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Difficulty: MediumClient Care Assignments and Collaboration

An interprofessional team consisting of a registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and an assistive personnel (AP) is managing care for a group of clients on an orthopedic postoperative unit. The LPN/VN is reviewing the assignments for the shift. Which of the following actions represent safe and appropriate practice by the LPN/VN? (Select all that apply.)

  1. Administering a scheduled subcutaneous anticoagulant to a client who is two days postoperativeAnswer
  2. B
    Conducting the initial admission assessment for a newly admitted client transferred from the emergency department
  3. Assigning the assistive personnel (AP) to apply anti-embolism stockings on a hemodynamically stable clientAnswer
  4. D
    Giving an initial dose of intravenous push (IVP) hydromorphone to a client reporting severe, sudden pain
  5. Reinforcing the registered nurse's previous discharge instructions regarding signs of wound infectionAnswer
  6. F
    Explaining the potential complications of a surgical procedure to a client prior to obtaining their consent signature

Answer

The correct actions include administering scheduled subcutaneous medications, assigning the AP to apply anti-embolism stockings, and reinforcing the registered nurse's previous discharge instructions.
The LPN/VN is legally authorized to administer scheduled, routine medications such as subcutaneous anticoagulants. They are also responsible for reinforcing initial education that has already been provided by the registered nurse. Furthermore, delegating a routine, predictable task with low risk, such as applying anti-embolism stockings to a stable client, is an appropriate assignment for an AP.

Step-by-Step Solution

1
Analyze the LPN/VN scope of practice regarding medication administration and client assessment.
The LPN/VN can administer routine subcutaneous medications but cannot perform initial comprehensive admission assessments or give high-risk intravenous push (IVP) medications for acute pain.
Initial assessments and IVP medications require comprehensive RN-level evaluation and clinical judgment.
2
Evaluate the principles of delegation to assistive personnel (AP).
Applying anti-embolism stockings to a stable client is a routine, non-invasive task that is safe to delegate to the AP.
The task has predictable outcomes and does not require nursing judgment.
3
Determine the role of the LPN/VN in client education and informed consent.
The LPN/VN can reinforce existing RN teaching but cannot provide the initial explanation of surgical risks for informed consent.
Initial teaching is an RN responsibility, and explaining surgical risks is the responsibility of the medical provider performing the procedure.

Key Concept

The LPN/VN safely provides care to stable clients with predictable outcomes, delegates routine tasks to APs, and reinforces existing teaching, while comprehensive assessment, initial teaching, and complex IV therapies are reserved for the RN.
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Topics

Client Care Assignments and Collaboration

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