BIOLOGY 265 delegation Questions/Answers LATEST SOLVED

The registered nurse assigned a task to unlicensed nursing personnel (UNP). The UNP observed a change when measuring a client’s blood pressure. What is the responsibility of the UNP in this situation? 1 Which description by the nurse is a correct explanation of delegation? 1 Which right is applicable when the delegator and delegatee understand a common work­related language? 4 Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply. 34 The registered nurse is evaluating the statements made by a student nurse after teaching ways to make appropriate delegation decisions. Which statement made by the student nurse indicates a need for correction? 4 Which description by the nurse is a correct explanation of delegation? The transfer of responsibility for the performance of an activity Delegation is the transfer of responsibility for the performance of an activity. Personal liability defines each person's responsibility and accountability for individual actions or omissions. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual. Assignment is the transfer of both the accountability and the responsibility from one person to another. When does a delegator identify that the delegatee is less able to perform in a given situation? When the delegatee is knowledge deficient A delegatee is identified as less able to perform a specific work when he or she has a knowledge deficit. When the delegatee is upset, bored, or anxious, the delegator will identify that the delegatee is unwilling to perform a specific task. Who is most accountable for an initial assessment and the ongoing evaluation of client care? Registered nurse Registered nurses are accountable for initial assessment and the ongoing evaluation of client care. The client is not responsible for assessment and evaluation. The licensed practical nurse has a responsibility to assess and report client care. Unlicensed nursing personnel perform tasks as delegated by the registered nurse. Who acts as a delegator in the absence of the registered nurse? Charge nurse The charge nurses act as a delegator on the basis of knowledge and experience in clinical settings. In the absence of a registered nurse, the charge nurse usually delegates the tasks. A patient care associate assists and monitors vital signs. Licensed practical nurses and unlicensed nursing personnel are considered delegatees due to insufficient experience and training. What is the main motto of the Hersey's 2006 model? Situational leadership Hersey's 2006 model provides a solid foundation for delegation decisions. The main motto of this model is situational leadership. The core competencies of a situational leader are the ability to diagnose the performance, competence, and commitment of others; to be flexible; and to partner for performance. Anthony and Vidal describe characteristics of communication that interfere with the delegation process, such as information decay. They also describe information salience, or the quality, meaning, and clarity of the information. Ana mentioned individual accountability, the expectation of accountability and responsibility in 2011, specifically referencing delegation. The healthcare team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse? Assessing the respirations Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patientcontrolled analgesia is within the scope of a registered nurse's practice. Which healthcare professional does the nurse know is authorized to delegate work to other healthcare members? Registered nurse (RN) Delegating work is the most effective professional management strategy that an RN can implement in clinical practice to improve the safety and quality of client care. RNs can delegate work to LPNs, UNP, or UAP. The registered nurse is organizing a community health care program for administering tetanus vaccinations. Which member of the health care team is most suitable for delegating the task of administering vaccinations? Licensed practical nurse Tetanus vaccination is administered through the intramuscular route. The licensed practical nurse can administer oral, topical, and intramuscular medications, except for intravenous. The nursing aide, certified technician, and patient care associate are unlicensed assistive personnel whose scope of practice is limited for administering medications Who is mainly responsible for analyzing the knowledge and work of newly hired unlicensed assistive personnel (UAP) before delegating a task? Registered nurse The registered nurse must analyze any individual's knowledge before delegating a task. The charge nurse mainly functions as a liaison between team leaders and other healthcare providers. The associate nurse follows the care plan in the absence of a registered nurse. The nursing manager is responsible for more than one unit and has other managerial responsibilities. The registered nurse (RN) administers intravenous fluids to a client who was in a motorcycle accident. Which assessments made by the nurse would be appropriate based on the principle of right task of delegation? Institutional policies of drug administration Right task of delegation includes information on whether the task performed would be appropriate based on institutional policies. Assessing if the environmental conditions are conducive for completing the task determines right circumstance of delegation. Right circumstance of delegation also includes the assessments of resources and equipment available for performing the task. Assessing the client's condition prior to drug administration may not be an appropriate intervention of the nurse under right task of delegation. Test-Taking Tip: There are five rights of delegation. Look for the answer that mainly focuses on right of supervision. Which component is the ability to perform duties in a specific role? Authority Authority is the ability to perform duties in a specific role. