# A charge nurse is making assignments for the upcoming shift. Which patient assignment would be most appropriate to delegate to a licensed practical nurse (LPN)?

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> subject: Next Gen NCLEX

## 문제

A charge nurse is making assignments for the upcoming shift. Which patient assignment would be most appropriate to delegate to a licensed practical nurse (LPN)?

## 보기

1. A 45-year-old patient with acute myocardial infarction requiring continuous cardiac monitoring and frequent assessments.
2. A 28-year-old patient with diabetic ketoacidosis requiring insulin drip titration and hourly blood glucose monitoring.
3. A 62-year-old patient post-operative day 1 from coronary artery bypass graft surgery with multiple chest tubes and drips.
4. A 55-year-old patient with stable chronic obstructive pulmonary disease (COPD) receiving routine medications and care. **✔ 정답**

**정답: 4**

## 해설

Stable COPD patients with routine care are appropriate for LPNs as they have predictable needs. Other patients require RN-level monitoring or complex interventions.

## 심화 해설

Understanding Delegation and Scope of Practice

The core of this question lies in the legal and professional boundaries that define what tasks a licensed practical nurse (LPN) can safely perform. In the NCLEX-RN framework, delegation is not simply about handing off a task; it requires a critical analysis of patient stability, task complexity, and the predictability of outcomes. The provided reference highlights that LPNs "deliver essential care that differs from RN/APRN roles," and that each role is strictly "governed by state-defined" scopes of practice [1]. An RN must always match the assignment to the LPN's educational preparation and legal parameters. The LPN's practice typically focuses on stable patients with predictable outcomes, where care involves standardized procedures and routine medication administration, rather than complex, continuously evolving assessments.

Analysis of Patient Assignments

To determine the most appropriate delegation, we must evaluate each patient's stability and the nature of the required nursing interventions.

Option 1: Acute Myocardial Infarction

This patient is hemodynamically unstable and requires continuous cardiac monitoring and frequent assessments. The potential for a sudden, life-threatening rhythm change demands the advanced assessment skills of an RN to interpret complex data, detect subtle changes, and initiate immediate, independent interventions. This assignment falls outside the LPN scope, which is directed toward stable patients with established plans of care.

Option 2: Diabetic Ketoacidosis with Insulin Drip

Managing a patient with diabetic ketoacidosis (DKA) on an insulin drip is highly complex and unstable. The task of titration—continuously adjusting the drip rate based on hourly blood glucose levels—requires critical thinking, frequent clinical evaluation, and the judgment to change a treatment plan based on assessment data. This is a core RN responsibility that involves ongoing analysis and cannot be delegated to an LPN, as the patient's status can change rapidly.

Option 3: Post-operative CABG Day 1

A patient on the first day after coronary artery bypass graft (CABG) surgery is critically ill and highly unstable. The presence of multiple chest tubes and intravenous drips requires continuous, complex hemodynamic monitoring and assessment for complications like hemorrhage, cardiac tamponade, or malignant arrhythmias. This situation demands the full scope of an RN's expertise in managing unstable, complex patients, making it entirely inappropriate for an LPN assignment.

Option 4: Stable COPD with Routine Care

This patient is described as stable with a chronic, non-critical condition and requires routine medications and care. The plan of care is established, outcomes are predictable, and the required tasks are standardized. This aligns perfectly with the LPN scope of practice, which, as the reference notes, involves delivering essential care for patients whose needs are consistent and do not require the complex, analytical decision-making reserved for the RN [1]. Administering routine medications and providing standard care for a stable patient is a safe and appropriate delegation.References (research sources)

- [1]The Role of the Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN) in Hemodialysis, Peritoneal Dialysis, and Home Dialysis Care.Research articleHaras MS, Bednarski D. (2025) · DOI: 10.37526/1526-744x.2025.52.3.233

## 임상 시나리오

Delegation to an LPN/LVNMatching assignments to the scope of practice
The most critical factor in delegation is the stability of the patient. An LPN/LVN assignment must involve a patient with a predictable outcome whose care consists of standardized procedures and routine medication administration.

The RN retains accountability for tasks requiring complex assessment, continuous monitoring of unstable conditions, and titration of high-risk medications like vasoactive drips or insulin infusions. These activities require the independent judgment and advanced knowledge base of the RN.

CautionAlways verify the specific LPN/LVN scope of practice defined in your state's Nurse Practice Act, as it is the ultimate legal authority. Do not delegate any task that requires independent clinical reasoning, initial assessment, or care of an unstable patient.

## 핵심 개념

- **Delegation** — The process by which an RN transfers the authority to perform a specific nursing task to a competent individual while retaining accountability for the outcome.
- **LPN Scope of Practice** — Legally defined parameters of care for a Licensed Practical Nurse, typically focused on stable patients with predictable outcomes, routine procedures, and standard medication administration, excluding complex assessments and unstable conditions.
- **Patient Acuity** — A measure of the severity of a patient's illness and the intensity of nursing care required, with higher acuity patients needing more complex, frequent assessments and interventions.

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