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Difficulty: HardAssignment, Delegation and Supervision

The registered nurse (RN) is managing care delivery on an acute neurovascular step-down unit. Which task assignment demonstrates adherence to the principles of safe delegation?

  1. A
    Assigning the unlicensed assistive personnel (UAP) to measure the orthostatic blood pressure of a client who experienced a transient ischemic attack and is now reporting sudden dizziness.
  2. B
    Directing the UAP to provide routine oral hygiene for a client with left-sided facial paralysis who currently has an absent gag reflex.
  3. Instructing the UAP to apply bilateral sequential compression devices (SCDs) to a client who is completely immobile following a severe hemorrhagic stroke.Answer
  4. D
    Asking the UAP to reinforce the physical therapist's previous instructions on safe bed-to-chair transfer techniques for a client preparing for discharge.

Answer

The correct delegation is instructing the UAP to apply bilateral sequential compression devices (SCDs) to the immobile client.
The correct answer identifies a task that is standard, routine, and carries a predictable outcome. While the client has a serious condition (hemorrhagic stroke), applying SCDs does not require ongoing clinical judgment, making it a perfectly safe and appropriate task to delegate to a UAP.

Step-by-Step Solution

1
Evaluate the clinical stability and required assessment for the client reporting sudden dizziness.
Sudden dizziness indicates a potential acute neurological change. The client is unstable.
An unstable client with new symptoms requires an RN assessment before any tasks are delegated (Right Circumstance).
2
Analyze the airway risk for the client needing oral hygiene with an absent gag reflex.
The absent gag reflex presents a severe aspiration risk, requiring continuous clinical judgment during oral care.
Tasks requiring nursing judgment, airway protection, and assessment cannot be delegated to a UAP (Right Task).
3
Determine if reinforcing physical therapy instructions falls within the UAP scope of practice.
Teaching and reinforcing education are beyond the scope of practice for a UAP.
The nursing process, including client education, cannot be delegated to unlicensed personnel (Right Task).
4
Assess the complexity of applying sequential compression devices (SCDs) to an immobile client.
Applying SCDs is a routine, standard procedure with predictable outcomes that does not require independent nursing judgment.
Even if a client has a severe underlying diagnosis, routine, non-invasive tasks can safely be delegated to a UAP.

Key Concept

The Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision)
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Topics

Assignment, Delegation and Supervision

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