A registered nurse (RN) is delegating tasks at the start of a 12-hour day shift on a medical-surgical unit. A licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) are on the team. The RN considers asking the LPN to administer 10 mg of IV push hydromorphone to a stable post-operative client for breakthrough pain. Which is the most appropriate nursing action?

The 5 Rights of Delegation (NCSBN) require the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. In most US state nurse practice acts, IV push administration of high-alert opioids is outside the LPN scope of practice and must be performed by a registered nurse. Hydromorphone IV push is a high-alert medication with rapid onset, a narrow therapeutic window, and a real risk of respiratory depression; it requires RN-level assessment, administration, and post-administration monitoring. Option 1 violates LPN scope of practice — stability of the client does not expand scope. Option 2 — UAP cannot administer any medication. Option 4 — even with direct RN supervision, scope of practice is defined by the underlying license and is not transferred by visual oversight.

In-depth explanation

<span class="merci-scenario-label">Clinical Judgment</span><br>Apply NCJMM: Recognize cues (<span class="merci-kw">RN delegating tasks; LPN and UAP on team; IV push hydromorphone is a high-alert opioid</span>) → Analyze cues (apply 5 Rights of Delegation: this is the wrong "person" — IV push opioid is outside LPN scope in most states) → Generate solutions (RN performs the IV push; LPN gets in-scope tasks) → Take action (RN administers hydromorphone, monitors respirations, assigns LPN to oral meds, dressings, finger-stick glucose, and VS) → Evaluate outcomes (medication safely delivered, team operating within scope).<br><br><span class="merci-scenario-label">Memory Tip</span><br><span class="merci-kw-mark">5 Rights of Delegation: Task, Circumstance, Person, Direction, Supervision.</span> <span class="merci-kw">High-alert IV push, blood transfusion administration, initial assessment, and teaching are RN-only.</span> LPN scope (most states): stable-client oral/IM/SC meds, dressings, finger-stick glucose, vital signs, sterile suctioning. UAP scope: ADLs, vital signs, ambulation, intake/output, height/weight.<br><br><span class="merci-scenario-label">KR vs US</span><br>The Korean and US LPN systems differ greatly. In Korea, IV medication administration generally falls to RNs and physicians. NCLEX answers for the US baseline scope reference <span class="merci-kw">most US states</span>; in some states an LPN with additional IV certification may push certain medications, but the default NCLEX answer is <span class="merci-kw">IV push opioid is not within LPN scope</span>.

Clinical scenario

<span class="merci-scenario-label">Clinical Practice Guide</span><br><span class="merci-kw">NCSBN 5 Rights of Delegation + state nurse practice acts</span>. Delegation is appropriate only when (1) the task is within the delegate scope, (2) the client is stable, (3) the outcome is predictable, (4) the RN gives clear direction, and (5) the RN can supervise and evaluate. RN-only tasks in most states include initial nursing assessment, IV push of high-alert medications (opioids, anticoagulants, insulin), blood/blood-product administration, formal teaching, plan-of-care development, and outcome evaluation.<br><br><span class="merci-scenario-label">Caution</span><br>NCLEX traps include (1) <span class="merci-kw">"the client is stable, so the LPN can do it"</span> — stability does not expand scope, (2) <span class="merci-kw">"the UAP can do it under supervision"</span> — medications are never delegated to UAP, (3) <span class="merci-kw">"direct visual supervision by RN"</span> — scope is defined by license, not by oversight. Always start with the question: is this task within the scope of THIS provider?

Key concepts

• 5 Rights of Delegation (NCSBN) — A nationally accepted framework for safe nursing delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. Used by the RN to decide whether and how to delegate any specific task to an LPN or UAP.
• LPN/LVN scope of practice — Defined by each state nurse practice act. In most US states the LPN may give oral, IM, SC, and certain non-high-alert IV medications to stable clients; perform dressing changes, finger-stick glucose, and vital signs; assist with ADLs and feeding; and perform sterile procedures within training. RN-only tasks include initial assessment, IV push of high-alert medications (opioids, anticoagulants), blood/blood-product administration, and formal teaching.
• UAP scope of practice — Unlicensed assistive personnel (CNA, nursing assistant). Limited to non-medication tasks: ADLs (bathing, feeding, toileting), ambulation, vital signs in stable clients, intake/output, height/weight, and basic safety measures. UAPs do NOT administer medications, perform sterile procedures, or interpret data.