager decides, but in other situations, the staff nurses decide.

The nurse is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)? 1. A client requiring dressing changes 2. A client requiring frequent temperature measurements 3. A client on a bowel management program requiring rectal suppositories and a daily enema 4. A client with diabetes mellitus requiring daily insulin and reinforcement of dietary measures

2.A client requiring frequent temperature measurements Assignment of tasks to the UAP needs to be made based on job description, level of clinical competence, and state law. Options 1, 3, and 4 involve care that requires the skill of a licensed nurse. The client described in the correct option has needs that can be met by a UAP.

The registered nurse (RN) is planning client assignments and cannot take a client assignment today. Two unlicensed assistive personnel (UAP) and a licensed practical nurse (LPN) also are assigned to the unit. Which client should the RN most appropriately assign to the LPN? 1. A client requiring frequent ambulation 2. A client scheduled for a cardiac catheterization 3. A client requiring range-of-motion (ROM) exercises 4. A client with a 24-hour urine collection who is on strict bed rest

2.A client scheduled for a cardiac catheterization The RN is legally responsible for client assignments and must assign tasks according to the guidelines of Nurse Practice Acts and the job description of the employing agency. A client scheduled for a cardiac catheterization requires physiological needs and frequent nursing assessments; this is the most appropriate assignment for the LPN. The RN can work with the LPN and supervise care. The UAP has been trained to care for a client on bed rest and on urine collection, provide assistance with ambulation, and perform ROM exercises. The RN would provide instructions to the UAP regarding the tasks, but the tasks required for these clients are within the role description of a UAP.

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? 1. A client scheduled to receive parenteral nutrition 2. A client who requires assistance with ambulation every 4 hours 3. A client scheduled for discharge who needs teaching about medications 4. A client with bladder cancer who is scheduled for a cardiac catheterization

2.A client who requires assistance with ambulation every 4 hours 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 to care for a client on bed rest who requires assistance with ambulation every 4 hours. The UAP is trained in this procedure. The client receiving parenteral nutrition and the client scheduled for a cardiac catheterization require the assessment skills that a licensed nurse can perform. Teaching needs to be done by the licensed nurse. The UAP does not have the education to teach a client about medications.

The nurse is responsible for the care of a client who has begun to experience hallucinations more frequently. Which activity in the care of the client can be most appropriately delegated to an unlicensed assistive personnel (UAP)? 1. Determining if the client has consistently been medication compliant 2. Providing distraction for the client by engaging the client in a board game 3. Discussing the frequency and duration of the hallucinations with the client 4. Assisting the client in identifying any new stressors he or she may be experiencing

2.Providing distraction for the client by engaging the client in a board game Although all of the options represent appropriate interventions, UAPs are permitted only to engage the client in a distraction such as a board game, and so it is an intervention that the nurse may delegate after sufficiently instructing the UAP. The other options, assessing medication compliance, the characteristics of the hallucinations, and stressors, are nursing responsibilities and may not be delegated to a UAP.

The registered nurse (RN) has provided instructions to a licensed practical nurse (LPN) regarding administering enemas to a client scheduled for a barium enema. The RN has instructed the LPN to administer enemas until they are clear. The LPN tells the RN that 3 enemas were administered and that the returns are still not clear. What most appropriate instruction should be given to the LPN? 1. Administer 1 more enema. 2. Stop administering the enemas. 3. Continue to administer enemas until the solution is clear. 4. Wait for 1 hour and then continue administering the enemas.

2.Stop administering the enemas. Client preparation for a barium enema may include the administration of enemas before the test. If administering enemas until clear is prescribed on the morning of the test, enemas should be administered no more than 3 times. The continuous administration of enemas may cause fluid and electrolyte disturbances and imbalances.

The nurse should instruct the unlicensed assistive personnel (UAP) to avoid the use of a straight razor for which client? 1. The postoperative client 2. The client taking warfarin 3. The client with an infection 4. The client taking acetaminophen

2.The client taking warfarin Warfarin is an anticoagulant, which places the client at risk for bleeding. Use of a straight razor increases the risk of abrasion and bleeding because of the client's ineffective clotting capability. Postoperative status, infection, and taking acetaminophen are not affected by the choice of shaving tools.

The registered nurse (RN) is planning assignments for the clients on a nursing unit. The RN needs to assign 4 clients and has 1 RN, 1 licensed practical (vocational) nurse, and 2 unlicensed assistive personnel (UAPs) on a nursing team. Which client would the nurse most appropriately assign to the licensed practical nurse? 1. The client who requires a 24-hour urine collection 2. The client with an abdominal wound requiring frequent wound irrigations 3. The older client requiring assistance with a bed bath and frequent ambulation 4. The client on a mechanical ventilator requiring frequent assessment and suctioning

2.The client with an abdominal wound requiring frequent wound irrigations When delegating nursing assignments, the nurse must consider the skills and educational level of the nursing staff. The licensed practical (vocational) nurse is skilled in wound irrigation and dressing changes, so this client would be assigned to this staff member. Collecting 24-hour urine and helping with a bed bath and frequent ambulation can most appropriately be assigned to the UAPs. The client on the mechanical ventilator requiring frequent assessment and suctioning should most appropriately be cared for by the RN.

