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assignment/ delegation
The night charge nurse is making assignments for the next shift. Which client is most
appropriate to assign to a nurse with less than a year of experience who is floated from
the orthopedic unit to the medical unit?
1. Client newly admitted for an evolving ischemic stroke.
2. Client newly diagnosed with diabetes mellitus who needs insulin administration
teaching.
3. Client with exacerbation of chronic obstructive pulmonary disease (COPD) with a new
tracheostomy.
4. Client with sickle cell crisis who requires frequent intravenous (IV) opioid medication
for pain - CORRECT ANSWER-4. Client with sickle cell crisis who requires frequent
intravenous (IV) opioid medication for pain.
Sickle cell crisis is managed with IV hydration, frequent IV pain medication, and
as-needed blood transfusion.
Many orthopedic clients require medication with opioids to control pain, IV fluids, and
blood transfusion (blood loss with surgery/trauma). The float nurse is familiar with the
policies and procedures for pain assessment and administering opioid medications,
which should be the same on non-specialty units within the same facility.
(Option 1) The client newly admitted for an evolving ischemic stroke is best assigned to
an experienced nurse who regularly works on the unit. The nurse will perform baseline
and frequent follow-up neurologic assessments to determine if the client's condition is
worsening.
(Option 2) The client newly diagnosed with diabetes mellitus who needs insulin
administration teaching is best assigned to a nurse who regularly works on the unit. The
nurse would be familiar with the location of diabetic teaching materials, documentation
procedure, and referral resources, and would be better able to evaluate the client's
understanding and performance of insulin administration the next day.
(Option 3) The client with exacerbation of COPD with a new tracheostomy is best
assigned to an experienced nurse who regularly works on the unit. Care of a new
tracheostomy requires the nurse to be familiar with assessment (eg, appearance,
bleeding) and care (eg, suctioning).
A nurse delegates a task to the unlicensed assistive personnel (UAP). The UAP states,
"I can't do that." Which is the best initial response for the nurse to make?
1. Ask the UAP the reason for the response.
2. Do the task, but discuss the UAP's response with the manager.
3. Ignore the UAP's initial response and repeat the delegation request.
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4. Remind the UAP of the importance of teamwork. - CORRECT ANSWER-1. Ask the
UAP the reason for the response.
Just as in clinical situations, the nurse should first assess in management situations.
The UAP may not have the skills or abilities to do the task or the availability if doing
something else. The nurse may need to reprioritize the tasks that the UAP has been
delegated or provide additional instructions/education. However, finding out the reason
for the response is the first step.
(Option 2) This does not solve the issue. The RN does not have the time to do
everything, which is the reason for delegating. Speaking to the manager is an
appropriate response if there is a pattern of insubordination or refusals, such as when
the UAP is capable, not busy, and yet does not respond to the nurse's encouragement
to help out.
(Option 3) It is important to find out the reason for the response to ensure client safety
and completion of the task. A repeat request would be more appropriate if the UAP did
not indicate a response (maybe the UAP didn't hear or understand) or gave an
inappropriate response (eg, not my team).
(Option 4) This response is more appropriate if the UAP has the ability and availability
but is citing something else for the refusal, such as the task not belonging to the UAP's
assigned team. Assessment for the reason should be first.
A client is admitted with a lower urinary tract infection from an obstructing ureteral
stone. Which tasks can the registered nurse (RN) delegate to the experienced
unlicensed assistive personnel (UAP)? Select all that apply.
1. Assisting the client in completing a health history form
2. Collecting a urine specimen for culture and sensitivity
3. Instructing the client to strain urine when voiding
4. Measuring and documenting urine output
5. Monitoring the color and characteristics of urine output - CORRECT ANSWER-2.
Collecting a urine specimen for culture and sensitivity
4. Measuring and documenting urine output.
Measuring intake and output and obtaining a urine specimen for culture and sensitivity
are both appropriate duties to delegate to the UAP. Objective measurements (eg, vital
signs, intake and output) do not require assessment skills and are therefore appropriate
for delegation (Option 4). Nursing actions that require assessment, teaching, evaluation,
or clinical judgment must be performed by the RN.
Collecting a urine specimen is a routine task with a predictable outcome and is therefore
appropriate for delegation to the experienced UAP under the instruction and supervision
of the RN (Option 2). The RN should always observe the five rights of delegation by
verifying that the UAP have the skills and experience necessary to collect a urine
specimen without contamination. If this client had a Foley catheter, specimen collection
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would be inappropriate for delegation to the UAP. Collecting a specimen from a Foley
catheter is considered a sterile procedure as it involves accessing a sterile collection
port and risks introducing bacteria into the closed drainage system if done improperly.
