Examkin

Question

Difficulty: HardAssignment, Delegation and Supervision

At the beginning of a shift on a respiratory step-down unit, client assignments are being distributed between a registered nurse (RN) and a licensed practical nurse (LPN/VN). Which client presentation represents the most appropriate assignment for the LPN/VN?

  1. A
    A client transferred from the intensive care unit 30 minutes ago following mechanical ventilation weaning and extubation.
  2. A client with a tracheostomy placed 3 days ago who requires scheduled sterile tracheostomy site care and continuous enteral feedings.Answer
  3. C
    A client preparing for discharge with a new diagnosis of pulmonary fibrosis who requires comprehensive education on home oxygen therapy.
  4. D
    A client with a closed-chest drainage system for a pleural effusion who is reporting a sudden onset of sharp chest pain upon inspiration.

Answer

The client with a tracheostomy placed 3 days ago who requires scheduled sterile tracheostomy site care and continuous enteral feedings.
The correct answer identifies a stable client with predictable care requirements. A tracheostomy placed 3 days ago is considered established, and scheduled sterile care along with continuous enteral feedings falls safely and appropriately within the licensed practical nurse (LPN/VN) scope of practice.

Step-by-Step Solution

1
Evaluate the acuity and stability of each client in the scenario.
Three clients exhibit signs of instability, transitional care needs, or require complex interventions, while one client is stable with predictable routine care needs.
Delegation decisions must prioritize client safety and adhere to the authorized scope of practice.
2
Apply the principles of delegation and the RN scope of practice.
The RN cannot delegate initial assessments, clinical judgments, or initial teaching to a licensed practical nurse or unlicensed personnel.
These tasks require the advanced knowledge and critical thinking skills of the RN.
3
Determine which client fits within the LPN/VN scope of practice.
The client requiring established tracheostomy care and enteral feedings is the only appropriate assignment.
LPN/VNs can legally and safely perform sterile procedures (like established tracheostomy care) and administer tube feedings for stable clients with predictable outcomes.

Key Concept

Delegation to the LPN/VN requires assigning stable clients with predictable outcomes while retaining unstable clients, initial assessments, and comprehensive teaching for the RN.
Rate this question

Topics

Assignment, Delegation and Supervision

More questions from this topic