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability determines whether a person's actions were appropriate and provides a detailed explanation of what occurred. Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual. Which member of the healthcare team would the nurse claim performs functions through passive delegation? Pharmacist A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees. Which task can be delegated to a cross-trained technician when paired with a registered nurse? Drawing blood samples Drawing the blood samples, or phlebotomy, can be delegated to crosstrained technicians when paired with the registered nurse. The cross-trained technician can only record the vital signs, monitoring the vital signs is outside the scope of practice for a cross trained technician. Intravenous medication can only be administered by the registered nurse. The cross trained technician is an assistive personnel who can reinforce the teaching but he or she cannot teach the client directly. What is the role of unlicensed assistive personnel in intravenous (IV) therapy for a client? Collecting the data to be used in the assessment of the IV site The role of unlicensed assistive professional in IV therapy is to collect the data that can be used in the assessment of the IV site. Monitoring clinical manifestation is performed by the licensed practical nurse (LPN). Administering IV fluids and medications is done by a registered nurse or LPN. Evaluating the client for clinical manifestations is performed by the registered nurse. A client with foot ulcers is admitted to the hospital. The nurse manager should delegate the task of maintaining hygiene to which staff members to maximize efficient use of human resources? Select all that apply. Patient care associate (PCA) Unlicensed nursing practitioner (UNP) Nurses, PCAs, and UNPs can perform the task of maintaining hygiene; however the best use of resources is to delegate to UNPs and PCAs so the nurses can complete medication administration and other skills the UNPs and PCAs are not legally able to perform under their scope of practice. Which nursing process includes tasks that can be delegated? 4 Which definition of delegation given by the nurse is correct? 4 Which characteristic should the nurse use during the nursing process as a guide for delegation? 2 The registered nurse (RN) is caring for an older client who has been admitted to the hospital. The RN allocates several tasks to the unlicensed nursing personnel (UNP). In order to evaluate the understanding of the UNP, the RN asks the UNP to describe which tasks have been allocated. Which responses given by the UNP indicate effective understanding of the tasks? Select all that apply. 145 Which employee should be competent in critical thinking, leadership, communication, and time management skills? Select all that apply. 13 Which component is the ability to perform duties in a specific role? 1 Which questions should the delegator assess to determine the right task? Select all that apply. 14 Which quality of the nursing assistant should be known by the delegator when assigning a task? Ability Who is responsible for establishing systems to monitor and verify the competency requirements related to delegation in an organization? 2 During the delegation process, which healthcare professional acts as a liaison between the team leader and healthcare provider? 1 What is an important consideration for delegation of care by the nurse when the delegatee has limited knowledge and ability to perform the task? Gui Which interventions are in the scope of a licensed practical nurse (LPN)? Select all that apply. 245 Which component of delegation is retained while the delegator is delegating the client’s care task to the nursing aide? Account What is the main motto of the Hersey’s 2006 model? 3 Which task is achieved by the delegator when he or she engages in self­care to enhance his or her ability to care for the healthcare team? 2 The registered nurse considers the qualification of the unlicensed nursing personnel (UNP) before delegating a task. Which right of delegation is followed by the nurse? Person Which activity indicates improper follow­through on the part of the delegatee? 1 Which work is automatically increased for the delegator when there is a decrease in direct client care? 2 A client with asthma and depression is admitted to the hospital. Which tasks delegated by the delegator would indicate the task is applicable for the registered nurse? 3 What is the duty of the nurse as delegator if the delegatee has limited knowledge and ability to perform a task? 1 Which nursing professional has the maximum span of control? 1 Which drawback indicates an improper follow­through on the part of a delegatee? 1 Which nursing model includes a registered nurse (RN) paired with technical assistance? 2 What entity outlined the principles of delegation for registered nurses? 3 What is the ultimate goal of delegation? 2 Which task can be delegated to the licensed vocational nurse (LVN)? Select all that apply. 45 Which healthcare team members began to increase in number during World War II and are delegated for providing care to clients at home? Select all that apply. 345 A registered nurse who has limited clinical experience must delegate in collaboration with a nursing assistant. Which communication method used by the registered nurse while supervising may affect the working performance of the nursing assistant? 4 What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply. 134 The nurse is caring for a client admitted with fluid overload. Which tasks are most appropriate to be delegated to the patient care associate? Select all that apply. 125 A registered nurse distributes a task to four healthcare professionals. When are both accountability and responsibility transferred to the healthcare professional? 1 A nurse manager transfers the task of caring for a client who has undergone appendectomy to a registered nurse (RN). Which element of the healthcare system is the RN practicing? 