CH 13: Delegation of Nursing Tasks Flashcards
the power or right to give orders, make decisions, and enforce obedience
authority
ability to make decisions without authorization
Responsibility
an obligation or willingness to accept responsibility for the actions of oneself and others
Accountability
process of transferring responsibility, authority, accountability of patient care to another member of the health care team
Assigning
Transferring authority and responsibility to another team member while retaining accountability
Delegating
Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team
supervising
T/F
The RN is accountable for all patient care.
true
A charge nurse is making client assignments for a team that includes an RN, an LPN, and a UAP. Which task is appropriate for the charge nurse to delegate to the UAP?
A. Administering oral pain medication to a client post-surgery
B. Monitoring a client’s response to IV diuretics
C. Assisting a client with ambulation after a total hip replacement
D. Assessing a newly admitted client’s respiratory status
C. Assisting a client with ambulation after a total hip replacement
Rationale: The UAP can be delegated tasks that are within their scope of practice, such as assisting with ambulation, hygiene, and activities of daily living. Tasks requiring assessment, evaluation, or medication administration must be performed by an RN or LPN.
A nurse is planning to delegate tasks to an experienced LPN. Which tasks can the nurse delegate to the LPN? (SATA)
A. Administering subcutaneous heparin injections
B. Developing a plan of care for a newly admitted client
C. Collecting a urine specimen from an indwelling catheter
D. Initiating blood transfusion therapy
E. Reinforcing teaching about insulin administration to a client
A. Administering subcutaneous heparin injections
C. Collecting a urine specimen from an indwelling catheter
E. Reinforcing teaching about insulin administration to a client
Rationale: The LPN can perform tasks such as administering subcutaneous injections, collecting urine specimens, and reinforcing client teaching. However, developing a plan of care and initiating blood transfusions require the expertise and judgment of an RN.
A nurse is working with a UAP and an LPN on a medical-surgical unit. Which task should the nurse assign to the LPN?
A. Performing initial teaching on a newly prescribed medication
B. Evaluating a client’s pain level after administering pain medication
C. Measuring and recording urinary output for a client with kidney disease
D. Monitoring a client’s vital signs after receiving IV morphine
D. Monitoring a client’s vital signs after receiving IV morphine
Rationale: The LPN can monitor a client’s response to medications, including vital signs and side effects. Initial teaching and evaluation require the RN’s assessment skills, while measuring urinary output is appropriate for a UAP.
An RN is assigning tasks to a UAP for a group of clients. Which tasks can the RN delegate to the UAP? (SATA)
A. Feeding a client with dysphagia after checking for aspiration precautions
B. Turning and repositioning a client at risk for pressure ulcers
C. Evaluating the effectiveness of pain medication
D. Obtaining and recording a client’s blood glucose level
E. Assisting a stable client with a bed-to-chair transfer
B. Turning and repositioning a client at risk for pressure ulcers
D. Obtaining and recording a client’s blood glucose level
E. Assisting a stable client with a bed-to-chair transfer
Rationale: The UAP can perform non-clinical tasks such as repositioning, obtaining blood glucose readings, and assisting with transfers. Feeding a client with dysphagia requires assessment and monitoring, and evaluating pain medication effectiveness is a nursing judgment, both of which must be performed by an RN.
A charge nurse is delegating tasks to an LPN on a medical-surgical unit. Which client assignment is appropriate for the LPN?
A. A client post-appendectomy who needs reinforcement of discharge instructions
B. A client with newly diagnosed diabetes mellitus who needs initial insulin teaching
C. A client with pneumonia receiving IV antibiotics and requiring frequent respiratory assessments
D. A client with a traumatic brain injury requiring frequent neurological assessments
A. A client post-appendectomy who needs reinforcement of discharge instructions
Rationale: LPNs can reinforce education that has already been initiated by an RN. Initial teaching, frequent respiratory assessments, and neurological monitoring require the clinical judgment of an RN.
A nurse manager is reviewing the scope of practice for LPNs with a group of new nurses. Which tasks can the LPN perform? (SATA)
A. Administering an IV push medication
B. Monitoring a client receiving IV fluids
C. Reinforcing discharge instructions for a post-operative client
D. Assessing a client’s pain level before administering IV morphine
E. Administering an IV piggyback antibiotic
B. Monitoring a client receiving IV fluids
C. Reinforcing discharge instructions for a post-operative client
E. Administering an IV piggyback antibiotic
Rationale: LPNs can monitor IV fluids, reinforce education provided by the RN, and administer IV piggyback (IVPB) medications. However, IV push medications and pain assessments requiring clinical judgment must be done by an RN.
