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Difficulty: HardAssignment, Delegation and Supervision

The charge nurse on a high-acuity progressive care unit is coordinating shift assignments. The nursing team consists of a registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which task delegation demonstrates the safest and most appropriate application of delegation principles?

  1. A
    Delegating the UAP to assist with the first ambulation of a client who underwent a total hip arthroplasty four hours ago and received epidural anesthesia
  2. Assigning the LPN/VN to administer scheduled oral analgesics and monitor the output of a closed-suction wound drain for a client who is two days post-operative from a bowel resectionAnswer
  3. C
    Assigning the LPN/VN to perform a focused respiratory assessment and administer PRN nebulized albuterol to a client exhibiting sudden, acute respiratory distress
  4. D
    Delegating the UAP to instruct a client with a newly placed permanent pacemaker on proper incision care and arm movement restrictions

Answer

Assigning the LPN/VN to administer scheduled oral analgesics and monitor the output of a closed-suction wound drain for a client who is two days post-operative from a bowel resection.
The correct assignment involves the LPN/VN caring for a client who is two days post-operative. This client is considered relatively stable with predictable outcomes. Administering scheduled oral medications and monitoring drain output are routine tasks that fall squarely within the scope of practice for an LPN/VN.

Step-by-Step Solution

1
Analyze the acuity and stability of each client described in the options.
Identified that the client with sudden respiratory distress is unstable, while the post-operative bowel resection client is stable.
Delegation decisions must prioritize client stability; unstable clients must be assigned to an RN.
2
Evaluate the specific task against the legal scope of practice for the designated team member.
Determined that initial teaching and initial post-operative ambulation assessment fall outside UAP scope.
The RN cannot delegate the core nursing processes of assessment, initial teaching, or clinical judgment.
3
Identify the option where the task matches the competency level and the client condition is stable.
The LPN/VN administering oral medications and monitoring a drain for a stable post-operative client is the only appropriate match.
This aligns with the five rights of delegation, specifically the right task and right circumstance.

Key Concept

Principles of Safe Delegation and Scope of Practice
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Topics

Assignment, Delegation and Supervision

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