# A registered nurse (RN) is working on a busy medical-surgical unit with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which task is most appropriate for the RN to delegate to the LPN? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=319551 > language: ko > subject: Next Gen NCLEX ## 문제 A registered nurse (RN) is working on a busy medical-surgical unit with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which task is most appropriate for the RN to delegate to the LPN? ## 보기 1. Developing a discharge teaching plan for a patient with newly diagnosed diabetes 2. Performing initial assessment on a patient admitted with chest pain 3. Evaluating the effectiveness of pain medication for a postoperative patient 4. Administering prescribed oral medications to stable patients **✔ 정답** **정답: 4** ## 해설 LPNs can safely administer oral medications to stable patients under RN supervision, as this falls within their scope of practice and training. Other options require RN-level assessment, evaluation, or planning skills. ## 심화 해설 Core Nursing Explanation This question tests the critical nursing management skill of appropriate delegation. Delegation is not just about assigning tasks; it's about matching the task to the team member's Key Point! **scope of practice, education, training, and competency**, while the RN retains ultimate accountability for patient outcomes. **Key Concept Analysis**: The core principle is the "Five Rights of Delegation": Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. An RN must delegate tasks that are within the delegatee's legal scope and for which they are competent. LPNs/LVNs are trained to provide basic nursing care, administer most medications (except IV push in many states), and perform routine procedures on stable patients. They work under the supervision of an RN or physician. UAPs assist with activities of daily living (ADLs) and basic, repetitive tasks with predictable outcomes. **Answer Rationale**: Key Point! **Administering prescribed oral medications to stable patients** is the most appropriate task to delegate to an LPN. This is a routine, procedure-based task that falls squarely within the standard scope of practice for LPNs. It requires knowledge of medications and administration techniques, which LPNs are trained for, but does not require the independent nursing judgment, comprehensive assessment, or complex planning/evaluation that defines the RN's role. The RN remains responsible for initial assessment of the patient's stability and for supervising the LPN. **Distractor Analysis**: - **Option 1 (Developing a discharge teaching plan)**: This requires assessment, diagnosis, planning, and synthesis of complex patient data (knowledge deficits, readiness to learn, cultural factors). Creating an individualized teaching plan is a core RN function that utilizes the nursing process at its highest level and cannot be delegated. - **Option 2 (Performing initial assessment on a patient with chest pain)**: The "initial assessment" of an unstable or potentially unstable patient (like one with chest pain) is a critical RN responsibility. It requires advanced assessment skills, clinical judgment to identify life-threatening issues, and the ability to formulate an immediate plan of care. This cannot be delegated. - **Option 3 (Evaluating effectiveness of pain medication)**: Evaluation is a step of the nursing process that requires professional judgment. Determining if a pain intervention was effective involves reassessing the patient, interpreting subjective and objective data, and making decisions about the next steps in care. This judgment belongs to the RN. **Related Concepts**: Remember the "CANNOT Delegate" rule: The initial nursing assessment, nursing diagnosis, care planning, evaluation of care, and patient education (especially for new, complex conditions) are RN-only functions. Tasks involving unstable patients, unpredictable outcomes, or requiring nursing judgment should not be delegated to LPNs or UAPs. Concept Summary **RN Role:** Utilizes full nursing process (Assess, Diagnose, Plan, Implement, Evaluate). Responsible for complex judgment, unstable patients, teaching, and supervision. **LPN/LVN Role:** Provides basic bedside care under RN supervision. Can administer most medications (oral, IM, SQ), perform dressing changes, monitor stable patients. Cannot perform initial assessments or develop care plans independently. **UAP Role:** Assists with ADLs (bathing, feeding, ambulation), vital signs for stable patients, and simple tasks like specimen collection. Cannot perform any task that requires nursing judgment or assessment. Side-by-Side Comparison! | Task | Appropriate for RN | Appropriate for LPN (under RN supervision) | Appropriate for UAP (under RN/LPN supervision) | | --- | --- | --- | --- | | Initial Patient Assessment | YES (Core Function) | NO | NO | | Administer Oral Medications | YES | YES (to stable patients) | NO | | Insert Urinary Catheter | YES | YES (if trained/competent) | NO | | Reinforce Pre-taught Education | YES | YES | NO (unless simple reminders) | | Ambulate a Stable Patient | YES | YES | YES | | Evaluate Care Plan Outcomes | YES (Core Function) | NO | NO | Anatomy, Physiology & Pharmacology Points While this question is about management, the underlying principle for safe delegation in tasks like medication administration is understanding patient stability. An LPN can administer meds to a "stable" patient. Stability implies predictable vital signs, no acute changes in condition, and a low risk of an adverse reaction requiring immediate advanced intervention. The RN must make this stability assessment first. Memory Tips - **Acronym: RN = ADPIE** (Assess, Diagnose, Plan, Implement, Evaluate). Don't delegate the A, D, P, or E! - **Rule of Thumb:** If the task requires "nursing judgment" or is part of the "nursing process" itself, it's an RN task. If it's a routine, procedure-based task on a stable patient, an LPN may do it. If it's a basic, non-invasive, repetitive task, a UAP may do it. - **Think: "Who can be held accountable?"