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Difficulty: Very hardClient Care Assignments and Collaboration

The nursing supervisor in a specialized oncology and palliative care center is determining client assignments for the upcoming shift. The staffing mix consists of registered nurses (RNs) and licensed practical nurses (LPNs). Which client assignment is clinically appropriate and legally within the scope of practice to allocate to an LPN?

  1. A
    A client admitted two hours ago with neutropenic fever who requires the initiation of a broad-spectrum intravenous antibiotic protocol.
  2. B
    A client with superior vena cava syndrome who is exhibiting new-onset facial swelling, tracheal deviation, and progressive dyspnea at rest.
  3. A client with advanced pancreatic cancer receiving a continuous subcutaneous opioid infusion via an established, locked pump, who requires scheduled complex wound care for a fungating tumor.Answer
  4. D
    A client scheduled to receive the initial dose of an investigational intravenous monoclonal antibody therapy for metastatic melanoma.

Answer

The client with advanced pancreatic cancer receiving a continuous subcutaneous opioid infusion via an established pump and requiring complex wound care.
The LPN/PN scope of practice includes caring for clients whose conditions are chronic or stable and whose care requirements are predictable. Monitoring an established, locked subcutaneous infusion and performing complex, yet routine, wound care are standard competencies for an LPN/PN. The severity of the underlying terminal illness does not inherently place the nursing tasks outside the LPN/PN scope if the client's physiological status and nursing needs are predictable.

Step-by-Step Solution

1
Analyze the legal scope of practice for the LPN/PN regarding client acuity.
LPNs/PNs must be assigned to clients whose conditions are chronic, stable, or have predictable outcomes.
LPNs/PNs are trained to perform focused data collection and established interventions, whereas RNs must handle comprehensive assessments and unstable clients.
2
Evaluate the stability and predictability of the client with pancreatic cancer.
The client has a terminal illness, but the care regimen (established subcutaneous pump, scheduled wound care) is predictable and routine.
The severity of the disease (advanced cancer) does not equate to physiological instability. Established tasks fall within LPN/PN competencies.
3
Examine the remaining client scenarios for signs of instability or the need for RN-level evaluation.
The other clients involve acute sepsis, new-onset airway compromise, and initial high-risk investigational therapies.
These scenarios require complex RN assessment, immediate clinical judgment, and continuous evaluation that exceed LPN/PN boundaries.
4
Select the assignment that safely aligns with LPN/PN delegation rules.
The assignment involving the established pump and wound care is the only appropriate choice.
It strictly requires implementation of an established plan of care and focused data collection, perfectly matching the LPN/PN role.

Key Concept

LPN/PN Scope of Practice: Differentiating Stable/Predictable Care from Unstable/Complex Needs
Estimated Time:2m 0s
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Topics

Client Care Assignments and Collaboration

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