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Difficulty: Very hardAssignment, Delegation and Supervision

The registered nurse (RN) is leading a care team with a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP) on an acute medical-surgical unit. Following shift report, arrange the following care management and delegation actions in the priority order the RN should execute them, from highest priority (first) to lowest priority (last).

  1. 1Instruct the UAP to immediately halt the planned ambulation of a client with a newly suspected deep vein thrombosis (DVT).
  2. 2Assess a client with a 12-hour-old ileal conduit who is exhibiting a rigid, board-like abdomen.
  3. 3Direct the LPN/VN to administer a time-sensitive, scheduled oral anticonvulsant to a clinically stable client.
  4. 4Assign the UAP to record the routine morning vital signs of a client who is awaiting discharge.
  5. 5Evaluate the LPN/VN's electronic documentation regarding the character and volume of a client's wound drain output.

Answer

The RN should first stop the UAP from ambulating the DVT client, then assess the client with a rigid abdomen, next delegate the anticonvulsant to the LPN/VN, then assign routine vital signs to the UAP, and finally review the LPN/VN's documentation.
In complex clinical scenarios, the RN must synthesize prioritization frameworks (like ABCs and safety/risk reduction) with delegation principles. The absolute highest priority is preventing immediate, imminent harm. Instructing the UAP to halt the ambulation of a client with a suspected DVT prevents a potentially fatal pulmonary embolism and takes only seconds. The second priority is addressing physiological instability; a rigid, board-like abdomen is a classic sign of peritonitis or perforation, requiring immediate RN assessment. The third priority is ensuring time-sensitive interventions are completed; delegating the oral anticonvulsant to the LPN/VN ensures this stable client does not suffer a seizure while the RN is busy. The fourth priority is routine data collection; assigning the UAP to take vital signs on a stable, discharging client is appropriate and safe. The final priority is administrative supervision; evaluating the LPN/VN's documentation is a necessary part of the delegation process but can be safely deferred until all direct care needs are addressed.

Step-by-Step Solution

1
Identify imminent safety hazards and active scope-of-practice violations.
The UAP preparing to ambulate a client with a suspected DVT is identified as an immediate threat.
Ambulating a client with an untreated DVT can cause the clot to dislodge, resulting in a fatal pulmonary embolism. Stopping the UAP takes seconds and prevents a sentinel event.
2
Prioritize clients with unstable, life-threatening physiological changes.
The client with a rigid, board-like abdomen is prioritized for immediate RN assessment.
A rigid abdomen post-operatively strongly suggests peritonitis or internal hemorrhage. The RN must assess this unstable client immediately after securing the safety of the first client.
3
Delegate time-sensitive tasks for stable clients to appropriate licensed personnel.
The LPN/VN is directed to administer the scheduled oral anticonvulsant.
Administering oral medications to stable clients is within the LPN/VN scope of practice. Delegating this ensures the medication is given on time to prevent a seizure while the RN manages the unstable client.
4
Delegate routine, predictable tasks for stable clients to unlicensed personnel.
The UAP is assigned to obtain vital signs for the discharge client.
The client awaiting discharge is stable. Routine vital signs require no clinical judgment and fall safely within the UAP's scope of practice.
5
Perform required supervisory and administrative duties.
The RN evaluates the LPN/VN's documentation of drain output.
Evaluation is the final step of the delegation process. It is an administrative priority that should be completed after all immediate physiological and safety needs are met.

Key Concept

Prioritization of Care and Principles of Safe Delegation
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Topics

Assignment, Delegation and Supervision

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