# A registered nurse is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) on a medical-surgical unit. The nurse has four patients with varying acuity levels. Which task delegation demonstrates the most appropriate use of the nursing team's scope of practice?

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> subject: Next Gen NCLEX

## 문제

A registered nurse is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) on a medical-surgical unit. The nurse has four patients with varying acuity levels. Which task delegation demonstrates the most appropriate use of the nursing team's scope of practice?

## 보기

1. Delegate medication administration for a stable diabetic patient to the LPN, while assigning the UAP
2. Assign the UAP to provide wound care for a patient with a complex surgical incision, while the LPN performs medication administration.
3. Have the LPN conduct patient education about insulin administration techniques, while the UAP monitors vital signs.
4. Delegate routine vital signs and basic hygiene care to the UAP, while assigning the LPN to administer medications under RN supervision. **✔ 정답**

**정답: 4**

## 해설

Proper delegation matches tasks to each team member's scope of practice. Option 4 appropriately delegates routine care to UAP and oral medication administration to LPN under RN supervision, ensuring patient safety and legal compliance. Other options involve tasks beyond UAP or LPN scope, such as complex wound care or patient education.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the core nursing management principle of Delegation and Supervision. The RN (Registered Nurse) is responsible for assessing patients, planning care, and delegating appropriate tasks to LPNs/LVNs (Licensed Practical/Vocational Nurses) and UAP (Unlicensed Assistive Personnel) based on their defined Scope of Practice. Effective delegation ensures patient safety, legal compliance, and optimal use of the healthcare team's skills.

**Answer Rationale**: Key Point! Option 4 is correct because it aligns tasks with the appropriate scope of practice. The UAP's role typically includes Activities of Daily Living (ADLs) like hygiene and obtaining routine vital signs. The LPN/LVN, working under the direction of an RN, is licensed to administer Oral medications and perform other stable, predictable patient care tasks. This delegation model allows the RN to oversee the plan, perform complex assessments, and manage higher-acuity needs.

**Distractor Analysis**:

• Watch out for confusion! Option 1 is incorrect because it is incomplete and nonsensical as written ("assign the UAP" to what?). More importantly, delegating all medication administration for a diabetic patient (which may include insulin, a high-alert medication) solely to an LPN without specifying RN oversight for assessment and evaluation is unsafe.

• Option 2 is incorrect because Complex wound care involving assessment, sterile technique, and evaluation of healing is generally outside the UAP's scope. This is a skilled nursing task requiring licensure (RN or LPN under specific protocols). Assigning it to a UAP violates the principle of delegating based on the complexity and stability of the patient's condition.

• Option 3 is incorrect because Patient education, especially for a skill like insulin administration which requires assessment of learning readiness, comprehension, and psychomotor ability, is a responsibility of the RN. While LPNs may reinforce teaching, the initial, comprehensive education and evaluation of learning outcomes fall under the RN's scope.

**Related Concepts**: The "Five Rights of Delegation" (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation) is a fundamental framework. The RN retains accountability for all delegated tasks. Tasks involving Nursing judgment, initial assessment, patient education, and care planning cannot be delegated.

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are the RN in charge of a 30-bed medical-surgical unit. Your team includes two LPNs and three UAPs. You receive report on four patients: Mr. A (post-op day 1 from abdominal surgery, stable), Ms. B (admitted for heart failure exacerbation, on IV diuretics), Mr. C (stable diabetic needing discharge teaching), and Mrs. D (elderly patient with pneumonia).

**Nursing Intervention Strategy**:
1.  **Assessment & Planning (RN Role)**: After receiving report, you quickly assess all patients, prioritizing Ms. B (heart failure) due to her acuity. You develop the initial care plan.
2.  **Delegation**: You delegate appropriately:
• To UAP: Obtain vital signs for all patients and assist Mrs. D with morning hygiene.
• To LPN #1: Administer the 9 AM oral medications to Mr. A and Mrs. D (following the medication administration record you reviewed).
• To LPN #2: Assist with turning, positioning, and simple dressing reinforcement for Mr. A's surgical incision (per established protocol), while you perform the complex wound assessment.
3.  **Supervision & Evaluation (RN Role)**: You administer IV diuretics to Ms. B and assess her respiratory status. You then check on Mr. A's wound with the LPN, evaluate Mrs. D's response to antibiotics, and finally conduct the discharge teaching for Mr. C regarding his insulin.

**Patient Safety and Precautions**: Never delegate tasks that require professional nursing judgment. The RN must assess before delegating (is the patient stable?), supervise during the shift, and evaluate outcomes. Clear, specific communication is essential: "Please report Mr. A's blood pressure if it is below 110/70 or above 140/90."

Nursing Procedure & Medication Flow

| Team Member | Tasks Typically WITHIN Scope (Can be delegated) | Tasks Typically OUTSIDE Scope (Should NOT be delegated) |
| --- | --- | --- |
| RN | Comprehensive assessment, care planning, patient education, IV push meds, blood transfusions, complex procedures. | N/A (Accountable for all delegated care) |
| LPN/LVN | Stable patient care, oral/IM/SQ meds (per state law), routine dressing changes, reinforcing teaching, monitoring established IVs. | Initial assessment, care planning, IV push meds (in most states), patient/family education initiation, unstable patient care. |
| UAP (CNA/PCT) | Vital signs, ADLs (bathing, feeding), ambulation, specimen collection, intake/output. | Any task requiring assessment, judgment, or sterile technique (meds, wound care, teaching). |

A Word from Your Senior Nurse
"Delegation isn't about dumping work; it's about leading a team to provide safe, efficient care. On the NCLEX, they love to test if you know who can do what. In real life, knowing your team's strengths and scopes is how you prevent errors and keep your license safe. Always ask yourself: 'Is this task appropriate for this person's license/skill, given this specific patient's condition?' If there's any doubt, you do it yourself or provide direct supervision. That's professional accountability!"

## 핵심 개념

- **Delegation** — The process by which a registered nurse (RN) directs another person (LPN, UAP) to perform nursing tasks and activities while retaining accountability for the outcome.
- **Scope of Practice** — The range of roles, functions, responsibilities, and activities which a licensed healthcare professional is authorized to perform, as defined by state law and professional boards.
- **Five Rights of Delegation** — A framework for safe delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation.
- **Unlicensed Assistive Personnel** — Healthcare workers who are not licensed but are trained to perform basic, non-invasive patient care tasks under the supervision of an RN or LPN (e.g., Certified Nursing Assistant - CNA).
- **Licensed Practical Nurse (LPN) / Licensed Vocational Nurse** — A nurse with 1-2 years of education, licensed to provide basic nursing care under the direction of an RN or physician. Scope varies by state but typically includes stable patient care and medication administration (excluding IV push in many states).

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