However, when provided with the appropriate instructions, the UAP and even clients
themselves may collect a clean-catch or midstream urine specimen.
(Option 1) Conducting a review of the client's complete past medical history is an
important responsibility of the RN during the admission assessment. This requires skills
and understanding beyond the level of the UAP.
(Option 3) Client education about the procedure and rationale for straining urine is the
responsibility of the RN. After the RN assesses the knowledge and competency level of
the UAP, the UAP can gather supplies, remind the client to strain the urine, and report
any abnormal findin
The registered nurse is caring for multiple clients on a medical-surgical unit and has
finished the morning assessment. Which task is appropriate for the nurse to delegate to
unlicensed assistive personnel?
1. Apply a collagenase dressing to a client's pressure ulcer for wound debridement
2. Assist a client 1 day postoperative hip fracture repair to the bathroom.
3. Feed a client through a gastrostomy tube after elevating the head of the bed
4. Offer orange juice to a client if the blood glucose level is <70 mg/dL (<3.9 mmol/L). -
CORRECT ANSWER-2. Assist a client 1 day postoperative hip fracture repair to the
bathroom.
Delegation is the process of transferring responsibility of performing a task while
maintaining the ultimate responsibility for the action and its outcome. The registered
nurse (RN) should take into account the five rights of delegation (right task, right person,
right circumstances, right communication/direction, and right supervision/evaluation)
and the scope of practice when deciding which tasks to delegate. The unlicensed
assistive personnel (UAP) can assist clients out of bed or to the bathroom, assist with
activities of daily living, and position clients. The RN is responsible for assessing the
client and adhering to the nursing process.
(Option 1) Debridement of a wound involves removing debris or dead tissue to convert
contaminated wounds into clean wounds so that normal healing can take place.
Dressing (eg, collagenase) changes for debridement require sterile technique; UAP can
change dressings only for chronic wounds using clean technique.
(Option 3) The UAP can elevate the head of the bed when a client receives enteral
nutrition to prevent aspiration. However, feeding through a gastrostomy tube cannot be
delegated to the UAP as it requires assessment of tube placement and aspiration of
gastric residual volume.
(Option 4) Offering orange juice is an intervention for treating hypoglycemia that is
outside the UAP's scope of practice. The UAP should report the blood glucose level to
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the RN so that the RN can first reassess the client for accompanying symptoms of
hypoglycemia; these would require RN assessment and interpretation before
intervention.
The registered nurse (RN) and licensed practical nurse (LPN) are caring for a client with
an established colostomy. Which nursing actions may the RN delegate to the LPN?
Select all that apply.
1. Assess perfusion of the stoma tissue
2. Assist the client in changing the ostomy pouch
3. Auscultate the client's bowel sounds
4. Develop plan of care to prevent skin breakdown
5. Monitor the color of ostomy drainage - CORRECT ANSWER-2. Assist the client in
changing the ostomy pouch
3. Auscultate the client's bowel sounds
5. Monitor the color of ostomy drainage
Tasks requiring initial assessment, initial or discharge education, care planning, or care
of an unstable client require the clinical judgment of the registered nurse (RN) and may
not be delegated. The RN may delegate care of stable clients with established ostomies
to the licensed practical nurse (LPN).
The following actions related to ostomy care are generally within the LPN scope of
practice:
Provide ostomy care and observe for skin breakdown (Option 2)
Perform specific assessments (eg, bowel sounds, stoma color) (Option 3)
Monitor drainage characteristics (eg, color, amount) (Option 5)
Reinforce education
Irrigate an established ostomy
Document observations and interventions
(Option 1) The RN may delegate specific assessments to the LPN. The LPN focuses on
data collection and determining normal versus abnormal findings. For example, the LPN
may determine that a client's colostomy stoma is an abnormal color whereas the RN
synthesizes assessment findings (eg, color, temperature, capillary refill) to determine
the quality of tissue perfusion.
(Option 4) Developing the plan of care is the responsibility of the RN and cannot be
delegated.
A nurse is preparing to perform postmortem care on a client who recently died from
metastatic cancer. No family members were present at the time of death. What
interventions can be delegated to experienced unlicensed assistive personnel? Select
all that apply.
