Staffing-Ortega Cherry 20 Flashcards
The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to whom?
a. The registered nurse (RN)
b. The licensed practical/vocational nurse (LPN/LVN)
c. Unlicensed assistive personnel (UAP)
d. All levels of staff, because the information is about the past and cannot change
a. The registered nurse (RN)
Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.
An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN bases decisions on what fact?
a. The role of the LPN/LVN is the same from state to state.
b. The LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided.
c. Review of the state‘s nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN.
d. The Joint Commission has certified and established roles for the LPN/LV
c. Review of the state‘s nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN.
The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.
Which task is most likely to be considered in a state‘s practice act as appropriate to delegate to a LPN/LVN if the patient‘s condition is stable and competence in the task has been established?
a. Administer an enema for an elective surgery patient.
b. Administer an antiarrhythmic medication IV while interpreting the patient‘s rhythm on the cardiac monitor.
c. Develop a plan of care for a stable patient admitted for observation after a head injury.
d. Teach a patient how to instill eye drops for glaucoma.
a. Administer an enema for an elective surgery patient.
The RN who is delegating must consider the following: (1) the delegate‘s current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.
A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading?
a. RN
b. LPN/LVN
c. Unlicensed assistive personnel (UAP)
d. Since all are trained, the task can be delegated to anyone
a. RN
The patient‘s condition is not stable; therefore, the skills of an RN are required.
A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task
of assisting with oral hygiene, knowing that this assignment ―does not require decisions based on the nursing process.‖ The nurse is correctly using which of the five rights of delegation?
a. Supervision
b. Communication
c. Person
d. Circumstance
ANS: D Circumstance
Right circumstance involves the delegation of tasks that do not require independent nursing judgments.
A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to focus on what?
a. Supplementing the staffing pattern when an RN is not available
b. Aiding the RN by performing appropriately delegated care tasks
c. Replacing the RN when the health care facility provides long-term care
d. Providing patient teaching, allowing more direct care to be provided by the RN
ANS: B. Aiding the RN by performing appropriately delegated care tasks
The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice.
An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for what associated task?
a. Delegating the task to another UAP if he or she does not have the time or skill to
complete the task
b. Keeping the RN informed of any abnormal blood pressure readings
c. Calling the physician when the patient‘s vital signs are not within established
parameters
d. Informing the dietary department to initiate a low-sodium diet for patients who are
hypertensive
b. Keeping the RN informed of any abnormal blood pressure readings
After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. The remaining options are the responsibility of the RN.
Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegate has had experience and training?
a. Evaluate the ability of a patient to swallow ice after a gastroscopy.
b. Assist a patient who is postoperative hip replacement to ambulate with a walker for
the first time.
c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy
patient if secretions are thick and tenacious.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.
Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.
An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision?
a. There is no supervision, because at times the LPN/LVN is not with the RN.
b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care.
c. Continual supervision is being provided until the RN determines competency.
d. Initial supervision is being provided because this is the LPN/LVN‘s first day on the unit.
c. Continual supervision is being provided until the RN determines competency.
This level of supervision is required when the working relationship is new, the task is complex, or the delegate is inexperienced or has not demonstrated an acceptable level of competence.
An RN is counseled by the nurse manager regarding inappropriate delegation when the RN engages in what activity?
a. Instructing the nursing assistant to greet ambulatory surgery patients and show them to their rooms.
b. When asking a novice nursing assistant to collect a sputum specimen, the RN states, ―I will show you this time and you can show me the next time
c. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.
d. Asking an LPN/LVN who has demonstrated competence to perform a dressing change before the patient is discharged home.
c. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.
Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation.
An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The RN then observes the LPN/LVN recording a patient‘s medication administration just before entering the patient‘s room. What is the RN‘s initial intervention?
a. Checking the patient‘s drug packages to ensure that the correct drugs were given.
b. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action.
c. Contact the nurse manager and ask that the LPN/LVN‘s license be suspended.
d. Call the pharmacy and ask for replacement medications for the patients.
b. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action.
The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN‘s initial responsibility requires that he or she intervene and identify concerns with the LPN/LVN.
Which statement related to delegation is correct?
a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act.
b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training.
c. Supervision is not required when routine tasks are delegated to a competent individual.
d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.
d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.
Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice.
During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that what is the basis for this practice?
a. The health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training.
b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN.
c. The RN can determine what tasks are legally delegable to the LPN/LVNs on his/her care team.
d. The nurse practice act and state regulations related to delegation override the organization‘s policies.
d. The nurse practice act and state regulations related to delegation override the organization‘s policies.
The state‘s nurse practice act is the deciding factor regarding what can legally be delegated.
A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. What should the RN do to best acquire the necessary information?
a. Query the state nursing association to determine their stance on the role of LPNs.
b. Ask the LPNs on the unit to list what tasks they routinely performed.
c. Contact the state board of nursing to determine legal scope of practice for LPNs.
d. Refer to California‘s nurse practice act because the scope of LPNs/LVNs is consistent across the United States.
c. Contact the state board of nursing to determine legal scope of practice for LPNs.
If the nurse practice act lacks clarity, the state board of nursing can provide guidance.
An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation?
a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin.
b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound.
c. An unlicensed assistive person (UAP) is assigned the task of assisting a patient with late stages of Huntington‘s disease to ambulate.
d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.
c. An unlicensed assistive person (UAP) is assigned the task of assisting a patient with late stages of Huntington‘s disease to ambulate.
Risk of falling is great in later stages of Huntington‘s disease due to chorea movements; this makes it inappropriate to delegate ambulation to the UAP.
