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Difficulty: HardAssignment, Delegation and Supervision

A nursing care team comprising a registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP) is initiating the day shift on a busy orthopedic and trauma ward. Which specific client care directive represents the most appropriate delegation by the RN?

  1. Authorizing the LPN/VN to execute a routine sterile dressing change and administer scheduled oral analgesics for a client who is three days post-total knee arthroplasty.Answer
  2. B
    Requesting the UAP to demonstrate the correct technique for daily pin site care to a client preparing for discharge with a tibial external fixator.
  3. C
    Assigning the UAP to provide the morning meal to a client who recently developed voice hoarseness and frequent throat clearing after an anterior cervical discectomy.
  4. D
    Directing the LPN/VN to perform the comprehensive admission assessment for a client arriving directly from the emergency department with a newly applied pelvic binder.

Answer

The most appropriate delegation is authorizing the LPN/VN to perform a sterile dressing change and administer oral analgesics for a stable, three-day post-operative client.
The correct delegation involves assigning an LPN/VN to provide care for a stable, three-day post-operative client. Performing a routine sterile dressing change and administering scheduled oral medications are entirely within the legal scope of practice for an LPN/VN, provided the client's condition is predictable and not rapidly changing.

Step-by-Step Solution

1
Analyze the delegation to the LPN/VN for the total knee arthroplasty client.
The client is three days post-operative and stable. The required tasks are a sterile dressing change and oral medication administration.
To verify that the tasks fall within the LPN/VN scope of practice, which safely includes standard procedures and medication administration for clients with predictable outcomes.
2
Evaluate the task assigned to the UAP regarding the external fixator.
The task involves demonstrating a technique to a client, which is considered initial teaching.
To apply the National Council of State Boards of Nursing (NCSBN) principle that teaching and evaluation cannot be delegated to unlicensed personnel.
3
Assess the clinical stability of the client who had an anterior cervical discectomy.
The client is exhibiting hoarseness and throat clearing, which are signs of potential airway edema or new-onset dysphagia.
To recognize that feeding a client with a potential airway or swallowing compromise carries a high risk of aspiration and must be assessed by the RN first.
4
Review the LPN/VN assignment for the newly admitted client with a pelvic binder.
The client requires a comprehensive admission assessment and possesses a high-acuity trauma injury (pelvic fracture).
To enforce the rule that RNs must perform all initial admission assessments and must retain care for highly unstable clients.

Key Concept

RNs must delegate tasks based on client stability, potential for harm, task complexity, and the legal scope of practice for LPNs/VNs and UAPs.
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Topics

Assignment, Delegation and Supervision

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