1. Notifying the family of the client's death
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assignment/ delegation
The night charge nurse is making assignments for the next shift. Which client is most
appropriate to assign to a nurse with less than a year of experience who is floated from
the orthopedic unit to the medical unit?
1. Client newly admitted for an evolving ischemic stroke.
2. Client newly diagnosed with diabetes mellitus who needs insulin administration
teaching.
3. Client with exacerbation of chronic obstructive pulmonary disease (COPD) with a new
tracheostomy.
4. Client with sickle cell crisis who requires frequent intravenous (IV) opioid medication
for pain - CORRECT ANSWER-4. Client with sickle cell crisis who requires frequent
intravenous (IV) opioid medication for pain.
Sickle cell crisis is managed with IV hydration, frequent IV pain medication, and
as-needed blood transfusion.
Many orthopedic clients require medication with opioids to control pain, IV fluids, and
blood transfusion (blood loss with surgery/trauma). The float nurse is familiar with the
policies and procedures for pain assessment and administering opioid medications,
which should be the same on non-specialty units within the same facility.
(Option 1) The client newly admitted for an evolving ischemic stroke is best assigned to
an experienced nurse who regularly works on the unit. The nurse will perform baseline
and frequent follow-up neurologic assessments to determine if the client's condition is
worsening.
(Option 2) The client newly diagnosed with diabetes mellitus who needs insulin
administration teaching is best assigned to a nurse who regularly works on the unit. The
nurse would be familiar with the location of diabetic teaching materials, documentation
procedure, and referral resources, and would be better able to evaluate the client's
understanding and performance of insulin administration the next day.
(Option 3) The client with exacerbation of COPD with a new tracheostomy is best
assigned to an experienced nurse who regularly works on the unit. Care of a new
tracheostomy requires the nurse to be familiar with assessment (eg, appearance,
bleeding) and care (eg, suctioning).
A nurse delegates a task to the unlicensed assistive personnel (UAP). The UAP states,
"I can't do that." Which is the best initial response for the nurse to make?
1. Ask the UAP the reason for the response.
2. Do the task, but discuss the UAP's response with the manager.
3. Ignore the UAP's initial response and repeat the delegation request.
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4. Remind the UAP of the importance of teamwork. - CORRECT ANSWER-1. Ask the
UAP the reason for the response.
Just as in clinical situations, the nurse should first assess in management situations.
The UAP may not have the skills or abilities to do the task or the availability if doing
something else. The nurse may need to reprioritize the tasks that the UAP has been
delegated or provide additional instructions/education. However, finding out the reason
for the response is the first step.
(Option 2) This does not solve the issue. The RN does not have the time to do
everything, which is the reason for delegating. Speaking to the manager is an
appropriate response if there is a pattern of insubordination or refusals, such as when
the UAP is capable, not busy, and yet does not respond to the nurse's encouragement
to help out.
(Option 3) It is important to find out the reason for the response to ensure client safety
and completion of the task. A repeat request would be more appropriate if the UAP did
not indicate a response (maybe the UAP didn't hear or understand) or gave an
inappropriate response (eg, not my team).
(Option 4) This response is more appropriate if the UAP has the ability and availability
but is citing something else for the refusal, such as the task not belonging to the UAP's
assigned team. Assessment for the reason should be first.
A client is admitted with a lower urinary tract infection from an obstructing ureteral
stone. Which tasks can the registered nurse (RN) delegate to the experienced
unlicensed assistive personnel (UAP)? Select all that apply.
1. Assisting the client in completing a health history form
2. Collecting a urine specimen for culture and sensitivity
3. Instructing the client to strain urine when voiding
4. Measuring and documenting urine output
5. Monitoring the color and characteristics of urine output - CORRECT ANSWER-2.
Collecting a urine specimen for culture and sensitivity
4. Measuring and documenting urine output.
Measuring intake and output and obtaining a urine specimen for culture and sensitivity
are both appropriate duties to delegate to the UAP. Objective measurements (eg, vital
signs, intake and output) do not require assessment skills and are therefore appropriate
for delegation (Option 4). Nursing actions that require assessment, teaching, evaluation,
or clinical judgment must be performed by the RN.
Collecting a urine specimen is a routine task with a predictable outcome and is therefore
appropriate for delegation to the experienced UAP under the instruction and supervision
of the RN (Option 2). The RN should always observe the five rights of delegation by
verifying that the UAP have the skills and experience necessary to collect a urine
specimen without contamination. If this client had a Foley catheter, specimen collection
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would be inappropriate for delegation to the UAP. Collecting a specimen from a Foley
catheter is considered a sterile procedure as it involves accessing a sterile collection
port and risks introducing bacteria into the closed drainage system if done improperly.
