assignment/ delegation Correctly Answered Questions| UpToDate | Already Graded A+

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 ☑: 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 asneeded 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. EXCELLENCE 2 (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. 4. Remind the UAP of the importance of teamwork. ☑: 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 EXCELLENCE 3 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 EXCELLENCE 4 5. Monitoring the color and characteristics of urine output ☑: 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 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 knowle