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Difficulty: Very hardAssignment, Delegation and Supervision

Care is being organized for four clients admitted to a progressive care unit. The personnel available includes one registered nurse (RN) and one licensed practical/vocational nurse (LPN/VN). Which client is most appropriate to assign to the LPN/VN?

  1. A
    A client recovering from a cardiac catheterization who exhibits a blood pressure of 108/86 mm Hg and a resting heart rate of 112 beats/minute
  2. B
    A client experiencing an acute asthma exacerbation whose recent arterial blood gas reveals a pH of 7.38 and a PaCO2 of 42 mm Hg
  3. A client with cor pulmonale who maintains an oxygen saturation of 89% on 2 liters of oxygen via nasal cannula and requires scheduled oral furosemideAnswer
  4. D
    A client transitioning from a continuous heparin infusion to oral apixaban who requires education regarding bleeding precautions prior to discharge

Answer

The most appropriate client to assign to the LPN/VN is the client with cor pulmonale who has an oxygen saturation of 89% and requires scheduled oral furosemide.
The client with cor pulmonale presents with chronic, expected baseline findings (oxygen saturation of 89%) and requires a routine, predictable intervention (oral furosemide administration). Because this client's condition is stable and the required task does not involve initial assessment, complex clinical judgment, or initial teaching, this assignment falls safely within the LPN/VN scope of practice.

Step-by-Step Solution

1
Analyze the scope of practice limitations for an LPN/VN.
LPN/VNs are assigned stable clients with predictable outcomes, can administer routine medications, but cannot perform initial teaching or advanced clinical assessments.
Safe delegation requires matching the client's acuity and task complexity to the personnel's legal scope of practice.
2
Evaluate the stability of the client recovering from a cardiac catheterization.
Calculate the pulse pressure (108−86=22 mm Hg108 - 86 = 22 \text{ mm Hg}). The combination of a narrow pulse pressure and tachycardia (112 bpm112 \text{ bpm}) signals early shock.
Identifying subtle physiological decline is required to prevent assigning an unstable client to a practical nurse.
3
Evaluate the stability of the client with an acute asthma exacerbation.
Recognize that a 'normal' PaCO2\text{PaCO}_2 (42 mm Hg42 \text{ mm Hg}) during an asthma attack indicates respiratory muscle fatigue, not recovery. This is a medical emergency.
Patients in impending respiratory failure require immediate RN intervention and continuous advanced assessment.
4
Evaluate the client requiring education on apixaban.
Identify that providing initial discharge education is an exclusive RN responsibility.
The 'teach' component of the nursing process (Assess, Diagnose, Plan, Implement, Evaluate, Teach) cannot be delegated.
5
Evaluate the stability of the client with cor pulmonale.
Identify that an oxygen saturation of 89%89\% is an expected, stable chronic baseline for severe right-sided heart failure secondary to lung disease, and oral furosemide is a routine medication.
Stable clients with predictable baseline abnormalities are the safest and most appropriate assignments for LPN/VNs.

Key Concept

Delegation and Physiological Prioritization
Estimated Time:2m 0s
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Topics

Assignment, Delegation and Supervision

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