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Difficulty: MediumAssignment, Delegation and Supervision

A nursing coordinator at a regional medical center is directing workflow for a team comprising a registered nurse (RN), a licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which task delegation by the coordinator demonstrates the safest practice?

  1. Assigning the LPN/VN to administer scheduled oral analgesics to a client with chronic back pain who is preparing for routine discharge.Answer
  2. B
    Directing the UAP to complete the initial admission skin integrity assessment for an older adult transferring from a long-term care facility.
  3. C
    Delegating the primary care of a post-operative client exhibiting a narrowing pulse pressure, mild tachycardia, and increasing restlessness to the LPN/VN.
  4. D
    Instructing the UAP to empty the bedside commode of a client with a confirmed Clostridioides difficile infection and follow up with an alcohol-based hand rub.

Answer

Assigning the LPN/VN to administer scheduled oral analgesics to a client with chronic back pain who is preparing for routine discharge.
The correct delegation assigns a routine, predictable task (administering oral medication) for a stable client (preparing for routine discharge) to the LPN/VN, which perfectly aligns with standard scope of practice principles.

Step-by-Step Solution

1
Evaluate each task for the requirement of clinical judgment, initial assessment, or nursing evaluation.
Identify that the admission skin assessment requires RN judgment and cannot be delegated.
The RN retains responsibility for establishing the initial baseline assessment.
2
Analyze the clinical stability of the clients assigned to the LPN/VN.
Recognize that the post-operative client with a narrowing pulse pressure is unstable.
Narrowing pulse pressure and tachycardia indicate early shock, requiring rapid RN intervention.
3
Review infection control principles related to delegated tasks for the UAP.
Identify that alcohol-based hand rubs are contraindicated for C. difficile.
Proper delegation includes ensuring the right direction and communication regarding safety protocols, which mandates soap and water for spore-forming bacteria.
4
Determine the safest delegation among the remaining choices.
Select the medication administration for the stable client awaiting discharge.
Administering routine oral medications to a stable client is well within the LPN/VN scope of practice.

Key Concept

Scope of Practice and The Five Rights of Delegation
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Topics

Assignment, Delegation and Supervision

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