** The RN is always ultimately accountable, so they delegate tasks, not responsibility. High-Frequency NCLEX Topics Delegation and assignment questions are extremely common on the NCLEX-RN. The exam tests your ability to prioritize, manage resources, and understand legal scopes of practice. Always ask yourself: "Is this within this person's scope? Is the patient stable enough? Does this task require the judgment of an RN?" Watch Out for Question Variations! - **Shift from Task to Priority:** "The RN must delegate four tasks. Which task should the RN perform *first*?" (Answer: The one requiring RN-level assessment of an unstable patient). - **Including UAP:** "Which task is appropriate to delegate to the UAP?" (Look for ADLs, stable vital signs, feeding, ambulation). - **Supervision Focus:** "The LPN reports a patient's blood pressure is 80/50 mmHg. What is the RN's priority action?" (Answer: Assess the patient immediately—supervision includes intervening when problems arise). ## 임상 시나리오 Nursing Clinical Practice Guide **Clinical Scenario:** You are the charge RN on a 30-bed med-surg unit. Your team includes two LPNs and three UAPs. You receive a report that includes: a stable post-op patient day 2 needing oral analgesics, a newly admitted patient with abdominal pain awaiting MD assessment, and a patient with heart failure who needs discharge teaching on fluid restriction and diuretics. **Nursing Intervention Strategy:** - **Assessment & Triage (RN):** You quickly assess the new admission with abdominal pain yourself (RN assessment). You determine the post-op patient is stable (vitals normal, alert). - **Delegation (RN):** You delegate to an LPN: "Please administer the scheduled oral acetaminophen to Mr. Smith in room 204, he's stable post-op." You delegate to a UAP: "Please help Mrs. Jones in room 210 to the bathroom and then take her afternoon vital signs." - **Planning & Education (RN):** You sit down with the heart failure patient to develop and initiate the discharge teaching plan (RN function). - **Supervision & Evaluation (RN):** You check in with the LPN after medication administration and evaluate the post-op patient's pain level. You review the vital signs taken by the UAP. **Patient Safety and Precautions:** - **Know Your State's NPA (Nurse Practice Act):** Scopes of practice for LPNs can vary slightly by state (e.g., IV push medications). Always verify. - **Clear Communication is Key:** When delegating, use the "Five Rights." Give clear instructions, expected outcomes, and parameters for reporting back (e.g., "Report any BP below 100/60 or if the patient complains of dizziness."). - **Never Delegate an Unfamiliar Task:** Even if a task is within an LPN's general scope, if they are not competent or trained for a specific procedure (e.g., wound vac management), you cannot delegate it to them. Nursing Procedure & Medication Flow When delegating medication administration to an LPN: - **RN Assessment First:** RN assesses patient stability, checks for any new allergies, reviews the medication order. - **Delegate the Task:** "LPN, please administer the 10am oral medications to patients in rooms 205, 207, and 209. They are all stable. Let me know if Mr. in 209's pulse is above 100 before giving his digoxin." - **LPN Procedure:** LPN performs the "Five Rights" of medication administration, administers the drugs, documents. - **RN Follow-up:** RN is available for questions, reviews documentation, and later evaluates the patient for therapeutic effects or side effects. A Word from Your Senior Nurse "Teamwork makes the dream work, but safe delegation is what keeps the team and the patients safe. As an RN, you are the conductor of the healthcare orchestra. You need to know exactly what instrument each member plays (their scope) and give them the right sheet music (clear delegation). Your license and your patient's well-being depend on your judgment. In clinicals and on the NCLEX, always think: 'Can someone else do this safely, or does it require my RN brain?' Mastering this will make you an effective nurse leader from day one." ## 핵심 개념 - **Delegation** — The process of transferring the authority to perform a selected nursing task in a selected situation to a competent individual, while the RN retains accountability for the outcome. - **Scope of Practice** — The range of roles, functions, responsibilities, and activities which a registered nurse, licensed practical/vocational nurse, or assistive personnel is educated, competent, and authorized to perform as defined by state law (Nurse Practice Act) and organizational policy. - **Five Rights of Delegation** — A framework for safe delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. - **Nursing Process** — A systematic, critical thinking framework nurses use to provide patient-centered care: Assessment, Diagnosis, Planning, Implementation, and Evaluation. The core functions of the RN role. - **Accountability** — Being answerable for one's own actions and the actions of those to whom tasks have been delegated. The RN is ultimately accountable for all nursing care and judgments made under their license. ## 같은 주제 문제 - [A registered nurse is working with a licensed practical nurse (LPN) and unlicensed assisti…](https://mymerci.kr/pages/nclex_q.php?qn_id=319498) - [A charge nurse is working with a team that includes two registered nurses (RNs), one licen…](https://mymerci.kr/pages/nclex_q.php?qn_id=319499) - [The charge nurse is making assignments for the upcoming shift. 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