# An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed assistive personnel (UAP). Which activity should the RN retain?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=362464&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed assistive personnel (UAP). Which activity should the RN retain?

## Option

1. Ask the UAP to obtain routine vital signs for a stable client and report values outside stated parameters.
2. Assign the LPN/VN to administer scheduled oral medications to a stable client when permitted by law and policy.
3. Ask the UAP to assist a stable client with ambulation after the RN has assessed the client and set safety directions.
4. Perform the initial assessment of a newly admitted client with chest pain and develop the nursing plan of care. **✔ Correct answer**

**Correct answer: 4**

## Explanation

The RN should retain the initial assessment of a newly admitted client with chest pain and the development of the nursing plan of care (option 4), because these activities require nursing judgment and cannot be delegated. Routine vital signs and ambulation for stable clients may be delegated to a trained UAP with clear parameters and supervision (options 1 and 3). Scheduled oral medication administration to a stable client may be assigned to an LPN/VN when allowed by the applicable nurse practice act and organizational policy (option 2).

## In-depth explanation

Clinical Judgment
First identify whether the activity requires assessment, diagnosis, planning, or evaluation. The RN retains those judgment-intensive activities. Then confirm that any assigned activity matches the client's stability, the team member's verified competence, the jurisdiction's nurse practice act, and organizational policy.

Memory Tip
Five rights: task, circumstance, person, directions and communication, supervision and evaluation.

## Clinical scenario

Clinical Practice Guide
Use the five rights of delegation: right task, circumstance, person, directions and communication, and supervision and evaluation. Assignment to an LPN/VN must remain within the jurisdiction's nurse practice act and organizational policy. UAP activities must be routine, predictable, and supported by clear directions. The RN retains activities that require initial assessment, nursing diagnosis, care planning, or evaluation of an unstable or newly changing condition.

Caution
Specific medication and procedure permissions for LPN/VNs vary by jurisdiction. A reliable delegation item should test the need for RN clinical judgment rather than claim that one technical procedure is universally prohibited.

## Key concepts

- **5 Rights of Delegation (NCSBN)** — A nationally accepted framework for safe nursing delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. Used by the RN to decide whether and how to delegate any specific task to an LPN or UAP.
- **LPN/LVN scope of practice** — Defined by each state nurse practice act. In most US states the LPN may give oral, IM, SC, and certain non-high-alert IV medications to stable clients; perform dressing changes, finger-stick glucose, and vital signs; assist with ADLs and feeding; and perform sterile procedures within training. RN-only tasks include initial assessment, IV push of high-alert medications (opioids, anticoagulants), blood/blood-product administration, and formal teaching.
- **UAP scope of practice** — Unlicensed assistive personnel (CNA, nursing assistant). Limited to non-medication tasks: ADLs (bathing, feeding, toileting), ambulation, vital signs in stable clients, intake/output, height/weight, and basic safety measures. UAPs do NOT administer medications, perform sterile procedures, or interpret data.

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