Examkin

Question

Difficulty: Very hardAssignment, Delegation and Supervision

The charge nurse on a busy surgical trauma step-down unit is planning care assignments for the upcoming shift. The staffing mix includes a core trauma registered nurse (RN), an RN floated from the inpatient psychiatric unit, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which of the following delegation and assignment decisions are appropriate? Select all that apply.

  1. Assigning the psychiatric float RN to care for a client who is 2 days post-operative from a femur fracture repair and is exhibiting severe acute alcohol withdrawal deliriumAnswer
  2. B
    Delegating the administration of a scheduled oral analgesic to the LPN for a client admitted 1 hour ago with a suspected tension pneumothorax awaiting emergent chest tube insertion
  3. C
    Delegating to the UAP the task of titrating a client's nasal cannula oxygen flow rate to maintain an oxygen saturation of 92% or greater
  4. Assigning the core trauma RN to conduct hourly neurological assessments on a client with a skull fracture who developed sluggish pupillary responses during the previous shiftAnswer
  5. Delegating the performance of sterile tracheostomy care to the LPN for a client whose tracheostomy was placed 5 days ago and is currently hemodynamically stableAnswer
  6. F
    Delegating to the UAP the responsibility of teaching a client's family about aspiration precautions during oral feedings

Answer

The correct assignments include assigning the psychiatric float RN to the client with alcohol withdrawal, assigning the core trauma RN to the client with sluggish pupillary responses, and delegating sterile tracheostomy care for an established stoma to the LPN.
The appropriate delegation decisions prioritize client stability, adhere to legal scopes of practice, and leverage specialized skills. The psychiatric float RN is uniquely qualified to manage the behavioral complexities of acute alcohol withdrawal in a surgically stable client. The core RN is correctly assigned to the client with acute neurological deterioration. Furthermore, sterile tracheostomy care on an established, 5-day-old stoma in a stable client is a safe and appropriate task for an experienced LPN.

Step-by-Step Solution

1
Analyze the client assigned to the psychiatric float RN.
The client is surgically stable but has acute alcohol withdrawal delirium.
Float nurses should be assigned clients whose conditions align with their core competencies or who are highly stable; a psychiatric RN is uniquely qualified to manage severe withdrawal delirium safely.
2
Evaluate the task delegated to the LPN regarding the client with a suspected tension pneumothorax.
The client is highly unstable and awaiting emergent intervention.
Regardless of the simplicity of the delegated task, LPNs must be assigned to stable clients with predictable outcomes. A client with a tension pneumothorax requires immediate RN oversight.
3
Assess the delegation of oxygen titration to the UAP.
Titrating oxygen requires clinical judgment based on oxygen saturation readings.
UAPs can perform standard, unchanging tasks but cannot evaluate responses or adjust medical treatments based on changing clinical parameters.
4
Review the assignment for the core trauma RN.
The client has acute neurological changes following a skull fracture.
Unstable clients experiencing acute changes require the advanced assessment and critical thinking skills of the core RN.
5
Evaluate the delegation of sterile tracheostomy care to the LPN.
The tracheostomy is 5 days old, and the client is stable.
While initial tracheostomy care on a fresh stoma is often an RN responsibility, sterile care on an established, stable tracheostomy falls well within the LPN scope of practice.
6
Analyze the delegation of teaching aspiration precautions to the UAP.
Teaching is outside the scope of practice for a UAP.
The RN must retain all teaching responsibilities and cannot delegate educational tasks to unlicensed personnel.

Key Concept

Delegation requires matching client needs with staff competencies (such as floating a psychiatric RN to manage delirium), assessing overall client stability regardless of task simplicity, and strictly adhering to the scope of practice for LPNs and UAPs.
Rate this question

Topics

Assignment, Delegation and Supervision

More questions from this topic