4 The registered nurse is delegating a task to a newly hired unlicensed nursing personnel (UNP) and feels that the UNP requires explanation. Why does the RN feel the need to provide explanation? 4 The charge nurse is delegating tasks for the nursing assistants regarding the postpartum care of a client. Which task is appropriate to be delegated to an unlicensed assistive personnel (UAP) to provide effective client care? Select all that apply. 124 When does delegation become more challenging? Select all that apply. 25 The registered nurse assesses if an unlicensed assistive personnel (UAP) new to the unit is capable of carrying out a task. Which principle of delegation does this illustrate? 2 The registered nurse is teaching a novice nurse about the rights of delegation. Which statement by the novice nurse indicates a need for further teaching? 3 The registered nurse is evaluating the statements made by a student nurse after teaching about the delegation communication template. Which statement made by the student nurse indicates a need for correction? 4 The registered nurse finds information decay during the process of delegation. What possible causes may have contributed to this? Select all that apply. 123 The registered nurse (RN) is caring for a client who underwent ileostomy. Which activity performed by the nurse indicates following the principle of right circumstance of delegation? Select all that apply. 23 While working with a delegatee, the registered nurse says to the delegate, "It’s easy; you can do the procedure tomorrow after watching me do it today. Just follow the steps I have demonstrated." What is the behavior of the registered nurse in this situation? Sell The registered nurse oversees five unlicensed nursing personnel (UNP), and each UNP cares for five clients, so the registered nurse in effect has responsibility for five UNPs and 25 clients. What do these numbers of subordinate and clients indicate? 2 The nurse delegates the tasks of caring for a postpartum client. During assessment, the nurse observes an infection in the client caused by lack of hygiene. Which member of the health care team is most likely responsible for the client’s condition? Select all that apply. 25 What are the elements integrated into delegacy? Select all that apply. 14 While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN? 2 The registered nurse orders unlicensed nursing personnel (UNP) to check blood oxygen saturation levels every 6 hours and to report the results regularly. Which activity is the registered nurse performing in this situation? 1 A client is admitted to the hospital with severe backache and chest discomfort. After reviewing the client’s condition, there is a need for 24­hour client care by the registered nurse (RN). Which healthcare professional is responsible for assigning the task to a registered nurse when 24­hour client care is needed? 1 The registered nurse delegates a task to the unlicensed assistive personnel (UAP). After the UAP starts the task, the registered nurse (RN) asks for feedback related to the task. Which right of delegation is the RN following? Supervis The registered nurse finds that the delegatee is only working for half a day in the healthcare unit. Which is the most appropriate leadership style in this situation? 2 Which statement of the nurse is true regarding Hersey’s Situational Leadership Model? 2 While caring for a post­operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply. 12 While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate? 4 While assigning a task, the registered nurse finds that one of the delegatees is not competent to hold the current position. Which strategy does the nurse follow for managing this issue during delegation? 4 Which question does the registered nurse recognize as related to the right of circumstance when delegating? 1 What type of relationship between the nurse delegator and delegatee causes the nurse delegator to use the leadership behavior of telling? 1 The registered nurse delegates the tasks related to caring for a client who has undergone surgery. What are the benefits of delegation in this situation? Select all that apply. Increased efficiency Improved quality of client care Increased professional skills of the unlicensed assistive personnel The charge nurse is communicating with the registered nurse about caring for a client with a respiratory disorder. Which instructions are delegated to the registered nurse to provide effective care to the client? Select all that apply. "Assess the client's respirations after 1 hour." "Provide intravenous medication every 3 hours." A client is prescribed apomorphine. Which concern would be a priority while addressing patient needs? Operating heavy machinery or driving The emergency department (ED) nurse is providing care to a burn trauma client. Which is the priority for the nurse to monitor for after removing the client's clothing? Hypothermia Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply. Appetite Activity status Emotional status Which client should the nurse consider to need the highest priority care? A client with a CURB-65 score of 5 A major city hospital is planning to implement primary nursing. What issues must be considered prior to the implementation of this care approach? Select all that apply. Salaries of care providers Disposition of current support staff Educational preparation of the staff Number of registered nurses needed The nurse is teaching a group of nursing students how to gather historic data for a client experiencing acid-base imbalance. Which statements indicate the student nurses need further teaching? Select all that apply. "I should compare the mental status of the client with that of the family statement." "I should compare the mental status of the client with the statement provided in the health record of the client." What does Hersey's situational leadership model describe about ability and willingness? Select all that apply. An individual's ability does not change from one moment to the next. An individual's willingness can