# The charge nurse is making assignments for the upcoming shift. Which task is most appropriate to delegate to an unlicensed assistive personnel (UAP)?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=319500  
> language: ko  
> subject: Next Gen NCLEX

## 문제

The charge nurse is making assignments for the upcoming shift. Which task is most appropriate to delegate to an unlicensed assistive personnel (UAP)?

## 보기

1. Assisting a stable post-operative patient with ambulation who had knee replacement surgery 2 days ago **✔ 정답**
2. Administering oral pain medication to a patient with chronic back pain
3. Teaching a newly diagnosed diabetic patient how to perform blood glucose monitoring
4. Assessing a patient's surgical wound for signs of infection

**정답: 1**

## 해설

Delegation must align with scope of practice. Assisting a stable post-operative patient with ambulation is appropriate for UAPs as it involves routine mobility support without clinical judgment. UAPs cannot administer medications, provide patient education, or perform assessments, which require nursing licensure.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the fundamental nursing principle of Delegation and Scope of Practice. The nurse must know which tasks can be safely assigned to an Unlicensed Assistive Personnel (UAP) based on their training, the patient's condition, and the need for nursing judgment. The core rule is that UAPs can perform **non-invasive, routine tasks** that do not require clinical assessment, independent judgment, or specialized nursing knowledge.

**Answer Rationale**: Key Point! Assisting a stable post-operative patient with ambulation is the correct answer because it is a routine, non-invasive activity that supports the patient's mobility and recovery plan. The patient is described as "stable" and the surgery was 2 days ago, indicating the activity is part of expected post-operative care. The UAP can safely perform this task under the nurse's supervision, following established protocols.

**Distractor Analysis**:
Watch out for confusion! **Choice 2 (Administering oral pain medication)**: Medication administration is a **licensed nursing function**. It requires knowledge of the "Five Rights" of medication administration, understanding of drug actions, side effects, and the ability to assess the patient's need and response. This is outside a UAP's scope.

**Choice 3 (Teaching a newly diagnosed diabetic patient)**: Patient education is a complex nursing intervention that requires assessment of the patient's readiness to learn, evaluation of comprehension, and the ability to tailor information. Teaching a new skill like blood glucose monitoring involves assessment and evaluation, which are part of the nursing process.

**Choice 4 (Assessing a surgical wound)**: Assessment is a core, independent function of the registered nurse. Evaluating a wound for signs of infection (e.g., redness, swelling, drainage, odor) requires clinical judgment and knowledge to interpret findings and decide on subsequent actions. This cannot be delegated.

**Related Concepts**: The "Five Rights of Delegation" (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation) are crucial for safe practice. Tasks involving nursing judgment, assessment, evaluation, or patient education must be performed by the RN.

Concept Summary

| Task Type | Can be delegated to UAP? | Rationale |
| --- | --- | --- |
| Routine vital signs | Yes | Task is standardized; UAP reports abnormal values to RN. |
| Assisting with ADLs (Activities of Daily Living) | Yes | Bathing, feeding, ambulation for stable patients. |
| Specimen collection (urine, stool) | Yes | Routine procedure following a protocol. |
| Medication administration (any route) | No | Requires licensed judgment (RN/LPN). |
| Initial patient assessment/Re-assessment | No | Core RN function requiring clinical judgment. |
| Patient/Family education | No | Requires assessment of learning needs and evaluation. |

Side-by-Side Comparison!

| Role | Scope of Practice (Examples) | Tasks NOT Allowed |
| --- | --- | --- |
| Unlicensed Assistive Personnel (UAP) (CNA, PCA) | ADL assistance, routine vital signs, ambulation, feeding, making beds, transporting stable patients. | Assessment, medication administration, sterile procedures, patient education, care planning. |
| Licensed Practical Nurse (LPN/LVN) | Administering most medications (oral, topical, some IV per state law), basic wound care, data collection. Works under RN supervision. | Initial assessments, IV push medications (varies), developing care plans, patient education for new diagnoses. |
| Registered Nurse (RN) | Comprehensive assessment, nursing diagnosis, care planning, patient education, medication administration (all routes), evaluation of care, delegation and supervision. | Cannot delegate tasks requiring RN licensure to UAPs. |

Anatomy, Physiology & Pharmacology Points
While this question is primarily about delegation, the clinical context involves post-operative knee replacement care. Early ambulation is critical to prevent complications like Deep Vein Thrombosis (DVT), pneumonia, and muscle atrophy. The RN retains responsibility for assessing the patient's pain level, circulatory status (neurovascular checks), and tolerance before and after delegation of ambulation.

