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Difficulty: Very hardAssignment, Delegation and Supervision

The charge nurse on a pediatric acute care unit is coordinating shift assignments. The available nursing team consists of one experienced pediatric registered nurse (RN), one RN floated from an adult orthopedic unit, and one licensed practical nurse (LPN/VN). Which of the following client assignments represents the safest and most appropriate delegation of care?

  1. Assigning the adult orthopedic float RN to a 16-year-old client who is 48 hours post-operative from an open reduction and internal fixation (ORIF) of a fractured femur and requires scheduled intravenous antibiotics.Answer
  2. B
    Assigning the experienced LPN/VN to evaluate the respiratory status and determine the effectiveness of a newly prescribed bronchodilator for a 7-year-old client admitted with asthma.
  3. C
    Assigning the adult orthopedic float RN to a 4-month-old infant admitted with respiratory syncytial virus (RSV) who is receiving high-flow nasal cannula therapy and exhibiting mild sternal retractions.
  4. D
    Assigning the experienced LPN/VN to monitor and adjust the continuous intravenous insulin infusion for a 12-year-old client admitted with diabetic ketoacidosis (DKA) whose blood glucose levels are trending downward.

Answer

The safest and most appropriate assignment is delegating the care of the 16-year-old post-operative orthopedic client to the adult orthopedic float RN.
The safest and most appropriate assignment aligns the nurse's scope of practice and clinical experience with the client's acuity and physiological needs. A 16-year-old client is physiologically similar to an adult. Because the float RN works on an adult orthopedic unit, managing a client 48 hours post-operative from an open reduction and internal fixation (ORIF) with scheduled intravenous antibiotics perfectly matches their core clinical competencies and comfort level. This client is stable and requires predictable, routine care.

Step-by-Step Solution

1
Analyze the competencies and legal scope of practice for each available staff member on the unit.
The team includes a specialized pediatric RN (best for unstable/complex children), an adult orthopedic float RN (best for adult-like patients with musculoskeletal issues), and an LPN/VN (best for stable clients with predictable outcomes).
Delegation must strictly align with the provider's legal scope of practice and clinical familiarity to ensure client safety.
2
Evaluate the acuity, physiological stability, and developmental needs of the clients described in each assignment option.
The 16-year-old is stable; the 7-year-old requires clinical evaluation; the 4-month-old is respiratory unstable; and the 12-year-old is metabolically unstable on a high-alert infusion.
Identifying client stability dictates which tasks must be retained by the core RN versus what can be safely delegated.
3
Match the staff members to the appropriate client based on the NCSBN delegation guidelines.
The float RN is appropriately assigned to the 16-year-old orthopedic client, while the other assignments incorrectly delegate RN-level clinical judgment or unstable clients to personnel without the appropriate scope or expertise.
Assigning the adolescent with a femur fracture to the adult ortho float RN perfectly matches the nurse's core competencies with the client's needs.

Key Concept

Delegation and Scope of Practice (NCSBN Guidelines)
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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