A nurse preceptor is evaluating a newly hired LPN’s understanding of their scope of practice. Which statement by the LPN requires correction?
A. “I can administer an IVPB antibiotic to a stable client.”
B. “I can reinforce discharge instructions that the RN initially provided.”
C. “I can initiate IV fluid therapy for a dehydrated client.”
D. “I can monitor a client’s IV fluid intake and document the findings.”
C. “I can initiate IV fluid therapy for a dehydrated client.”
Rationale: LPNs can monitor and calculate IV fluids but cannot initiate IV therapy. Initiating IV therapy requires the clinical judgment and skill of an RN.
A nurse is delegating tasks to an LPN during a shift. Which client care tasks are appropriate to delegate to the LPN? (SATA)
A. Administering an IVPB dose of vancomycin
B. Developing an initial plan of care for a newly admitted client
C. Monitoring a client receiving a continuous IV infusion
D. Teaching a newly diagnosed hypertensive client about lifestyle modifications
E. Reinforcing dietary education for a client with chronic kidney disease
A. Administering an IVPB dose of vancomycin
C. Monitoring a client receiving a continuous IV infusion
E. Reinforcing dietary education for a client with chronic kidney disease
Rationale: LPNs can administer IV piggyback medications, monitor IV fluids, and reinforce education initially provided by an RN. However, creating a plan of care and initial client education require the RN’s assessment and judgment.
The transfer of responsibility to another person for performance of an activity while retaining the accountability for the outcome of that activity.
delegation
What are the 5 rights of delegation?
Right task
Right circumstance
Right person
Right direction/communication
Right supervision
Name this “right of delegation”.
- Know the nurse practice act within your state
- Be aware of any specifics about delegation within your state
- Know what your facility policy says about delegation
a. Right task
b. Right circumstance
c. Right person
d. Right direction/communication
e. Right supervision
a. Right task
Name this “right of delegation”.
- Match the care needs to the skill level of the health care team member being considered for delegation
- Consider the workload of the team member
- Consider any specifics in your state
a. Right task
b. Right circumstance
c. Right person
d. Right direction/communication
e. Right supervision
b. Right circumstance
Name this “right of delegation”.
You must know the health care team member’s job description, their competency level, individual skill level & education level.
a. Right task
b. Right circumstance
c. Right person
d. Right direction/communication
e. Right supervision
c. Right person
Name this “right of delegation”.
Individual must know exactly what is being asked of them. Give clear directions & a clear time frame; what needs to be done, what is the follow-up needed?
a. Right task
b. Right circumstance
c. Right person
d. Right direction/communication
e. Right supervision
d. Right direction/communication
A nurse is preparing to delegate tasks for a busy shift. Which principle should the nurse consider when delegating to ensure safe and effective delegation?
A. The RN is not accountable for the outcome of delegated tasks once responsibility is transferred
B. The RN should always delegate to the highest-qualified individual available
C. The RN must ensure the delegated task aligns with the individual’s scope of practice and hospital policies
D. The RN should delegate all client care tasks to maximize time management
C. The RN must ensure the delegated task aligns with the individual’s scope of practice and hospital policies
Rationale: The RN remains accountable for delegated tasks and must ensure that tasks are within the scope of practice of the delegatee. Simply delegating to the highest-qualified individual or delegating all tasks without assessment does not ensure safe delegation.
A charge nurse is mentoring a newly licensed RN on appropriate delegation. Which statements by the newly licensed RN indicate a correct understanding of delegation? (SATA)
A. “I will assess the complexity of the task before delegating it.”
B. “Once I delegate a task, I am no longer accountable for it.”
C. “I will ensure that the delegatee understands the expected outcome.”
D. “I can delegate tasks that require clinical judgment to an experienced LPN.”
E. “I will consider the 5 rights of delegation when making assignments.”
A. “I will assess the complexity of the task before delegating it.”
C. “I will ensure that the delegatee understands the expected outcome.”
E. “I will consider the 5 rights of delegation when making assignments.”
Rationale: Proper delegation involves assessing the task’s complexity, ensuring the delegatee understands expectations, and applying the 5 rights of delegation. The RN remains accountable for delegated tasks and cannot delegate clinical judgment.
A nurse is using an algorithm to determine if they should accept an assignment. Which situation would require the nurse to decline the assignment?
