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Question

Difficulty: HardClient Care Assignments and Collaboration

A practical/vocational nurse (LPN/VN) receives the shift handoff on a surgical orthopedics unit. While organizing the daily workflow, the nurse identifies several pending client interventions. Which of the following tasks must the LPN/VN recognize as being outside their legal scope of practice and requiring reassignment to a registered nurse (RN)? Select all that apply.

  1. Creating the initial discharge education plan for a client who had a total hip arthroplasty.Answer
  2. B
    Administering a scheduled subcutaneous injection of enoxaparin for deep vein thrombosis prophylaxis.
  3. Evaluating a client's respiratory status following an urgent nebulizer treatment for sudden-onset wheezing.Answer
  4. D
    Performing a routine sterile dressing change on a 3-day-old below-the-knee amputation stump.
  5. Administering an intravenous (IV) push dose of hydromorphone for breakthrough incisional pain.Answer
  6. F
    Emptying a closed-wound drainage system and documenting the characteristics of the collected fluid.

Answer

The tasks that exceed the LPN/VN scope and require RN reassignment are creating the initial discharge education plan, evaluating a client's response to an urgent breathing treatment, and administering an IV push dose of hydromorphone.
The tasks that exceed the practical nurse's scope of practice involve comprehensive assessment, initial education planning, evaluation of unstable clients, and administration of high-risk intravenous push medications. Formulating an initial discharge plan requires the registered nurse's clinical judgment. Evaluating a client with a sudden respiratory compromise involves complex, continuous assessment of an unstable condition. Finally, pushing intravenous narcotics is restricted to the RN scope due to the rapid onset and risk for severe respiratory depression.

Step-by-Step Solution

1
Analyze each delegated task against the established legal boundaries of practical nursing.
Identify whether each task involves routine care on a stable client or complex assessment on an unstable client.
The LPN/VN is legally obligated to refuse or reassign tasks that exceed their scope of practice to ensure client safety.
2
Evaluate the task involving the initial discharge education plan.
Recognize this as outside the LPN/VN scope.
The RN is responsible for synthesizing data to initiate teaching plans; the LPN/VN may only reinforce established teaching.
3
Evaluate the task involving sudden-onset wheezing.
Recognize this as outside the LPN/VN scope.
A client with an acute, sudden respiratory change is unstable. Evaluating their response requires comprehensive RN assessment, not basic data collection.
4
Evaluate the administration of IV push hydromorphone.
Recognize this as outside the LPN/VN scope.
Due to the inherent risks and need for immediate clinical judgment regarding adverse reactions, IV push medications are generally restricted to RNs.
5
Verify the remaining tasks (subcutaneous injection, established sterile dressing, emptying drains).
Confirm these are within the LPN/VN scope.
These represent standard, predictable care procedures on stable clients and do not require complex RN-level clinical judgment.

Key Concept

LPN/VN Scope of Practice: Distinguishing Between Independent Tasks and Required RN Collaboration
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Topics

Client Care Assignments and Collaboration

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