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

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> subject: Next Gen NCLEX

## 문제

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

## 보기

1. Administering oral medications to a stable patient with diabetes
2. Assisting a post-operative patient with ambulation in the hallway **✔ 정답**
3. Teaching a newly diagnosed diabetic patient about insulin injection techniques
4. Assessing a patient's wound for signs of infection

**정답: 2**

## 해설

UAPs can perform basic care activities like ambulation assistance under supervision, which does not require nursing judgment. Other options involve medication administration, teaching, or assessment requiring licensed nursing scope.

## 심화 해설

Core Nursing Explanation
This question tests the critical nursing management skill of appropriate delegation. The RN (Registered Nurse) is responsible for assigning tasks based on the scope of practice of team members, ensuring patient safety and effective care delivery. The core principle is that tasks requiring **nursing judgment, assessment, evaluation, teaching, or clinical decision-making** cannot be delegated to Unlicensed Assistive Personnel (UAP). UAPs are trained to perform Key Point! routine, non-invasive tasks with predictable outcomes under the supervision of a licensed nurse.

**Answer Rationale**

Key Point! **Assisting a post-operative patient with ambulation** is a fundamental, routine activity of daily living (ADL). It is a task with a predictable outcome (helping the patient walk safely) and does not require independent assessment, evaluation, or teaching. The UAP can perform this under the RN's direction, reporting any patient concerns (e.g., dizziness, pain) back to the nurse. This aligns perfectly with the UAP's role.

**Distractor Analysis**

Watch out for confusion! It's crucial to distinguish between *doing* and *deciding/assessing/teaching*.

**① Administering oral medications:** This is a medication administration task. Even for a "stable" patient, it requires the licensed nurse's judgment to verify the "Five Rights," assess the patient's ability to swallow, and evaluate for potential side effects or interactions. This is outside the UAP's scope.

**③ Teaching insulin injection techniques:** Patient education is a core independent nursing function. It requires assessing the patient's readiness to learn, evaluating comprehension, and modifying the teaching plan based on the patient's response. This requires professional knowledge and judgment that a UAP does not possess.

**④ Assessing a wound for signs of infection:** Assessment and evaluation are the hallmarks of the nursing process. Determining signs of infection (redness, warmth, drainage characteristics) requires clinical judgment to interpret findings and decide on the next steps. A UAP may *report* observations about a dressing, but the formal *assessment* must be done by the nurse.

**Related Concepts**

Delegation follows the "**Five Rights of Delegation**": Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. This question primarily tests the "Right Task." Remember the acronym **DELEGATE**: Duties that are Everyday, Low-risk, Established routines, Guided by policy, Already trained for, Typical for the role, and Evaluated easily.

Concept Summary

| Role | Can Delegate To UAP (Examples) | Cannot Delegate To UAP (Requires RN/LPN) |
| --- | --- | --- |
| Registered Nurse (RN) | Vital signs, Ambulation, Feeding, Bathing, Bed making, Specimen collection (urine, stool). | Initial/ongoing assessment, Nursing diagnosis, Care planning, Patient education, Medication administration, Sterile procedures, Wound assessment/evaluation. |
| Licensed Practical Nurse (LPN/LVN) | Under RN supervision, may perform similar tasks as UAP plus some advanced skills per state scope (e.g., simple dressing changes, administering certain medications). | Initial assessment, Developing care plans, Independent patient teaching, Administering IV push medications (typically). |

Side-by-Side Comparison!

| Task | Appropriate for UAP? | Rationale & Key Differentiator |
| --- | --- | --- |
| Assisting with ambulation | YES | Routine ADL, predictable, requires no independent judgment. |
| Reporting "the patient says his leg hurts" | YES | Reporting patient statements is communication, not assessment. |
| Evaluating pain level & planning intervention | NO (RN/LPN) | Requires assessment (pain scale), judgment (cause), and planning (medication, positioning). |
| Changing a simple dry dressing | Maybe (State/Policy Dependent) | If trained and policy allows for unchanged, non-sterile dressings. Never for sterile dressing changes or wound assessment. |

Anatomy, Physiology & Pharmacology Points
While this is a management question, the underlying principle connects to patient safety. Improper delegation of tasks like medication administration could lead to pharmacological errors (wrong dose, wrong time, missed interaction). Delegating wound assessment could miss early signs of infection (increased WBC >10,000/mm³, fever), delaying treatment.

Memory Tips

- **Acronym: A TEA** tasks cannot be delegated to UAPs: **A**ssessment, **T**eaching, **E**valuation, and tasks requiring professional judgment/**A**ccountability.

