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Difficulty: HardAssignment, Delegation and Supervision

Mid-morning on a high-acuity infectious disease ward, the charge nurse must dynamically adjust client assignments for a multi-disciplinary team. The current staffing includes a registered nurse (RN), a licensed practical nurse (LPN/VN), and unlicensed assistive personnel (UAP). Which task reallocation represents the safest application of delegation principles?

  1. Transitioning the care of a client with a resolving methicillin-resistant Staphylococcus aureus (MRSA) wound infection to the LPN/VN to administer scheduled oral antibiotics and perform a sterile dressing change.Answer
  2. B
    Reassigning the LPN/VN to assume primary care for a client who recently returned from a thoracentesis and is suddenly manifesting tachycardia, tachypnea, and a narrowing pulse pressure.
  3. C
    Directing the UAP to provide hygiene care for a client newly diagnosed with disseminated herpes zoster (shingles) without verifying the UAP's immunity status or issuing an N95 respirator.
  4. D
    Instructing the UAP to evaluate a client's balance and readiness to independently ambulate with a new assistive device prior to the client's scheduled discharge.

Answer

The most appropriate delegation is assigning the LPN/VN to administer oral antibiotics and perform a sterile dressing change for the stable client with a resolving MRSA infection.
The correct answer involves assigning an LPN/VN to perform routine, standard procedures (oral medication administration and sterile dressing changes) for a client whose condition is explicitly stated as 'resolving.' Because the client is stable and the tasks do not require initial assessment or complex clinical judgment, this falls perfectly within the LPN/VN scope of practice.

Step-by-Step Solution

1
Analyze the core principles of delegation and the legal scope of practice.
Identify that RNs cannot delegate assessment, teaching, clinical judgment, or evaluation (EAT). LPN/VNs can perform complex but routine skills (like sterile dressings) on stable clients. UAPs handle standard, non-invasive tasks.
Establishing the baseline rules of delegation is necessary to evaluate each option.
2
Evaluate the stability and needs of the client returning from a thoracentesis.
The client has tachycardia, tachypnea, and a narrowing pulse pressure, indicating acute deterioration (potential shock or pneumothorax). This requires an RN.
Unstable clients with unpredictable outcomes must remain under the direct care of a registered nurse.
3
Assess the infection control requirements for disseminated herpes zoster.
Disseminated shingles requires airborne and contact precautions. The UAP was not provided proper PPE (N95) or vetted for immunity, making the assignment unsafe.
Delegation includes ensuring the environment and instructions are safe for the personnel performing the task.
4
Review the task delegated to the UAP regarding ambulation.
The task asks the UAP to 'evaluate' readiness, which violates the rule against delegating evaluation or clinical judgment.
Only an RN or physical therapist can perform the initial assessment and evaluation of a client's ability to use a new assistive device safely.
5
Verify the appropriateness of the MRSA client assignment.
The client is stable ('resolving'). Oral medications and sterile dressing changes are within the LPN/VN scope, making this the only safe delegation.
Matching a stable client with predictable needs to the LPN/VN's skill set represents proper resource allocation.

Key Concept

Scope of Practice and Safe Delegation Principles
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Topics

Assignment, Delegation and Supervision

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