A. The nurse has never cared for a client with this condition but can review hospital protocols
B. The assignment exceeds the nurse’s scope of practice and hospital policies
C. The nurse is assigned multiple clients with varying levels of acuity
D. The nurse feels uncomfortable with the assignment but has no clinical limitations
B. The assignment exceeds the nurse’s scope of practice and hospital policies
Rationale: Nurses must decline assignments that exceed their legal scope of practice or violate hospital policies. Feeling uncomfortable or lacking experience does not necessarily mean a nurse should decline an assignment, as resources and guidance are available.
A nurse is reviewing the 5 rights of delegation before assigning tasks to team members. Which are components of the 5 rights of delegation? (SATA)
A. Right task
B. Right supervision/evaluation
C. Right experience level
D. Right circumstance
E. Right communication
A. Right task
B. Right supervision/evaluation
D. Right circumstance
E. Right communication
Rationale: The 5 rights of delegation include the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. Experience level is not explicitly part of the 5 rights but is considered when determining delegation appropriateness.
A nurse is delegating a task to a UAP. Which instruction ensures appropriate delegation?
A. “Can you take care of vital signs for all my clients?”
B. “Help the client in Room 204 with their medication.”
C. “Make sure all my clients are turned every 2 hours.”
D. “Please check Mr. Smith’s blood pressure every 15 minutes and report any systolic reading over 160 mmHg.”
D. “Please check Mr. Smith’s blood pressure every 15 minutes and report any systolic reading over 160 mmHg.”
Rationale: Effective delegation includes clear, specific instructions with expected outcomes. The other options are too vague and do not define the task or expected reporting.
A nurse is evaluating whether a delegated task was performed appropriately. Which action demonstrates the nurse’s accountability in delegation?
A. Assuming the task was completed without verifying the outcome
B. Asking the delegatee if they completed the task but not checking the result
C. Reviewing the task completion and ensuring the expected outcome was achieved
D. Delegating the same task next time without evaluating the previous outcome
C. Reviewing the task completion and ensuring the expected outcome was achieved
Rationale: The RN must follow up on delegated tasks, ensuring they were completed correctly and achieved the expected outcome. This demonstrates accountability and safe delegation practices.
Acknowledgment and assumption of responsibility for actions, decisions, and policies within the scope of the role or employment position and encompassing the obligation to report, explain, and be answerable for resulting consequences is referred to as:
A.Accountability
B.Autonomy
C.Authority
D.Assessment
A.Accountability
The person accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements in areas related to delegation is:
A.Nurse manager
B.Nurse leader, vice president of nursing
C.Nursing supervisor
D.All of the above
D.All of the above
Who works under the direction and supervision of the registered nurse?
A.Licensed practical nurse
B.Unlicensed personnel
C.Patient care technicians
D.All of the above
D.All of the above
You have just received report on a patient with an acute myocardial infarction, and are delegating patient case load to a patient care technician (PCT). Which of the following can be delegated to the PCT?
A.Dietary teaching
B.Physical care
C.Admission assessment
D.Asking the patient what pain level he or she is experiencing
B.Physical care
You just received report from the night shift nurse. You must assign both direct patient care and indirect patient care to staff members. An example of a direct patient care task is:
A.Restocking shelves and patient rooms
B.Performing an electrocardiogram
C.Asking patient what they are requesting when their light is on, then informing the RN
D.Transporting patients
B.Performing an electrocardiogram
Which of the following are delegation factors?
A.State nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards, clinical situation
B.State nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards
C.State nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards
D.State nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards
A.State nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards, clinical situation
Appropriate tasks for consideration in delegation decision making include those that frequently recur in the daily care of a client or group of clients. These include:
A.Tasks that do not use a standard and unchanging procedure.
B.Tasks related to medication delivery.
C.Tasks that do not require the unlicensed assistive personnel to exercise nursing judgment and do not require complex and/or multidimensional application of the nursing process.
D.Tasks that require nursing process assessment.
C.Tasks that do not require the unlicensed assistive personnel to exercise nursing judgment and do not require complex and/or multidimensional application of the nursing process.
At the end of a shift, a new RN tells the charge nurse that she has not documented her medications. You should:
A.Ask her why she was unable to chart medications
B.Tell the nurse manager about the situation
C.Tell her you will pay her overtime for proper documentation completion
D.Ask her if she would like the charge nurse to complete the documentation
A.Ask her why she was unable to chart medications
When delegating:
A.You will directly perform, together with the nursing assistant, the tasks delegated
B.You will not be responsible for determining patient progress
C.You will need excellent communication skills very clear
C.You will need excellent communication skills very clear
