# Stage 4 — Generate solutions. Help has arrived for Patient A, and the RN has completed the initial assessment of Patient D's acute confusion. Which assignments or delegations are appropriate if allowed by jurisdiction, facility policy, and verified competency? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372772&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question Stage 4 — Generate solutions. Help has arrived for Patient A, and the RN has completed the initial assessment of Patient D's acute confusion. Which assignments or delegations are appropriate if allowed by jurisdiction, facility policy, and verified competency? Select all that apply. 1 Ask the UAP to perform Patient A's initial focused cardiopulmonary assessment and decide whether the prescribed oxygen should be increased 2 Ask the UAP to obtain routine vital signs for stable Patient B plus stable Patient C, promptly reporting findings outside the RN's stated parameters 3 Ask the UAP to assist Patient D with toileting and fall precautions after RN assessment, remaining nearby and reporting any new change 4 Ask the LPN/VN to independently select, initiate, and titrate Patient A's therapeutic anticoagulant despite facility policy reserving this decision and titration for the RN 5 Assign the LPN/VN to give Patient B's scheduled oral antibiotic and reinforce established discharge teaching, reporting questions for RN evaluation 6 Assign the LPN/VN to collect focused pain data and give Patient C's prescribed PRN analgesic within verified scope, then report the response to the RN ## Explanation Four appropriate decisions Correct choices are 2, 3, 5, and 6. Stable, predictable vital signs and assisted toileting can be delegated to a competent UAP with explicit parameters and RN follow-up. A competent LPN/VN may provide established medication and teaching-reinforcement care for stable clients when permitted by the nurse practice act and facility policy. The RN performs Patient A's initial assessment and oxygenation decisions and cannot transfer a clinical anticoagulant-selection or titration decision that policy reserves for the RN. ## In-depth explanation Step 1 — Start with stability and predictability Patient A is unstable and requires RN assessment and judgment. Patients B and C have established plans and predictable care. Patient D's acute confusion first requires RN assessment; afterward, specific toileting and observation tasks can be delegated with immediate reporting instructions. Step 2 — Match the person to the task UAP work is limited to non-assessment activities with defined observations and reporting. LPN/VN activities vary by jurisdiction and policy; the item explicitly conditions the assignment on verified scope, policy, and competency. Step 3 — Retain RN accountability The RN sets directions, remains available, reviews the result, reassesses when findings change, and evaluates teaching and discharge readiness. NCLEX rule Do not memorize a universal task list. Apply client stability, task predictability, law, policy, competency, direction, and supervision. ## Clinical scenario Scenario (Stage 4 — Generate solutions) Patient A's PE pathway is active, and Patient D's acute mental-status change has received initial RN assessment. The team must safely cover all four clients. Clinical judgment target Apply delegation boundaries without treating LPN/VN scope as identical in every jurisdiction. ## Key concepts - **Delegation decision** — A clinical judgment based on the client, task, delegatee, jurisdiction, facility policy, competency, communication, and available supervision. - **Teaching reinforcement** — Review of an established education plan; the RN retains responsibility for initial teaching, evaluation, and discharge readiness as required by policy. - **RN accountability** — The RN remains responsible for appropriate delegation, directions, availability, supervision, follow-up, and evaluation of outcomes. ## 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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