TEST 2 - UNIT B - CH 6 - DELEGATION (Fundamentals Book)

Question 1

Delegation is the process of

Answer 1

transferring the performance of a task to another member of the health care team while retaining accountability for the outcome.

Question 2

Supervision is the process of

Answer 2

directing, monitoring, and evaluating the performance of tasks by another team member.

Question 3

Nurses are responsible for

Answer 3

supervising the performance of client care tasks they delegate to others.

Question 4

Licensed personnel are

Answer 4

nurses who have completed a course of study in nursing and successfully passed either a PN or RN examination.

Question 5

Unlicensed personnel are

Answer 5

individuals who have had training to function in an assistive role to licensed nurses in providing client care.

Question 6

These unlicensed individuals might be

Answer 6

nursing personnel (certified nursing assistants [CNAs], certified medication assistants [CMAs]) or non‑nursing personnel (dialysis technicians, monitor technicians, phlebotomists). Some facilities differentiate between licensed and unlicensed personnel by using the acronym NAP for nursing assistive personnel or AP for assistive personnel.

Question 7

A licensed nurse is responsible for providing

Answer 7

clear directions when delegating a task initially and for periodic reassessment and evaluation of the outcome of the task.

Question 8

RNs can delegate to

Answer 8

other RNs, PNs, and AP.

Question 9

RNs must be knowledgeable about their

Answer 9

state’s nurse practice act and the regulations that guide the use of PNs and AP.

Question 10

◯ RNs must delegate tasks so that

Answer 10

they can complete higher‑level tasks that only RNs can perform. This allows more efficient use of all team members.

Question 11

● PNs can delegate to other

Answer 11

PNs and to AP.

Question 12

● Nurses can only delegate tasks appropriate for the

Answer 12

skill and education level of the individual who is receiving the assignment (the delegatee).

Question 13

● RNs cannot delegate the

Answer 13

nursing process, client education, or tasks that require nursing judgment to PNs or to APs.

Question 14

TASK FACTORS: Prior to delegating client care, nurses should consider the:

Answer 14

PREDICTABILITY OF OUTCOME
POTENTIAL FOR HARM
COMPLEXITY OF CARE
NEED FOR PROBLEM SOLVING
LEVEL OF INTERACTION W/ CLIENT

Question 15

● Predictability of the outcome:

Answer 15

Will the completion of the task have a predictable outcome?
◯ Is it a routine treatment?
◯ Is it a new treatment for that client?

Question 16

● Potential for harm

Answer 16

Is there a chance that something negative could happen to the client (bleeding, aspiration)?
◯ Is the client unstable?

Question 17

● Complexity of care

Answer 17

◯ Does the client’s care require complex tasks?
◯ Does the state’s practice act or the facility’s policy allow the delegatee to perform the task, and does the delegatee have the necessary skills?

Question 18

● Need for problem solving and innovation

Answer 18

Is judgment essential while performing the task?
◯ Does it require nursing assessment or data‑collection skills?

Question 19

● Level of interaction with the client

Answer 19

: Does the delegate need psychosocial support or education during the performance of the task?

Question 20

DELEGATEE FACTORS

Answer 20

● Education, training, and experience
● Knowledge and skill to perform the task
● Level of critical thinking the task requires
● Ability to communicate with others as it pertains to the task
● Demonstration of competence
● The facility’s policies and procedures
● Licensing legislation (state’s nurse practice acts) (6.1)

Question 21

Examples of tasks nurses may delegate to PNs

Answer 21

● Monitoring findings (as input to the RN’s ongoing assessment)
● Reinforcing client teaching from a standard care plan
● Performing tracheostomy care
● Suctioning
● Checking NG tube patency
● Administering enteral feedings
● Inserting a urinary catheter
● Administering medication (excluding IV medication in some states)

Question 22

Examples of tasks nurses may delegate to APs

Answer 22

● Activities of daily living (ADLs)
◯ Bathing
◯ Grooming
◯ Dressing
◯ Toileting
◯ Ambulating
◯ Feeding (without swallowing precautions)
◯ Positioning
● Routine tasks
◯ Bed making
◯ Specimen collection
◯ Intake and output
◯ Vital signs (for stable clients)

Question 23

● Use the five rights of delegation to decide

Answer 23

Tasks to delegate (right task)
◯ Under what circumstances (right circumstances [setting and resources])
◯ To whom (right person)
◯ What information to communicate (right direction and communication)
◯ How to oversee and appraise (right supervision and evaluation)

Question 24

● Use _____ ____________ and _______ __________ skills when delegating.

