Examkin

Question

Difficulty: Very hardAssignment, Delegation and Supervision

At the start of the shift on an adult medical-surgical floor, the charge nurse is finalizing patient assignments. The shift's personnel matrix consists of a core staff registered nurse (RN), an RN temporarily floated from the maternal-newborn (postpartum) unit, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which delegation decision by the charge nurse is most appropriate?

  1. Assigning the maternal-newborn float RN to a client who is 72 hours post-exploratory laparotomy, has an active closed-suction surgical drain, and requires scheduled intravenous antibiotics.Answer
  2. B
    Assigning the maternal-newborn float RN to a client with a history of chronic obstructive pulmonary disease (COPD) who has newly developed paradoxical chest wall movement.
  3. C
    Delegating the LPN to evaluate the effectiveness of a continuous bladder irrigation (CBI) for a client 12 hours post-prostatectomy and titrate the instillation rate accordingly.
  4. D
    Directing the UAP to provide continuous one-to-one room observation for a client with active suicidal ideation and to document a psychosocial mood assessment every 15 minutes.

Answer

Assigning the maternal-newborn float RN to a client who is 72 hours post-exploratory laparotomy, has an active closed-suction surgical drain, and requires scheduled intravenous antibiotics.
When floating to a different unit, an RN should be assigned stable clients with care requirements that closely align with their home unit's specialty. A maternal-newborn (postpartum) RN is highly proficient in managing clients recovering from major abdominal surgery (such as cesarean births), which includes maintaining fluid balance, assessing surgical incisions, managing closed-suction drains, and administering routine intravenous antibiotics. Assigning this float RN to a stable client who is 72 hours post-exploratory laparotomy is the safest and most legally defensible utilization of their transferrable skills.

Step-by-Step Solution

1
Analyze the legal scope of practice for each available team member (Core RN, Float RN, LPN, UAP).
Identified that RNs perform complex assessments and evaluations; float RNs require stable patients matching their skill set; LPNs perform routine care on stable patients but do not evaluate; UAPs perform basic tasks and do not assess.
Establishing boundaries is the first step in safe delegation.
2
Evaluate the acuity and stability of each client presented in the options.
Identified that the COPD client is highly unstable (paradoxical breathing), the laparotomy client is stable (72 hours post-op), and the other clients require specific nursing judgments.
Client stability dictates who can safely assume care.
3
Match the float RN's specialized experience to the client assignments.
Correlated postpartum nursing skills (managing cesarean section abdominal incisions, surgical drains, and routine IVs) with the needs of the stable laparotomy client.
Float nurses must be assigned clients whose care requirements align with their transferrable skills.
4
Identify and eliminate options that violate the NCSBN delegation principles (EAT: Evaluate, Assess, Teach).
Eliminated the option asking the LPN to 'evaluate and titrate' and the option asking the UAP to perform a 'mood assessment'.
Clinical judgment and assessment can never be delegated down the nursing chain.

Key Concept

Assignment, Delegation and Supervision
Rate this question

Topics

Assignment, Delegation and Supervision

More questions from this topic