Examkin

Question

Difficulty: HardAssignment, Delegation and Supervision

A mass casualty incident has activated the hospital's disaster plan, requiring an influx of clients to the surgical step-down unit. The charge nurse is working with a core team consisting of one staff registered nurse (RN), one experienced licensed practical nurse (LPN), and one unlicensed assistive personnel (UAP). To ensure safe and effective care, which delegation decision by the charge nurse is the most appropriate?

  1. A
    Directing the UAP to obtain the initial admission vital signs and orient a newly arrived client transferring from the emergency department.
  2. B
    Instructing the LPN to evaluate the respiratory status and titrate the oxygen flow rate for a client exhibiting sudden restlessness and confusion.
  3. Assigning the LPN to perform routine tracheostomy care and administer scheduled enteral tube feedings to a chronically ventilator-dependent client.Answer
  4. D
    Delegating the UAP to feed a client who suffered an ischemic stroke 12 hours ago and is attempting to consume solid food for the first time.

Answer

Assigning the LPN to perform routine tracheostomy care and administer scheduled enteral tube feedings to a chronically ventilator-dependent client.
The LPN's scope of practice includes performing sterile procedures (such as tracheostomy care) and administering medications or tube feedings to clients with stable, chronic, and predictable conditions. A chronically ventilator-dependent client is considered stable in this context, making this a safe and appropriate delegation.

Step-by-Step Solution

1
Analyze the client assignments for stability, predictability, and the level of clinical judgment required.
Identify which tasks require RN-level assessment versus tasks that follow standard, predictable procedures.
The RN must retain tasks involving the nursing process (Assess, Diagnose, Plan, Implement, Evaluate) for unstable clients or those experiencing acute changes.
2
Evaluate the legal scope of practice for both the LPN and the UAP.
Determine that LPNs can care for stable clients and perform sterile procedures, while UAPs assist with routine activities of daily living for stable clients.
Adhering to scope of practice guidelines prevents unsafe delegation and protects client safety.
3
Apply the Five Rights of Delegation to each presented option.
Identify that delegating chronic tracheostomy care and enteral feedings to the LPN represents the right task and right circumstance.
A chronically ventilator-dependent client is considered stable in this context, making routine sterile care and feeding well within the LPN's capabilities.

Key Concept

Delegation and Scope of Practice
Rate this question

Topics

Assignment, Delegation and Supervision

More questions from this topic