Answer 24

professional judgment
professional judgment

Question 25

Identify which tasks are appropriate to delegate for

Answer 25

each specific client.

Question 26

● A right task is

Answer 26

repetitive, requires little supervision, and is relatively noninvasive for the client.

Question 27

● Delegate activities to appropriate levels of team members (RN, PN, AP) according to

Answer 27

professional standards of practice, legal and facility guidelines, and available resources.

Question 28

RIGHT TASK: Delegate an AP to assist a client who has pneumonia to

Answer 28

use a bedpan.

Question 29

WRONG TASK: Delegate an AP to administer a nebulizer treatment to a client who has

Answer 29

pneumonia.

Question 30

● Determine the

Answer 30

health status and complexity of care the client requires.

Question 31

● Match the complexity of care demands to

Answer 31

the skill level of the delegatee.

Question 32

● Consider the

Answer 32

workload of the delegatee.

Question 33

RIGHT CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative

Answer 33

and stable.

Question 34

WRONG CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative and

Answer 34

required naloxone to reverse respiratory depression.

Question 35

Determine and verify the

Answer 35

competence of the delegatee.

Question 36

● The task must be

Answer 36

within the delegatee’s scope of practice or job description.

Question 37

● The delegatee must have

Answer 37

the necessary competence and training.

Question 38

● Continually review

Answer 38

the performance of the delegate and determine care competence.

Question 39

● Evaluate the delegatee’s performance according to

Answer 39

standards, and when necessary, take steps to remediate any failure to meet standards.

Question 40

RIGHT PERSON: Delegate a PN to administer enteral feedings to a client who has

Answer 40

a head injury.

Question 41

WRONG PERSON: Delegate an AP to administer enteral feedings to a client who has

Answer 41

a head injury.

Question 42

Right direction and communication in

Answer 42

writing, orally, or both

Question 43

● Communicate what

Answer 43

data to collect.

Question 44

● Provide a

Answer 44

method and timeline for reporting, including when to report concerns and assessment findings.

Question 45

● Communicate

Answer 45

specific task(s) to perform and client‑specific instructions.

Question 46

● Detail

Answer 46

expected results, timelines, and expectations for follow‑up communication.

Question 47

Delegate an AP to assist Mr. Martin in room 312 with a shower before 0900.

Answer 47

RIGHT DIRECTION AND COMMUNICATION:

Question 48

Delegate an AP to assist Mr. Martin in room 312 with morning hygiene.

Answer 48

WRONG DIRECTION AND COMMUNICATION:

Question 49

● Provide supervision, either

Answer 49

directly or indirectly (assigning supervision to another licensed nurse).

Question 50

● Monitor

Answer 50

performance.

Question 51

● Intervene

Answer 51

if necessary (for unsafe clinical practice).

Question 52

● Provide

Answer 52

feedback:
◯ Did the delegatee complete the tasks on time?
◯ Was the delegatee’s performance satisfactory?
◯ Did the delegatee document and report unexpected findings?
◯ Did the delegatee need help completing the tasks on time?

Question 53

● Evaluate the

Answer 53

client and determine the client’s outcome status.

Question 54

● Evaluate

Answer 54

task performance and identify needs for performance‑improvement activities and additional resources.

Question 55

Delegate an AP to assist with ambulating a client after the RN completes the admission assessment.

Answer 55

RIGHT SUPERVISION:

Question 56

Delegate an AP to assist with ambulating a client prior to the RN performing an admission assessment.

Answer 56

WRONG SUPERVISION:

Question 57

The five rights of delegation

Answer 57

Right task
Right circumstance
Right person
Right direction and communication
Right supervision and evaluation

Question 58

NURSING INTERVENTIONS: List at least five tasks the delegating nurse must perform when supervising and evaluating a delegatee.