Memory Tips
**UAP = "Doing" tasks.** Think: UAPs perform tasks that are routine, observed, and reported. They **DO** things like ambulate, bathe, feed.

**RN = "Thinking/Assessing" tasks.** The RN **ASSESSES, PLANS, TEACHES, EVALUATES, and ADMINISTERS** medications.

**Mnemonic: CAN'T Delegate** – **C**omplex procedures, **A**ssessment, **N**ew education, **T**eaching, and anything requiring judgment.

High-Frequency NCLEX Topics
Delegation and assignment-making are **extremely high-yield** on the NCLEX-RN. The exam consistently tests your ability to distinguish between the roles of RN, LPN, and UAP. Always ask: "Does this task require nursing judgment or follow-up assessment?" If yes, it's an RN task.

Watch Out for Question Variations!
* Instead of "most appropriate to delegate," the question may ask: "The nurse should intervene if the UAP is observed doing which action?" (Answer: performing an RN-only task like assessing a wound).

* The scenario may involve an unstable patient (e.g., "ambulating a patient 2 hours post-op who is dizzy"). Even a routine task becomes inappropriate to delegate if the patient's condition is unstable.

* Questions may mix in tasks for LPNs, testing if you know the differences between LPN and UAP scope (e.g., "Which task can be assigned to an LPN?" – might include medication administration).

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are the charge nurse on a medical-surgical unit. Mr. Jones, 68, is post-op day 2 from a total knee arthroplasty (TKA). His vital signs are stable, he is on oral pain medication, and his neurovascular checks (circulation, sensation, movement) are within normal limits. The physical therapist has seen him and recommended he ambulate in the hallway three times today with assistance.

**Nursing Intervention Strategy**:
1. **Assessment (RN)**: You assess Mr. Jones's pain level (using a 0-10 scale), check his surgical dressing, and perform a focused neurovascular assessment (color, temperature, capillary refill, sensation, movement) of his operative leg. You confirm he is stable and a candidate for assisted ambulation.

2. **Delegation & Communication (RN)**: You delegate the task to a UAP. You provide **specific direction**: "Please assist Mr. Jones in room 402 to walk in the hallway for about 50 feet. He uses a walker. He rated his pain as a 3/10 after his last medication. Please use the gait belt for safety. Stop the activity and call me immediately if he becomes dizzy, short of breath, or complains of severe pain."

3. **Supervision & Evaluation (RN)**: After the UAP assists the patient, you follow up. You evaluate Mr. Jones: reassess his pain, vital signs, and tolerance of the activity. You also evaluate the UAP's performance and provide feedback.

**Patient Safety and Precautions**: The key precaution is ensuring the patient is **stable** before delegating mobility tasks. Never delegate ambulation for a patient who is dizzy, hypotensive, has unstable vital signs, or has new-onset chest pain. Always ensure the UAP is trained in proper body mechanics and the use of assistive devices (walker, gait belt).

Nursing Procedure & Medication Flow
While this case doesn't involve a specific medication procedure, the delegation process is a critical procedure itself:
1. **Right Task**: Ambulation for a stable patient is appropriate.
2. **Right Circumstance**: Patient is stable post-op day 2.
3. **Right Person**: UAP is trained in safe patient handling.
4. **Right Direction/Communication**: RN gives clear, specific instructions including parameters for stopping.
5. **Right Supervision/Evaluation**: RN follows up to evaluate both patient outcomes and UAP performance.

A Word from Your Senior Nurse
"Delegation is a superpower for a nurse, but it comes with great responsibility. You are never 'dumping' a task—you are entrusting it while retaining ultimate accountability for the patient's outcome. In the real world, clear communication is everything. A quick, specific report to your UAP like, 'Watch for dizziness, call me if pain goes above 5,' can prevent a fall. On the NCLEX, they are testing your judgment: can you protect your license and your patient by knowing who can do what? Think safety, scope, and stability every time."

## 핵심 개념

- **Delegation** — The process by which a nurse directs another person 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.
- **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.
- **Five Rights of Delegation** — A framework for safe delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation.
- **Nursing Process** — A systematic, patient-centered framework for nursing care consisting of Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). Tasks requiring steps of this process (especially Assessment, Diagnosis, Evaluation) cannot be delegated to UAPs.

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