However, when provided with the appropriate instructions, the UAP and even clients
themselves may collect a clean-catch or midstream urine specimen.
(Option 1) Conducting a review of the client's complete past medical history is an
important responsibility of the RN during the admission assessment. This requires skills
and understanding beyond the level of the UAP.
(Option 3) Client education about the procedure and rationale for straining urine is the
responsibility of the RN. After the RN assesses the knowledge and competency level of
the UAP, the UAP can gather supplies, remind the client to strain the urine, and report
any abnormal findin
The registered nurse is caring for multiple clients on a medical-surgical unit and has
finished the morning assessment. Which task is appropriate for the nurse to delegate to
unlicensed assistive personnel?
1. Apply a collagenase dressing to a client's pressure ulcer for wound debridement
2. Assist a client 1 day postoperative hip fracture repair to the bathroom.
3. Feed a client through a gastrostomy tube after elevating the head of the bed
4. Offer orange juice to a client if the blood glucose level is <70 mg/dL (<3.9 mmol/L). -
CORRECT ANSWER-2. Assist a client 1 day postoperative hip fracture repair to the
bathroom.
Delegation is the process of transferring responsibility of performing a task while
maintaining the ultimate responsibility for the action and its outcome. The registered
nurse (RN) should take into account the five rights of delegation (right task, right person,
right circumstances, right communication/direction, and right supervision/evaluation)
and the scope of practice when deciding which tasks to delegate. The unlicensed
assistive personnel (UAP) can assist clients out of bed or to the bathroom, assist with
activities of daily living, and position clients. The RN is responsible for assessing the
client and adhering to the nursing process.
(Option 1) Debridement of a wound involves removing debris or dead tissue to convert
contaminated wounds into clean wounds so that normal healing can take place.
Dressing (eg, collagenase) changes for debridement require sterile technique; UAP can
change dressings only for chronic wounds using clean technique.
(Option 3) The UAP can elevate the head of the bed when a client receives enteral
nutrition to prevent aspiration. However, feeding through a gastrostomy tube cannot be
delegated to the UAP as it requires assessment of tube placement and aspiration of
gastric residual volume.
(Option 4) Offering orange juice is an intervention for treating hypoglycemia that is
outside the UAP's scope of practice. The UAP should report the blood glucose level to
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the RN so that the RN can first reassess the client for accompanying symptoms of
hypoglycemia; these would require RN assessment and interpretation before
intervention.
The registered nurse (RN) and licensed practical nurse (LPN) are caring for a client with
an established colostomy. Which nursing actions may the RN delegate to the LPN?
Select all that apply.
1. Assess perfusion of the stoma tissue
2. Assist the client in changing the ostomy pouch
3. Auscultate the client's bowel sounds
4. Develop plan of care to prevent skin breakdown
5. Monitor the color of ostomy drainage - CORRECT ANSWER-2. Assist the client in
changing the ostomy pouch
3. Auscultate the client's bowel sounds
5. Monitor the color of ostomy drainage
Tasks requiring initial assessment, initial or discharge education, care planning, or care
of an unstable client require the clinical judgment of the registered nurse (RN) and may
not be delegated. The RN may delegate care of stable clients with established ostomies
to the licensed practical nurse (LPN).
The following actions related to ostomy care are generally within the LPN scope of
practice:
Provide ostomy care and observe for skin breakdown (Option 2)
Perform specific assessments (eg, bowel sounds, stoma color) (Option 3)
Monitor drainage characteristics (eg, color, amount) (Option 5)
Reinforce education
Irrigate an established ostomy
Document observations and interventions
(Option 1) The RN may delegate specific assessments to the LPN. The LPN focuses on
data collection and determining normal versus abnormal findings. For example, the LPN
may determine that a client's colostomy stoma is an abnormal color whereas the RN
synthesizes assessment findings (eg, color, temperature, capillary refill) to determine
the quality of tissue perfusion.
(Option 4) Developing the plan of care is the responsibility of the RN and cannot be
delegated.
A nurse is preparing to perform postmortem care on a client who recently died from
metastatic cancer. No family members were present at the time of death. What
interventions can be delegated to experienced unlicensed assistive personnel? Select
all that apply.
1. Notifying the family of the client's death
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