# A charge nurse on a medical-surgical unit is making assignments for the day shift. The team includes one registered nurse (RN), one licensed practical nurse (LPN/LVN), and one unlicensed assistive personnel (UAP). Which client assignments are appropriate to delegate to the LPN? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=363953&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question A charge nurse on a medical-surgical unit is making assignments for the day shift. The team includes one registered nurse (RN), one licensed practical nurse (LPN/LVN), and one unlicensed assistive personnel (UAP). Which client assignments are appropriate to delegate to the LPN? Select all that apply. 1 A client newly admitted from the emergency department who needs an initial comprehensive admission assessment and individualized care plan 2 A stable post-operative day 2 client requiring routine vital signs, scheduled pain medication, and reinforcement of teaching previously initiated by the RN 3 A stable client with an established gastrostomy tube who requires scheduled tube feedings and routine flushing every 4 hours 4 A client receiving the first unit of packed red blood cells who requires initial verification and the first 15 minutes of close monitoring for a transfusion reaction 5 A client whose family is requesting urgent education about end-of-life care decisions and advance directives 6 A stable client who requires routine oral antibiotic administration and a clean dressing change to a healing surgical incision ## Explanation An LPN/LVN can care for stable clients with predictable outcomes and perform established tasks: administer scheduled medications, reinforce teaching initiated by the RN, provide established tube feedings, and perform clean dressing changes (Choices 2, 3, and 6). The RN retains the initial comprehensive assessment and care planning (Choice 1), initial complex teaching about end-of-life decisions (Choice 5), and initial verification and the first 15 minutes of a blood transfusion (Choice 4). Delegation must also follow state law and facility policy. ## In-depth explanation Clinical Judgment LPN can manage stable clients with predictable outcomes: routine PO meds, established dressing changes, scheduled tube feedings, routine VS, and reinforcement teaching. RN-Only Tasks Initial assessment · care plan creation · initial complex teaching · blood transfusion start — these require RN clinical judgment and cannot be delegated. Memory Tip "A · P · E · T": Assess (initial), Plan (care), Educate (initial), Transfuse (start) — keep with the RN. Caution LPN can reinforce teaching but not initiate it. After the first 15 minutes of a transfusion, LPN may continue monitoring per most state Nurse Practice Acts. ## Clinical scenario Scenario Medical-surgical day shift, 6 clients, team = 1 RN + 1 LPN + 1 UAP. Charge nurse must match acuity and complexity to scope of practice. Team Roles - RN: complex/initial assessments, care plan, initial teaching, transfusion start, IV push meds, unstable clients - LPN: stable client routine care, PO meds, established dressings, scheduled tube feedings, reinforcement teaching - UAP: ADLs, hygiene, stable VS, ambulation, intake & output recording Decision Rule Delegate to the lowest qualified team member who can safely perform the task within scope. ## Key concepts - **5 Rights of Delegation (NCSBN)** — Right Task / Right Circumstance / Right Person / Right Direction & Communication / Right Supervision & Evaluation. All delegation decisions must satisfy these five criteria. - **LPN/LVN scope of practice** — LPN provides routine care for stable clients with predictable outcomes: PO/IM meds, established dressings, scheduled tube feedings, routine vital signs, reinforcement of teaching. LPN cannot perform initial assessments, develop care plans, or initiate blood transfusions. - **RN-only tasks** — Initial admission assessment, creation/revision of nursing care plan, initial complex teaching (advance directives, new diagnosis, discharge planning), blood transfusion verification and first 15-minute monitoring, IV push of high-alert medications. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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