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Difficulty: HardAssignment, Delegation and Supervision

A nursing team consisting of a registered nurse (RN), a licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP) is providing care on a progressive cardiac care unit. Which task assignment by the RN demonstrates the most appropriate application of delegation principles?

  1. Directing the LPN/VN to administer a scheduled subcutaneous anticoagulant and monitor the femoral insertion site of a client who underwent a diagnostic cardiac catheterization 24 hours ago.Answer
  2. B
    Assigning the UAP to measure vital signs and provide clear oral fluids to a client admitted 30 minutes ago with acute substernal chest pain and diaphoresis.
  3. C
    Delegating the LPN/VN to formulate a customized sodium-restricted dietary teaching plan for a client who was recently diagnosed with severe congestive heart failure.
  4. D
    Instructing the UAP to assist with the morning feeding of a client who sustained an ischemic stroke 48 hours ago and exhibits frequent coughing and pocketing of food.

Answer

The most appropriate delegation is assigning the LPN/VN to administer subcutaneous medication and monitor the stable femoral site of the client who is 24 hours post-cardiac catheterization.
The correct delegation assigns an experienced LPN/VN to care for a client who is 24 hours post-procedure. At this stage, the client's condition is considered stable and the outcomes are predictable. The tasks of administering a scheduled subcutaneous medication and monitoring an established access site for routine complications (like bleeding or hematoma) are well within the legal and educational scope of practice for a licensed practical nurse.

Step-by-Step Solution

1
Analyze the clinical stability and acuity of the client in each assignment.
Identified that the client with acute chest pain and the client exhibiting dysphagia are unstable and require direct RN care.
Delegation decisions must prioritize client safety; unstable clients with unpredictable outcomes cannot be delegated to LPNs/VNs or UAPs.
2
Evaluate the specific task against the educational scope of practice for the designated staff member.
Determined that formulating an initial teaching plan is outside the scope of an LPN/VN, while assisting a high-aspiration-risk client is outside the scope of a UAP.
The RN is accountable for ensuring the 'Right Task' and 'Right Person' according to the Five Rights of Delegation.
3
Identify the option where a stable client is matched with a task appropriate for the assignee.
The 24-hour post-catheterization client is stable, and medication administration with routine monitoring aligns with LPN/VN capabilities.
This matches a predictable, routine care requirement with the appropriate licensed personnel, satisfying all delegation criteria.

Key Concept

Scope of Practice and Safe Delegation
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Topics

Assignment, Delegation and Supervision

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