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Difficulty: MediumAssignment, Delegation and Supervision

A multidisciplinary team is providing care on an acute post-surgical ward. The primary registered nurse (RN) is organizing the shift's workload with a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). Which decision by the RN demonstrates the most appropriate delegation of client care?

  1. Assigning the LPN to perform a scheduled sterile dressing change for a client with a healing abdominal incision.Answer
  2. B
    Delegating the UAP to evaluate the effectiveness of non-pharmacological pain interventions for a client reporting discomfort.
  3. C
    Assigning the LPN to assume primary care for a client who is exhibiting sudden, new-onset restlessness and a narrowing pulse pressure.
  4. D
    Directing the UAP to assist a client who is two hours post-lumbar laminectomy into a high Fowler's position for a meal.

Answer

Assigning the LPN to perform a scheduled sterile dressing change for a client with a healing abdominal incision.
Assigning the LPN to perform a scheduled sterile dressing change for a client with a healing abdominal incision is correct because this task falls clearly within the LPN's scope of practice. The client has a healing wound and is considered clinically stable, making this a safe and appropriate assignment.

Step-by-Step Solution

1
Analyze the scope of practice for the LPN and UAP.
Identify that the RN cannot delegate evaluation, assessment, or teaching (EAT) to a UAP or LPN.
Delegation must adhere to the legal scope of practice to ensure client safety.
2
Evaluate the clinical stability of the clients described in the options.
Recognize that the client with new-onset restlessness and a narrowing pulse pressure is unstable and experiencing early signs of shock.
LPNs should only be assigned to clients with stable, predictable outcomes. Unstable clients require an RN's advanced assessment skills.
3
Review post-operative safety and positioning requirements for specific surgical procedures.
Identify that placing a lumbar laminectomy client in a high Fowler's position is a contraindicated, unsafe practice.
The RN is responsible for ensuring that all delegated tasks do not place the client at risk for injury.
4
Select the delegation decision that correctly matches the task complexity and client stability with the team member's competency.
The sterile dressing change on a healing, stable wound is identified as the correct assignment for the LPN.
It involves a standard procedure on a stable client, fully within the LPN's scope of practice.

Key Concept

Delegation requires matching the complexity of the task and the clinical stability of the client with the legal scope of practice and competency of the healthcare team member.
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Topics

Assignment, Delegation and Supervision

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