fluctuate from one moment to another. Ability and willingness need to be assessed to determine the level of the follower's readiness. Which action in the delegation process represents accountability? Monitoring the client care given and determining outcomes After reviewing blood test reports, in which client's care plan does the nurse document monitoring jaundice as a priority nursing intervention? Client with hemoglobin level of 4g/dL As a part of the nursing curriculum, the nursing faculty is teaching nursing students about high-quality clinical delegation experiences and has also chosen to engage the students with nursing mentors. Which skill does the nursing faculty expect the nursing students to develop via this approach? Professional self-confidence in delegation For which situations would total client care be an appropriate delivery system? Select all that apply. Client with an endotracheal tube for pulmonary sepsis Client recovering from cardiovascular bypass graft surgery Client recovering from the placement of a cerebrospinal fluid shunt Which primary task is achieved by a delegator when delegating a task to a delegatee for an effective outcome? Motivating Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. Is the prospective delegatee a willing and able employee? Does the delegatee have the knowledge and experience to perform the specific task safely? The nurse is teaching a group of student nurses about emergency treatment procedures for the local complication of intravenous therapy involving thrombosis. Which statements made by the student nurse require correction? Select all that apply. "I should lower the extremity of the client." "I should apply warm compresses to stabilize the clot." "I should stop the infusion, but keep the short peripheral catheter in place." The nurse is delegating someone to care for a client with diabetes mellitus. Which instruction given by the nurse better explains the selling relationship with the delegatee? "You will take complete care of the client with diabetes and make sure to record the blood glucose level." The body temperature of a heat stroke client is above 104° F (40° C). What is the priority order the nurse would use for cooling the client so that breathing and circulation are not impaired? The nurse should remove the client's clothing then place ice packs on the neck, axillae, chest, and groin. The third step involves the nurse immersing the client in cold-water, making the body wet. In the fourth step, the nurse should fan the client rapidly to aid in cooling by evaporation. The nurse is teaching a group of students about neuromuscular manifestations of alkalosis with hypocalcemia. Which statements provided by a student nurse indicate the need for further learning? Select all that apply. "The client would show signs of hyporeflexia." "The client would show signs of paresthesias." The registered nurse is assigning a task to an unlicensed nursing personnel (UNP). Which key elements are considered while assessing the UNP's ability to perform work? Select all that apply. Safety Stability Critical Thinkinh What points should the nurse consider when delegating a task? Select all that apply. Checking the skill set of the delegatee Selecting the delegatee based on his or her competence levels Being certain that the delegatee is capable of completing the task The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a client with diarrhea. After 2 hours, the RN communicates with the UAP and decides that the client needs immediate assessment. Which statements by the UAP led the nurse to this conclusion? Select all that apply. "Temperature of the client is 105° C." "I have administered intravenous fluids to the client." The blood lab work for a client with purpuric lesions on the skin shows a thrombocyte count of 100,000 cells per microliter. Which nursing intervention would be priority in this patient to reduce the risk of bleeding? Advising the client to drink plenty of fluids A nurse is assigned to take care of a group of clients. Which client should the nurse see first? A 2-year-old client with diarrhea The client receives dosages of sedative and opioid drugs during the postoperative period following surgical correction of a small bowel obstruction. What is the most critical assessment to be performed as a nursing safety priority? Respiratory assessment The emergency department nurse is called to care for a client with a snake bite. What are the nursing interventions performed by the nurse in the order of priority? While providing prehospital care for a client with a snake bite, the nurse should first move the client to a safe area away from the snake and encourage rest to reduce venom circulation. Next, the nurse should remove constricting clothing and jewelry before swelling worsens. Then, the nurse should immobilize the affected area using a splint to limit the spread of venom. The nurse should then call for immediate emergency medical assistance. Lastly, digital photographs are taken at a safe distance to help in identification of the snake. Which charge-nurse remark would be expected in a care area that is using team nursing as a care delivery method? "Have you discussed this client care issue with your team leader?" Which quality of the nursing assistant should be known by the delegator when assigning a task? ability The nursing team is involved in effective pain management. Which task would be performed by a registered nurse (RN) in this case? Developing a treatment plan for client's pain What is the status of the unit secretary as a member of the healthcare team, which is in the span of control of a registered nurse (RN)? Devoid of legal authority How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply. Engage a nurse mentor for guidance. Reinforce delegation knowledge through continuing education. Seek high-quality clinical delegation experience early in their career. The registered nurse finds that the delegatee is only working for half a day in the healthcare unit. Which