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Difficulty: Very hardAssignment, Delegation and Supervision

An emergency code is initiated for a client on an inpatient oncology-hematology unit. The primary registered nurse (RN) must urgently transfer the care of three stable clients to a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP) who have just arrived from the float pool.

Which delegation instruction by the primary RN demonstrates the most accurate application of scope of practice principles?

  1. A
    Instructing the UAP to act as a sitter for a client receiving a first-time intravenous rituximab infusion and alert the RN immediately if the client exhibits throat tightness or sudden facial flushing.
  2. B
    Delegating the LPN/VN to evaluate a client's physiological response to an as-needed intravenous dose of hydromorphone administered 30 minutes ago for severe bone metastasis pain.
  3. C
    Assigning the LPN/VN to conduct the final review of the comprehensive discharge teaching packet regarding neutropenic precautions with a client who is scheduled to go home in two hours.
  4. Directing the LPN/VN to perform routine sterile tracheostomy site care, execute nasotracheal suctioning, and administer scheduled enteral bolus feedings for a client with advanced laryngeal cancer.Answer

Answer

Directing the LPN/VN to perform routine sterile tracheostomy site care, execute nasotracheal suctioning, and administer scheduled enteral bolus feedings for a client with advanced laryngeal cancer.
The correct answer involves tasks that are standard, routine procedures (sterile tracheostomy care, suctioning, and enteral feedings). Although these tasks appear complex because they involve the airway, they have predictable outcomes and follow established protocols. Therefore, they are safely within the LPN/VN scope of practice for a stable client with a chronic condition.

Step-by-Step Solution

1
Analyze the client stability and the complexity of the tasks in the correct option.
The client with laryngeal cancer requires tracheostomy care, suctioning, and tube feedings, which are standard procedures on an established airway.
Tasks with predictable outcomes that do not require independent nursing judgment can be safely delegated to an LPN/VN, even if they appear complex.
2
Evaluate the UAP delegation option regarding the biologic infusion.
The UAP is asked to monitor for specific signs of anaphylaxis (throat tightness, flushing) during a high-risk, first-time infusion.
This requires clinical assessment and interpretation of life-threatening symptoms, which falls strictly outside the UAP scope of practice.
3
Evaluate the LPN/VN delegation option regarding pain medication.
The LPN/VN is asked to evaluate the client's response to an intravenous narcotic.
Evaluation of interventions, especially for acute pain and IV medications, is a core component of the RN's nursing process and cannot be delegated.
4
Evaluate the LPN/VN delegation option regarding discharge teaching.
The LPN/VN is asked to conduct a final review of a comprehensive discharge packet.
While LPN/VNs can reinforce previously taught information, conducting final comprehensive discharge teaching and evaluating learning readiness is strictly an RN responsibility.

Key Concept

The RN cannot delegate tasks that require independent nursing knowledge, comprehensive assessment, clinical judgment, primary teaching, or evaluation. However, LPN/VNs can safely perform complex but standard physiological tasks (like sterile dressing changes, suctioning, and tube feedings) on stable clients with predictable outcomes.
Estimated Time:1m 30s
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Assignment, Delegation and Supervision

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