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Difficulty: HardAssignment, Delegation and Supervision

Shift responsibilities on a high-acuity cardiopulmonary and renal unit must be distributed by the coordinating RN. The available personnel for task distribution include one LPN/VN and one UAP. Based on the principles of safe delegation and scope of practice, which task assignment is correct?

  1. A
    Directing the UAP to gather a clean-catch urine specimen and teach the client the proper cleansing technique required before the collection.
  2. B
    Entrusting the LPN/VN to deliver an intravenous push (IVP) dose of furosemide and monitor the immediate respiratory changes in a client with acute pulmonary edema.
  3. Assigning the LPN/VN to administer an oral phosphate binder and auscultate the arteriovenous (AV) fistula bruit for a stable client with end-stage renal disease.Answer
  4. D
    Having the UAP reapply a non-invasive ventilation mask and secure the head straps for a client who just reported a sudden onset of chest tightness and severe dyspnea.

Answer

Assigning the LPN/VN to administer an oral phosphate binder and auscultate the arteriovenous (AV) fistula bruit for a stable client with end-stage renal disease.
The correct assignment applies the five rights of delegation by pairing a legally appropriate task with a clinically stable client. Auscultating a mature arteriovenous (AV) fistula for a bruit is a focused, predictable assessment, and administering oral medications falls well within the LPN/VN scope of practice. Because the client with end-stage renal disease is described as stable, this delegation decision is safe, correct, and properly utilizes the care team.

Step-by-Step Solution

1
Analyze the acuity and clinical stability of each client presented in the assignment options.
The client with end-stage renal disease is explicitly described as stable. The clients with acute pulmonary edema and sudden chest tightness are highly unstable, experiencing acute respiratory compromise.
Delegation requires adherence to the 'Right Circumstance,' meaning the delegated task must involve a stable client with predictable health outcomes.
2
Evaluate the scope of practice and authorized tasks for the assigned team member in each scenario.
The UAP is improperly assigned patient teaching (proper cleansing technique), and the LPN/VN is improperly assigned a high-alert IV push medication.
The RN must adhere to the 'Right Task' and 'Right Person' principles by ensuring the delegatee is legally and educationally permitted to perform the task.
3
Identify the option that correctly matches a stable client with a task appropriate for the delegatee's legal scope of practice.
Assigning the oral medication administration and a protocol-driven, focused assessment (auscultating the AV fistula) to the LPN/VN is the only fully appropriate choice.
This decision correctly applies all five rights of delegation, maintaining patient safety while efficiently utilizing the healthcare team.

Key Concept

Scope of Practice and the Five Rights of Delegation
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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