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Difficulty: HardAssignment, Delegation and Supervision

A registered nurse (RN) is prioritizing care and delegating tasks to a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP) on a medical-surgical unit. Place the following actions in the order of priority the RN should perform them, from highest to lowest priority.

  1. 1Assess a client with a history of heart failure who is newly reporting a cough with pink, frothy sputum.
  2. 2Assign the LPN/VN to administer scheduled oral pain medication to a client who is 3 days postoperative.
  3. 3Explicitly direct the UAP to report back immediately if a stable client's systolic blood pressure drops below 90 mm Hg.
  4. 4Delegate the task of distributing fresh water pitchers to all assigned clients to the UAP.
  5. 5Follow up with the postoperative client to evaluate the effectiveness of the pain medication administered by the LPN/VN.

Answer

The correct sequence prioritizes life-threatening emergencies first, followed by time-sensitive delegation, routine delegation, and finally, evaluation of delegated interventions.
The correct sequence accurately applies both the ABC prioritization framework and the National Council of State Boards of Nursing (NCSBN) five rights of delegation. The RN first addresses the immediate life-threatening physiological need (ABC). Once the emergency is managed, the RN initiates the delegation process by assigning a time-sensitive medication task to the LPN/VN (Right Person/Right Task). Next, the RN ensures safety by providing specific reporting parameters to the UAP (Right Direction/Communication). Routine tasks are then delegated. Finally, the RN closes the delegation loop by retaining accountability for evaluating the client's response to the medication (Right Supervision/Evaluation), which must logically occur last.

Step-by-Step Solution

1
Identify the most unstable client requiring immediate RN intervention.
The client with pink, frothy sputum is prioritized first due to a potential airway/breathing emergency (pulmonary edema).
Airway, Breathing, and Circulation (ABC) principles always take precedence over routine or delegated care.
2
Delegate time-sensitive tasks for stable clients to appropriate personnel.
The LPN/VN is assigned to administer the scheduled oral pain medication.
Delegating appropriately (Right Task, Right Person) allows the RN to maximize team efficiency while managing higher-acuity needs.
3
Provide specific communication and parameters for monitoring tasks.
The UAP is directed to report a systolic blood pressure below 90 mm Hg.
The 'Right Direction/Communication' principle ensures the UAP understands specific limits and when to escalate findings to the RN.
4
Delegate routine, low-priority tasks.
The UAP is assigned to distribute water pitchers.
Basic care tasks without the need for nursing judgment are the lowest priority to assign and fit the UAP scope of practice.
5
Complete the delegation process by evaluating the outcomes.
The RN evaluates the effectiveness of the pain medication administered by the LPN/VN.
Evaluation is strictly an RN responsibility and must chronologically follow the administration of the intervention.

Key Concept

Delegation Process and Prioritization
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Topics

Assignment, Delegation and Supervision

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