Answer 58

● Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse).
● Monitor performance.
● Intervene if necessary (for unsafe clinical practice).
● Provide feedback:
◯ Did the delegatee complete the tasks on time?
◯ Was the delegatee’s performance satisfactory?
◯ Did the delegatee document and report unexpected findings?
◯ Did the delegatee need help completing the tasks on time?
● Evaluate the client and determine the client’s outcome status.
● Evaluate task performance and identify needs for performance‑improvement activities and additional resources.

Question 59

1. A nurse on a medical‑surgical unit has received change‑of‑shift report and will care for four clients. Which of the following tasks should the nurse assign to an assistive personnel (AP)?
   A. Updating the plan of care for a client who is postoperative
   B. Reinforcing teaching with a client who is learning to walk using a quad cane
   C. Reapplying a condom catheter for a client who has urinary incontinence
   D. Applying a sterile dressing to a pressure injury

Answer 59

1. A. Updating the plan of care for a client requires professional nursing knowledge and judgment. Therefore, it is outside the range of function of an AP.
   B. Reinforcing teaching a client for a client requires professional nursing knowledge and judgment.
   C. CORRECT: The application of a condom catheter is a noninvasive, routine procedure that can be delegated to an AP.
   D. Applying a sterile dressing on a client requires professional nursing knowledge, skills, and judgment.

Question 60

2. A nurse manager is assigning care of a client who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the client to which of the following staff members?
   A. Charge nurse
   B. Registered nurse (RN)
   C. Practical nurse (PN)
   D. Assistive personnel (AP)

Answer 60

2. A. Although the charge nurse can provide all the care this client requires in the immediate postoperative period, administrative responsibilities might prevent the close monitoring and assessment this client needs.
   B. CORRECT: A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment of an RN to provide safe and effective client care.
   C. A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment that is outside the range of function of a PN.
   D. A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment that is outside the range of function of an AP.

Question 61

3. A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply.)
   A. The roommate ambulates independently.
   B. The client ambulates wearing slippers over antiembolic stockings.
   C. The client uses a front‑wheeled walker when ambulating.
   D. The client had pain medication 30 min ago.
   E. The client is allergic to codeine.
   F. The client ate 50% of breakfast this morning.

Answer 61

3. A. The AP does not need to know the status of the client’s roommate to complete this assignment.
   B. CORRECT: To complete this assignment safely, the AP should make sure the client wears stockings and slippers.
   C. CORRECT: To complete this assignment safely, the AP should make sure the client uses a front‑wheeled walker.
   D. CORRECT: To complete this assignment safely, the AP should know that the client should be feeling the effects of the pain medication.
   E. The AP does not need to know the client’s allergy status to complete this assignment.
   F. The AP does not need to know the client’s food intake to complete this assignment.

Question 62

4. A charge nurse is assigning client care for four clients. Which of the following tasks should the nurse assign to a PN?
   A. Creating a plan of care for a client who is recovering following a stroke
   B. Assessing a pressure injury on a client who is on bed rest
   C. Providing nasopharyngeal suctioning for a client who has pneumonia
   D. Teaching a client who has asthma to use a metered‑dose inhaler

Answer 62

4. A. Creating a plan of care requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN.
   B. Assessing a pressure injury requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN.
   C. CORRECT: Providing nasopharyngeal suctioning is within the scope of practice of the PN.
   D. Teaching requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN.

Question 63

5. A nurse is preparing an in‑service program about delegation. Which of the following are components of the five rights of delegation? (Select all that apply.)
   A. Right place
   B. Right supervision and evaluation
   C. Right direction and communication
   D. Right documentation
   E. Right circumstances

Answer 63

5. A. The right route is one of the rights of medication administration, not delegation.
   B. CORRECT: The right supervision and evaluation is one of the five rights of delegation. They also include the right task and the right person.
   C. CORRECT: Right direction and communication is one of the five rights of delegation. They also include the right task and the right person.
   D. The right documentation is one of the rights of medication administration, not delegation.
   E. CORRECT: The right circumstances is one of the five rights of delegation. They also include the right task and the right person.