is the most appropriate leadership style in this situation? Telling What is discussed in Hersey's 2006 model related to delegation? Core competencies of a situational leader The registered nurse in a hospice is working with a new assistant who has prior experience working in a physician's office. Which action made by the registered nurse will promote a healthy working environment? Encouraging the assistant to adopt the philosophy of the organization What are the various challenges related to delegation? Select all that apply. Providing clear direction to the delegatee Understanding the skill set of the delegatee Maintaining an open line of communication with the delegatee xThe registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task? critical thinking A registered nurse (RN) delegates a task to a licensed practical nurse (LPN). What should the RN do when the LPN executes the task improperly? 1 The registered nurse is delegating tasks to the healthcare team. Which team member is most suitable for achieving an effective outcome in the care of a client who is bedridden for long periods with seizures? 2 A critically injured client was brought to the hospital following a car accident and the client should be immediately triaged for determining the nature and acuity of the injuries. Who is delegated to perform the task? 2 Which activity performed by the registered nurse (RN) indicates effective supervision of the delegatee? 3 A registered nurse (RN) is sent to a rehabilitation center because of chemical impairment issues. Which member of the healthcare team will be asked to provide feedback about the RN’s progress? 1 Which intervention should the charge nurse perform to manage a task when the unlicensed nursing personal (UNP) is lacking competence? 3 A client is hospitalized with dehydration and dysphagia. Which tasks are appropriate to delegate to a licensed practical nurse? Select all that apply. 135 The registered nurse (RN) is caring for a client with epilepsy. Which tasks delegated by the registered nurse (RN) to the assistive personnel indicates active delegation? Select all that apply. 245 The registered nurse (RN) is caring for a client who is currently hospitalized for a stroke. What is the most effective professional management strategy for the RN to improve the safety and quality of client care? 1 A healthcare team is caring for a 68­year­old client with diabetes insipidus. Which task is most suitable to be delegated to licensed practical nurse (LPN) to provide effective client care? Select all that apply. 25 When delegating a task, the delegator says, "Please tell me how you are going to perform this procedure, and I will share my expectations regarding how we need to communicate with each other." What can be inferred about the delegatee? 3 The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance? 3 The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply. 124 What are some challenges faced in the process of delegation? Select all that apply. 124 Which activity performed by the registered nurse (RN) indicates effective delegation? 4 A client presents to the physician with a rash. The physician orders the application of a topical medication. Which healthcare team member will most likely carry out this order? Lpn In differentiating between a leader and a manager, a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization. ANS: C The terms leadership and management are used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes. Authority is the legitimate right to direct others that is given to a person by the organization through assignment to an authorized position such as a nurse manager. It is the nurse leader who has the ability to guide or influence, as well as to motivate and inspire, others on the team. Managers are assigned responsibility for accomplishing the goals of an organization. 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: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. nursing assistive personnel (NAP). d. all levels of staff, because the information is about the past and cannot change. ANS: A Only the RN can perform and sign the admission assessment, although some components such as vital signs may be delegated. The assessment must be completed and signed by the RN; however, some components may be delegated to the LPN/LVN. NAPs are not licensed, and only an RN can perform the initial assessment. The assessment includes present symptoms and treatments, as well as those reported from the past, and the RN must complete the initial patient assessment. 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 knows that: 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. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN. ANS: C 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. Each state determines the scope of practice of the LPN/LVN. Specific tasks and roles cannot be delegated except to another RN who has received the training required to perform the task or role. The purpose of The Joint Commission is to increase the safety and quality of care provided to consumers by providing voluntary accreditation that certifies that a hospital meets established standards. 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. ANS: A The RN who is delegating must consider the following: (1) the delegatee'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. Administration of an antiarrhythmic drug requires the skill of an RN to evaluate outcomes, especially when it is administered IV because of its fast rate of distribution. Only an RN can develop the patient's plan of care, although others may assist in updating information. The task of teaching is limited to RNs. 