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Difficulty: HardAssignment, Delegation and Supervision

A registered nurse (RN) is coordinating care for clients on a pediatric hematology/oncology unit with the assistance of a licensed practical/vocational nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Which of the following task delegations by the RN are appropriate? Select all that apply.

  1. Assigning the LPN/VN to administer a subcutaneous injection of filgrastim to an adolescent with neutropeniaAnswer
  2. Assigning the UAP to measure and record the urinary output from the indwelling catheter of a child receiving intravenous chemotherapyAnswer
  3. C
    Assigning the LPN/VN to perform the initial admission assessment on a toddler transferred from the emergency department
  4. Assigning the LPN/VN to reinforce discharge teaching regarding infection prevention with the family of a client with leukemiaAnswer
  5. E
    Assigning the UAP to obtain the 15-minute vital signs for a school-aged child who has just started receiving a packed red blood cell transfusion
  6. F
    Assigning the LPN/VN to evaluate the effectiveness of a PRN intravenous opioid analgesic administered for severe bone pain

Answer

The appropriate delegations are assigning the LPN/VN to administer the subcutaneous injection and to reinforce discharge teaching, and assigning the UAP to measure and record urinary output.
Delegation must adhere strictly to the nurse practice act and the Five Rights of Delegation. The registered nurse (RN) retains ultimate responsibility for the core nursing process, which includes initial assessment, nursing diagnosis, establishing the care plan, initial client teaching, and evaluating outcomes. It is within the licensed practical/vocational nurse (LPN/VN) scope of practice to administer medications via standard routes (such as subcutaneous injections) and to reinforce education that has already been initiated by the RN. It is within the unlicensed assistive personnel (UAP) scope of practice to perform routine, non-invasive tasks with predictable outcomes, such as measuring and recording urinary intake and output.

Step-by-Step Solution

1
Analyze the scope of practice for the LPN/VN in the given scenario.
The LPN/VN is permitted to administer subcutaneous medications and reinforce initial teaching, but cannot perform initial assessments or evaluate care outcomes.
The RN is required to retain responsibility for the core nursing process, including comprehensive assessment and evaluation.
2
Analyze the scope of practice for the UAP in the given scenario.
The UAP can perform standard procedures like measuring urinary output, but cannot monitor for critical physiological changes such as an acute blood transfusion reaction.
UAP tasks must have predictable outcomes and cannot require clinical nursing judgment or interpretation of data.
3
Evaluate each option against safe delegation principles.
Administering filgrastim (LPN/VN), measuring urinary output (UAP), and reinforcing teaching (LPN/VN) are correct and safe delegations.
These specific tasks align with legal scopes of practice and do not involve unauthorized clinical judgment.

Key Concept

Delegation and Scope of Practice
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Topics

Assignment, Delegation and Supervision

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