A charge nurse is delegating care for four patients to a licensed practical nurse (LPN) and two unlicensed assistive personnel (UAP). Which delegation decision demonstrates the highest priority for patient safety?
1Assign the UAP to take vital signs for a stable post-operative patient who had an appendectomy 2 days ago
2Assign the LPN to administer medications and monitor a patient with unstable blood glucose levels requiring close observation✓ 정답
3Assign the UAP to assist with activities of daily living for a patient with mild cognitive impairment
4Assign the LPN to perform wound care for a patient with a clean, healing surgical incision
해설
Delegation decisions must prioritize patient safety by matching acuity with staff competency. Assigning an LPN to a patient with unstable blood glucose ensures skilled monitoring and medication administration, addressing the highest risk. Other options involve stable patients or tasks within UAP scope, posing lower immediate safety concerns.
Core Nursing ExplanationKey Concept Analysis: This question tests the core nursing principle of Delegation and Assignment based on patient acuity and staff competency. The RN (Registered Nurse) must make delegation decisions that prioritize patient safety by ensuring the right task is assigned to the right person with the right skills. The highest priority for safety is always the patient with the Key Point!most unstable condition requiring skilled nursing judgment and intervention.
Answer Rationale: Option ② is correct because it demonstrates appropriate delegation to the LPN for a high-acuity patient. A patient with unstable blood glucose levels requires skilled assessment (monitoring for signs of hypo/hyperglycemia), critical thinking to interpret glucose trends, and the legal authority to administer medications. These are all within the LPN's scope of practice under RN supervision, but beyond the scope of a UAP. This delegation directly addresses the patient with the highest potential for rapid deterioration.
Distractor Analysis:
Watch out for confusion! Option ①: Taking vital signs for a stable post-operative patient is a routine, data-collection task well within a UAP's scope. It is appropriate delegation but does not represent the *highest* safety priority among the choices.
Option ③: Assisting with ADLs (Activities of Daily Living) for a patient with mild cognitive impairment is a typical and safe task for a UAP. While important for patient comfort and dignity, it does not involve clinical instability.
Option ④: Performing wound care for a clean, healing incision is within an LPN's scope. However, the wound is described as "clean" and "healing," indicating a stable, low-risk situation. This is appropriate delegation but, again, the patient's condition is not as acute as the one with unstable glucose.
Related Concepts: The "Five Rights of Delegation" (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation) are fundamental. The RN retains accountability for all delegated tasks and must evaluate outcomes. Understanding the Scope of Practice for LPNs/LVNs (focused, task-oriented care, medication administration in many states) versus UAPs/CNAs (non-invasive, basic care tasks) is critical for safe practice.
Concept Summary
Concept
Key Takeaway
Delegation Priority
Match the patient with the highest acuity and risk to the staff member with the highest relevant skill level (RN or LPN).
LPN/LVN Scope
Administer medications (in most states), perform routine procedures (wound care, catheter insertion), monitor stable patients, collect data.
Requires continuous assessment, critical thinking, and complex decision-making.
Stable patient requiring medication or procedure (Option ② & ④)
LPN/LVN (under RN supervision)
Within their licensed scope for technical skills and medication administration.
Stable patient requiring routine care/data collection (Option ① & ③)
UAP/CNA
Tasks are non-invasive, routine, and do not require nursing judgment.
Anatomy, Physiology & Pharmacology Points
While this is primarily a management question, the underlying physiology relates to the patient in option ②: Unstable blood glucose. This indicates poor glycemic control, risking hypoglycemia (confusion, sweating, tachycardia, coma) or hyperglycemia (polyuria, polydipsia, ketoacidosis). Monitoring requires understanding these signs and knowing when to notify the RN.
Memory Tips
Acuity = Authority: The higher the patient's acuity (instability), the higher the licensure level (authority/skill) needed to care for them.
RN = Assess, Plan, Evaluate; LPN = Implement, Monitor; UAP = Assist, Report. This oversimplification helps frame the roles.
Think: "Could this task go wrong in a way that requires immediate nursing judgment to fix?" If yes, it likely needs an LPN or RN.
High-Frequency NCLEX Topics
Delegation and assignment are Key Point!extremely high-yield on the NCLEX-RN. The exam constantly tests your ability to prioritize patient care and assign tasks appropriately based on client need and staff competency. You will see many questions with a mix of RNs, LPNs, and UAPs.
Watch Out for Question Variations!
Priority Action: "The charge nurse must first reassign staff after a call-out. Which patient should be reassigned to the RN?" (Answer: The most unstable patient).
Inappropriate Delegation: "Which task, if delegated to a UAP by the RN, would require intervention?" (Answer: Anything requiring assessment or sterile technique, like evaluating a wound or inserting a Foley catheter).
Supervision: "Which statement by an LPN to the RN requires immediate follow-up?" (Answer: An LPN reporting an abnormal assessment finding they are unsure about).
Nursing Clinical Practice GuideClinical Scenario: You are the RN charge nurse on a medical-surgical unit. At the start of the shift, you have one LPN and two nursing assistants (UAPs) to assign for the care of 12 patients. Your patient list includes Mr. Jones, 3 days post-op, stable; Mrs. Smith with dementia needing feeding; Mr. Garcia with a healing diabetic foot ulcer; and Ms. Chen, newly admitted with Type 1 Diabetes and blood glucose readings fluctuating between 55 mg/dL and 280 mg/dL over the last 4 hours.
Nursing Intervention Strategy:
Assessment & Triage: Quickly review all patients. Identify Ms. Chen as the highest acuity due to unstable glucose, posing risks for seizures (hypoglycemia) or DKA (Diabetic Ketoacidosis - hyperglycemia).
Planning & Delegation: Assign the LPN to Ms. Chen. Direct the LPN to administer scheduled insulin per protocol, check blood glucose every 1-2 hours, and report any readings outside the parameters you set (e.g., < 70 mg/dL or > 250 mg/dL). Assign the UAPs