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Difficulty: HardAssignment, Delegation and Supervision

A charge nurse on an acute gastroenterology unit is reviewing shift allocations for a team consisting of a registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which specific delegation decision by the RN demonstrates safe and legally sound practice?

  1. A
    Delegating the LPN/VN to formulate a discharge teaching plan regarding low-residue dietary modifications for a client with Crohn's disease.
  2. B
    Asking the UAP to assist with feeding a client who exhibited new-onset coughing and gagging during breakfast.
  3. Instructing the UAP to empty a mature ileostomy appliance and document the effluent volume for a medically stable client.Answer
  4. D
    Directing the LPN/VN to perform a focused abdominal assessment on a client reporting sudden, severe epigastric pain.

Answer

Instructing the UAP to empty a mature ileostomy appliance and document the effluent volume for a medically stable client.
Emptying a mature ileostomy pouch and recording the volume is a routine, standardized procedure with predictable outcomes. Because the client is medically stable and the stoma is mature, this task does not require clinical judgment or advanced assessment skills, making it safe and appropriate to delegate to a UAP.

Step-by-Step Solution

1
Analyze the acuity and clinical stability of each client presented in the options.
Three clients have changing, complex, or potentially unstable conditions; one client is medically stable.
Safe delegation requires verifying that the client's condition is stable and predictable.
2
Evaluate the legal scope of practice for the assigned personnel for each task.
Creating teaching plans and performing complex assessments fall outside LPN/VN and UAP scopes; routine ostomy care is permissible for a UAP.
The RN must adhere to the legal scope of practice constraints and the Five Rights of Delegation.
3
Select the task that matches a stable client with an appropriate personnel skill level.
The UAP emptying the mature ileostomy appliance is the only legally and clinically sound assignment.
This task involves a routine, standard procedure requiring no independent nursing judgment.

Key Concept

Scope of Practice and the Five Rights of Delegation
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Topics

Assignment, Delegation and Supervision

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