- **Think: "See one, do one, teach one."** UAPs can *do* routine tasks they have been trained to see. RNs must *assess* before delegating and *teach/evaluate* the patient.

High-Frequency NCLEX Topics
Delegation and supervision are **extremely high-yield** on the NCLEX-RN. The exam tests your ability to prioritize patient safety by knowing *who can do what*. Expect questions involving UAPs, LPNs, and other RNs. The NCLEX often presents a scenario with multiple patient needs and asks, "Which task is appropriate to delegate to the UAP?" or "Which patient should the charge nurse assign to the LPN?"

Watch Out for Question Variations!

- **Priority Delegation:** "The nurse has one UAP. Which patient care activity should the nurse delegate *first*?" (Combine delegation rules with patient acuity/priority).

- **Supervision:** "A UAP reports a patient's blood pressure is 88/50 mmHg. What is the nurse's *priority action*?" (The nurse must now assess the patient—supervision/evaluation).

- **Assignment vs. Delegation:** Questions may differentiate between making an assignment to another licensed staff member (LPN) versus delegating a task to a UAP.

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**
You are the evening charge nurse on a busy 30-bed medical-surgical unit. Your team includes two LPNs and three UAPs. You receive report that Mr. Jones in room 304 is 1-day post-op total knee replacement, is stable, and has orders to ambulate with assistance TID (three times a day). Ms. Smith in room 310 is newly diagnosed with Type 2 Diabetes and needs education on self-monitoring of blood glucose before discharge tomorrow.

**Nursing Intervention Strategy**

- **Assessment & Planning:** Review all patient orders, acuity, and staff competencies. Identify tasks that are routine and predictable (vitals, ambulation, hygiene) vs. those requiring your nursing license (assessment, teaching, medication administration).

- **Delegation:** You appropriately delegate assisting Mr. Jones with ambulation to a UAP. You provide clear direction: "Please assist Mr. Jones in 304 to walk in the hallway with his walker. Use his gait belt. He has a pain rating of 2/10 post-medication. Report back to me if he has increased pain, dizziness, or any difficulty."

- **Retention of Responsibility:** You retain responsibility for Ms. Smith's diabetic teaching. You schedule time to assess her learning needs, demonstrate the glucometer, and evaluate her return demonstration.

- **Supervision & Evaluation:** Later, the UAP reports Mr. Jones ambulated 50 feet without issue but felt a little short of breath afterward. You now must *assess* Mr. Jones yourself (vital signs, lung sounds) to evaluate this new finding—this is your non-delegable duty.

**Patient Safety and Precautions**

- **Know Your State's Nurse Practice Act:** Scopes of practice for UAPs and LPNs can vary by state. Always follow facility policy, but the state law is the ultimate authority.

- **Never Delegate the Unstable:** Do not delegate care for unstable patients or those requiring frequent, complex assessments to UAPs.

- **Clear Communication is Key:** Vague instructions like "check on the patient" are unsafe. Be specific about the task, parameters, and what to report.

Nursing Procedure & Medication Flow
While this case doesn't involve a specific procedure, the delegation principle applies universally. For example, if a UAP is collecting a urine specimen, the RN must ensure the UAP knows how to instruct the patient for a clean-catch, but the RN is responsible for labeling the specimen, ensuring timely transport to the lab, and later interpreting the lab results (positive leukocyte esterase) and acting on them.

A Word from Your Senior Nurse
"Delegation is one of the hardest skills to master as a new nurse because it feels easier to just do everything yourself. But on a busy shift, effective delegation is what keeps your patients safe and allows you to focus your expertise where it's most needed. Trust your team, but verify. Your UAPs are your eyes and ears—train them well on what to report. When you're studying, every time you see a task, ask yourself: 'Does this require my nursing license, or can a competent UAP do this safely under my direction?' That mindset will make you a safe, effective team leader on the NCLEX and on the unit."

## 핵심 개념

- **Delegation** — The process by which a registered nurse (RN) directs another person (e.g., UAP, LPN) to perform nursing tasks and activities while retaining accountability for the outcome. It involves the Five Rights.
- **Unlicensed Assistive Personnel** — A healthcare team member who is not licensed but is trained to perform basic, non-invasive patient care tasks under the supervision of a licensed nurse (e.g., CNA, Patient Care Technician).
- **Scope of Practice** — The range of duties and activities that a healthcare professional is legally authorized and competent to perform, as defined by law (Nurse Practice Act), education, and experience.
- **Five Rights of Delegation** — A framework for safe delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation.
- **Nursing Judgment** — The intellectual process of making clinical decisions based on critical thinking, assessment data, and professional knowledge. It is a core, non-delegable function of the RN.

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