Which tasks should the registered nurse (RN) delegate to the licensed practical nurse (LPN)? Select all that apply. 1. Assessment 2. Urinary catheterization 3. Endotracheal suctioning 4. Intramuscular medication administration 5. Subcutaneous medication administration 6. Intravenous push medication administration

2.Urinary catheterization 3.Endotracheal suctioning 4.Intramuscular medication administration 5.Subcutaneous medication administration In general, an LPN can perform the tasks that an unlicensed assistive personnel can perform (skin care, range-of-motion exercises, grooming, ambulation, hygiene measures) as well as dressing changes, endotracheal suctioning, urinary catheterization, and medication administration (oral, subcutaneous, intramuscular, some piggyback medications). Assessment and administration of intravenous medications are responsibilities of the RN and outside of the scope of practice of the LPN.

The nurse manager meets with the staff nurses and announces that management has developed a new policy and procedure that is significantly different from old practices. Which statement by the nurse manager reflects the manager's use of legitimate power? 1. "The health care system services a client population that presents particular challenges. The changes made will enhance client safety and reduce errors." 2. "If you don't follow the new policy and procedure, I'll have no choice but to give you a notice about poor performance, which could lead to termination of your employment." 3. "Every manager has the responsibility to see that these new policies and procedures are followed 100% of the time. Please join me in this organization's effort to continue to improve quality care." 4. "You're just going to have to trust me on this one. I was a member of the committee that wrote the policy and procedure, and there are good reasons why the specific nursing actions need to be done this new way."

3."Every manager has the responsibility to see that these new policies and procedures are followed 100% of the time. Please join me in this organization's effort to continue to improve quality care." Option 3 describes legitimate power. Legitimate power is based on a person's position within an organization or society. The organizational leadership has mandated performance outcomes, and management has the responsibility to see that the mandate is met. Option 1 demonstrates informational power. The manager is using data to drive compliance with the mandate. Option 2 reflects an example of coercive power. Coercive power is a "do this or else" type of approach. Option 4 reflects expert power. The manager is asking the staff nurses to comply with the mandate because the manager possesses expert knowledge and skill levels. In addition to coercive, informational, expert, and legitimate power, the manager has referent, reward, and personal power.

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an unlicensed assistive personnel (UAP)? 1. A client requiring a colostomy irrigation 2. A client receiving continuous tube feedings 3. A client who requires urine specimen collections 4. A client with difficulty swallowing food and fluids

3.A client who requires urine specimen collections 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 the UAP would be to care for the client who requires urine specimen collections. The UAP is skilled in this procedure. Colostomy irrigations and tube feedings are not performed by UAPs because these are invasive procedures. The client with difficulty swallowing food and fluids is at risk for aspiration.

The nurse is preparing the client assignment. Which should be assigned to a licensed practical nurse (LPN)? 1. A client who requires teaching about an insulin pump 2. Completing an admission assessment on a newly admitted client 3. Administration of a new oral medication to a client with Alzheimer's disease 4. An assessment of a client whose pulse oximetry reading is 85% and who is having difficulty breathing

3.Administration of a new oral medication to a client with Alzheimer's disease Oral medication administration is within the scope of practice for an LPN. Teaching is the responsibility of the registered nurse (RN). Assessments are also done by the RN. The LPN's scope of practice is restricted to data collection.

The nurse is preparing to perform a general survey of a client who was admitted to the hospital a few hours ago. Which components of the general survey may be delegated to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Inspecting skin surfaces 2. Observing the client's behavior 3. Measuring the client's height and weight 4. Assessing the client's general appearance 5. Monitoring oral intake and urinary output

3.Measuring the client's height and weight 5.Monitoring oral intake and urinary output The general survey is a review of the client's main health problems and includes assessment of vital signs, height and weight, general behavior, and appearance. The nurse can delegate some aspects, such as measuring height and weight and monitoring intake and output, to UAPs, but the nurse is responsible for performing the general survey, including assessment of general appearance, behavior, and skin.

The nurse is caring for a client with acute glomerulonephritis. The nurse instructs the unlicensed assistive personnel (UAP) to implement which action when caring for the client? 1. Ambulate the client frequently. 2. Encourage a diet that is high in protein. 3. Remove the water pitcher from the bedside. 4. Monitor the client's temperature every 2 hours.

3.Remove the water pitcher from the bedside. The client with acute glomerulonephritis commonly experiences an excess of fluid volume and fatigue. Interventions include fluid restriction and monitoring weight, intake, and output. The diet is high in calories but low in protein. The client is placed on bed rest, or at least encouraged to rest, because there is a direct correlation between proteinuria and hematuria and increased activity levels. It is unnecessary to monitor the temperature as frequently as every 2 hours.