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Difficulty: HardAssignment, Delegation and Supervision

Following a local industrial accident, a registered nurse (RN) is coordinating care with a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP) in an emergency overflow area. The RN must allocate immediate tasks for four newly arrived clients. Which delegation decision demonstrates the safest and most appropriate care management?

  1. Assigning the LPN/VN to administer a prescribed intramuscular analgesic to a client with a closed, splinted tibia fracture who is awaiting transport.Answer
  2. B
    Directing the UAP to obtain the initial baseline vital signs for a client who just developed audible stridor and increased work of breathing.
  3. C
    Delegating the LPN/VN to perform the primary triage assessment and assign a color-coded disaster tag to a client with a blunt head injury.
  4. D
    Instructing the UAP to explain the signs of localized infection and proper home dressing change technique to a client being discharged.

Answer

The most appropriate action is assigning the LPN/VN to administer an intramuscular analgesic to the client with the closed, splinted fracture.
The administration of an intramuscular analgesic to a client with a stabilized, closed fracture is within the scope of practice for an LPN/VN. This client has a predictable condition and does not require immediate, complex RN assessment, making this a safe and appropriate delegation decision.

Step-by-Step Solution

1
Evaluate the stability of each client presented in the options.
The client with stridor is unstable; the client needing triage requires initial assessment; the client being discharged requires teaching; the client with the splinted fracture is stable.
Delegation decisions must first consider client stability and acuity.
2
Apply the principles of the RN scope of practice regarding E.A.T. (Evaluation, Assessment, Teaching).
Disaster triage (Assessment) and discharge instructions (Teaching) must be performed by the RN.
Tasks involving nursing judgment cannot be delegated to LPNs/VNs or UAPs.
3
Match the remaining tasks to the appropriate personnel scope of practice.
Administering an intramuscular medication to a stable client is an appropriate task for an LPN/VN.
LPNs/VNs are licensed to administer most medications and care for clients with predictable outcomes.

Key Concept

Delegation based on client stability and staff scope of practice
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Topics

Assignment, Delegation and Supervision

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