# A home hospice RN is leading care for a 72-year-old patient with end-stage heart failure. The team includes one LPN and a hospice aide. Which tasks may the RN appropriately delegate to the LPN or hospice aide? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372731&lang=en  
> language: en  
> subject: Advance Directives  
> category: MOC

## Question

A home hospice RN is leading care for a 72-year-old patient with end-stage heart failure. The team includes one LPN and a hospice aide. Which tasks may the RN appropriately delegate to the LPN or hospice aide? Select all that apply.

1

LPN: reinforcing teaching previously provided by the RN about the symptom management plan and signs of imminent death.

2

Hospice aide: titrating the morphine PCA basal rate based on the patient's pain rating during the visit.

3

LPN: administering scheduled oral and subcutaneous opioids and antiemetics that have been ordered by the provider and reviewed by the RN.

4

Hospice aide: making the initial admission assessment and developing the plan of care during the patient's first home visit.

5

Hospice aide: bathing, oral hygiene, and gentle range-of-motion exercises during the morning visit.

## Explanation

Correct options: 1, 3, 5. Option 1 is correct because the LPN may reinforce teaching that was previously provided by the RN. Option 3 is correct because the LPN may administer scheduled oral and subcutaneous opioids and antiemetics that have been ordered and reviewed. Option 5 is correct because the hospice aide’s scope includes personal care such as bathing, oral hygiene, and gentle range-of-motion exercises. Option 2 is incorrect because titrating an opioid PCA basal rate requires nursing judgment and is outside the hospice aide’s scope. Option 4 is incorrect because the initial admission assessment and development of the plan of care are non-delegable RN responsibilities.

## In-depth explanation

The five rights of delegation guide every handoff to LPN or UAP/aide: right task, right circumstance, right person, right direction or communication, and right supervision or evaluation. Initial assessment, planning, evaluation, and teaching are RN-only functions. The LPN scope generally includes administering scheduled medications (oral, SC, IM, sometimes IV per state), reinforcing teaching, performing focused assessments, and monitoring stable patients; LPNs cannot perform the initial holistic assessment, IV push of high-risk drugs (state-dependent), or titration of vasoactive or analgesic infusions. The hospice or CNA aide scope is limited to personal care: bathing, oral hygiene, dressing, basic comfort measures, ambulation assistance, and basic vital signs. Aides cannot administer medications, perform sterile procedures, conduct assessments, or modify a care plan.

## Clinical scenario

A **home hospice RN** is leading care for a **72-year-old patient with end-stage heart failure**. The team includes **one LPN** and a **hospice aide**.

## Key concepts

- **Five Rights of Delegation** — Right task, right circumstance, right person, right direction/communication, right supervision/evaluation. Apply each before any handoff to LPN or UAP/aide. Initial assessment, planning, evaluation, and teaching are RN-only functions.
- **LPN Scope of Practice** — Generally includes administering scheduled medications (oral, SC, IM, sometimes IV per state), reinforcing teaching, performing focused assessments, monitoring stable patients. Cannot do initial holistic assessment, IV push of high-risk drugs (state-dependent), titration of vasoactive or analgesic infusions.
- **Hospice/CNA Aide Scope** — Personal care: bathing, oral hygiene, dressing, basic comfort, ambulation assistance, basic vital signs. Cannot administer medications, perform sterile procedures, conduct assessments, or modify a care plan.

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