# A registered nurse (RN) is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task assignment demonstrates appropriate delegation principles?

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> subject: Next Gen NCLEX

## 문제

A registered nurse (RN) is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task assignment demonstrates appropriate delegation principles?

## 보기

1. Assigning the UAP to administer oral medications to stable patients
2. Delegating the LPN to perform initial nursing assessments on newly admitted patients
3. Having the UAP develop and modify nursing care plans for assigned patients
4. Assigning the LPN to monitor and document vital signs for post-operative patients **✔ 정답**

**정답: 4**

## 해설

Proper delegation requires matching tasks to team members' scope of practice. LPNs can monitor and document vital signs for post-operative patients under RN supervision. UAPs cannot administer medications, perform assessments, or develop care plans, as these require nursing judgment and licensure.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the core principles of delegation in nursing, specifically the Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation). The RN is responsible for delegating tasks appropriately based on the Scope of Practice of the LPN (Licensed Practical Nurse) and UAP (Unlicensed Assistive Personnel). Tasks requiring independent nursing judgment, assessment, planning, and evaluation must be performed by the RN.

**Answer Rationale**: Key Point! Option ④ is correct because monitoring and documenting vital signs for stable, post-operative patients is within the LPN's scope of practice. LPNs are licensed to perform data collection and routine procedures under the direction of an RN. This task is appropriate for delegation as it does not require the initial or ongoing nursing assessment and judgment that is the exclusive domain of the RN.

**Distractor Analysis**:
Watch out for confusion! Option ① is incorrect because UAPs cannot administer any medications, including oral ones. Medication administration is a licensed nursing function that requires knowledge of pharmacology, dosage calculation, and patient assessment. Delegating this to a UAP violates the "Right Task" principle.

Option ② is incorrect because the initial nursing assessment is a complex process that forms the foundation of the nursing process. It requires synthesis of data, clinical judgment, and identification of patient problems—all skills reserved for the RN. LPNs can contribute data but cannot perform the initial, comprehensive assessment.

Option ③ is incorrect because developing and modifying the nursing care plan is a core RN function. The nursing care plan is based on nursing diagnoses (which only RNs can formulate) and outlines the plan of care. UAPs implement specific, delegated tasks from the care plan but do not create or modify it.

**Related Concepts**: The RN retains ultimate accountability for all delegated tasks. Effective delegation involves clear communication of the task, expected outcome, and parameters for reporting back. Understanding state-specific Nurse Practice Acts is also crucial, as scopes of practice can have minor variations.

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are the RN in charge of a busy 30-bed medical-surgical unit. Your team includes two LPNs and three UAPs. You have several post-op patients, two new admissions pending, and a patient whose condition is deteriorating.

**Nursing Intervention Strategy**:
1.  **Assessment & Triage**: Quickly assess all patients. Identify stable vs. unstable patients. Stable post-op patients needing routine VS checks are ideal for delegation to LPNs.
2.  **Delegation Planning**: Match tasks to licensure.
*   **RN**: Perform the initial assessment on the new admissions. Re-assess the deteriorating patient, notify the provider, and plan interventions.
*   **LPN**: Assign to monitor and document vital signs q4h for the stable post-op patients. The LPN can also reinforce patient education you have already provided and perform dressing changes on established wound care plans.
*   **UAP**: Assign to assist patients with activities of daily living (ADLs) like bathing and ambulation, obtain routine weights, and stock supplies.
3.  **Communication & Supervision**: Give clear, specific instructions: "Mr. Smith in room 204 is 1-day post-op knee replacement. Please take his vitals now and every 4 hours. Report any temperature > 38°C (100.4°F), heart rate > 110, or systolic BP < 100 to me immediately." Periodically evaluate that tasks are completed correctly.

**Patient Safety and Precautions**: Never delegate the nursing process (Assessment, Diagnosis, Planning, Evaluation). Never delegate tasks to UAPs that require clinical judgment (e.g., interpreting data, patient teaching, sterile procedures). Always ensure the delegatee has the competency to perform the task. The RN must evaluate the outcome of all delegated care.

Concept Summary

| Team Member | Key Functions (Can Do) | Key Limitations (Cannot Do) |
| --- | --- | --- |
| Registered Nurse (RN) | Full nursing process (Assess, Diagnose, Plan, Implement, Evaluate). Initial assessment. Care plan development. Medication administration (all routes). Patient education. Complex procedures. | N/A - Holds full scope of practice within licensure. |
| Licensed Practical Nurse (LPN/LVN) | Data collection (vitals, I&O). Routine procedures (dressing changes, catheter care). Administer some medications (oral, topical, SQ, IM - per state law). Reinforce RN-provided teaching. | Cannot perform initial/ongoing assessment. Cannot formulate nursing diagnoses. Cannot develop/modify care plans. Cannot administer IV push meds or titrate IV drips (typically). |
| Unlicensed Assistive Personnel (UAP/CNA) | Assist with ADLs (bathing, feeding, ambulation). Obtain routine vitals and weights. Transport patients. Stock supplies. | Cannot assess, diagnose, plan, or evaluate. Cannot administer medications. Cannot perform sterile or invasive procedures. Cannot provide patient education. |

Side-by-Side Comparison!

| Delegation Principle | Appropriate Example | Inappropriate Example | Reason |
| --- | --- | --- | --- |
| Right Task (Routine, predictable) | LPN: Dressing change per established protocol. | UAP: Assessing lung sounds after a treatment. | Assessment requires licensure and judgment. |
| Right Circumstance (Stable patient) | UAP: Ambulating a 2-day post-op patient who is stable. | UAP: Ambulating a patient who is dizzy and hypertensive. | Patient condition is unstable, requiring RN assessment. |
| Right Person (Competent, licensed) | LPN: Monitoring a stable blood transfusion. | UAP: Monitoring a blood transfusion. | Monitoring for transfusion reactions is a nursing function. |

Anatomy, Physiology & Pharmacology Points
While this question focuses on management, remember that tasks like **vital sign monitoring** are tied to physiology. An LPN must understand normal ranges (e.g., BP 120/80 mmHg, HR 60-100 bpm) and recognize abnormalities like tachycardia >100 bpm post-op (possible sign of hemorrhage or infection) to know when to report back to the RN.

Memory Tips
**Mnemonic: RNs Do All Planning (RNDAP)** – Reminds you that the RN is responsible for the core steps: **R**esponsibility, **N**ursing Process, **D**iagnosis, **A**ssessment, **P**lanning.

**UAP = "Unlicensed, Assist with Physical/Practical tasks only."**

High-Frequency NCLEX Topics
Delegation and assignment-making are **extremely high-yield** on the NCLEX. The exam constantly tests your ability to distinguish between RN, LPN, and UAP roles. Focus on the "can't do's": UAPs can't assess, teach, or give meds; LPNs can't take the first assessment or make the care plan.

Watch Out for Question Variations!
*   **Priority Setting**: "The RN must assess which patient first?" vs. "Which task can be delegated to the LPN?" – The principles are linked; you can't delegate if you haven't first assessed the patient's stability.
*   **Supervision**: "An LPN reports a patient's BP is 88/50. What is the RN's *next* action?" (Assess the patient yourself – evaluation of delegated task).
*   **Assignment vs. Delegation**: Assignment is giving tasks to staff within their normal job description. Delegation is transferring authority for a specific task. NCLEX often uses these terms.

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