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. Nursing assistive personnel (NAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring. The patient's condition is not stable; therefore, the skills of an RN are required. The assessment expertise of an RN is needed because of the unstable nature of the patient's condition. Obtaining a baseline set of vital signs for an unstable patient would be considered high-risk delegation for a NAP. The patient's condition is very dynamic; assessments will have to be completed by the RN on admission and then as indicated by the stability of the patient. A nurse is delegating to the newly hired nursing assistive personnel (NAP) 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 Right circumstance involves the delegation of tasks that do not require independent nursing judgments. Right supervision of delegation involves providing feedback to monitor how the process is working and to suggest improvements to the process. Right communication involves giving clear explanations about tasks and expected outcomes; information is provided about when the delegatee should report to the RN. Right person involves delegating to someone who is qualified and competent, and, because the NAP is a new hire, the RN cannot evaluate the competency level of the delegatee. A student nurse is concerned about delegation practices and wonders why hospitals employ nursing assistive personnel (NAP) 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: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing simple, routine patient care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN. ANS: B The NAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice. The NAP and the LPN/LVN cannot supplement staffing when the RN is not available but can assume responsibility for tasks that are simple and routine and do not require adherence to the nursing process. An RN must oversee the care provided by NAPs and LPNs/LVNs in long-term care settings. Only RNs can provide patient teaching. An RN delegates to NAP the task of performing blood pressure checks for a group of patients on a nursing unit. The NAP accepts the task and is responsible for: a. delegating the task to another NAP 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. After accepting the assignment, the NAP is responsible for completing the task and reporting any patient concerns to the RN. The NAP cannot delegate to any member of the health care team; delegation is the responsibility of the RN. RNs are responsible and accountable for accepting physician orders. Dietary consults are independent nursing orders that only the RN can initiate. Which task is appropriate for the RN to delegate to the nursing assistive personnel (NAP), provided the delegatee 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. ANS: D 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. Evaluation requires the expertise of the RN; assessing the gag response may prevent aspiration after surgery and is not within the scope of practice for NAP. Assisting a patient who is ambulating after surgery is not an appropriate task to delegate. An RN will have to assess the patient's tolerance and coordinate care on the basis of this assessment. Changing the tracheotomy cannula is a skill that requires critical thinking and carries a high risk for injury, making the task inappropriate 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. ANS: C This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence. Supervision is always a required component of delegation. The RN does not know about the training and competencies of the LPN/LVN and has not yet developed a working relationship with this staff member. Initial supervision consists of oversight of a delegated task once a shift; however, this approach should be used when the RN knows the competencies of the LPN/LVN. An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen, and the RN states, "I will show you this time and you can show me the next time." c. RN assigns 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. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home. ANS: C 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. The RN should provide clear directions for assigned tasks, and this assignment falls within typical job duties for nursing assistive personnel (NAP). The RN received appropriate feedback and is providing directions and is demonstrating a skill for which the nursing assistive personnel (NAP) has not shown competency. Routine repetitive dressing changes are within the scope of practice for the LPN/LVN who has demonstrated competency for the skill. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. 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. ANS: B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervenes and identifies concerns with the LPN/LVN. Checking the patient's drug packages to ensure that the correct drugs were given is not proactive intervening for patient safety because an inappropriate medication would have already been given. The RN must intervene immediately to protect the patient but may later discuss with the nurse manager a plan of corrective action for the LPN/LVN. The first step is to stop the violation of the five rights of medication administration; consequently, medications will not have to be replaced. Which statement related to delegation is correct? a. The practice of nursing assistive personnel (NAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and/or NAP 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 NAP. ANS: D 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. Most state laws do not define practice for NAP. Nursing practice cannot be delegated; only tasks can be delegated. The RN must determine that tasks have been completed and were performed correctly. 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: a. the health care facility can override the state practice act by having all LPN/LVNs and nursing assistive personnel (NAPs) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. NAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies. ANS: D The state's nurse practice act is the deciding factor regarding what can legally be delegated. Although on-site training may increase the competency of the individual, legal rules of delegation remain with the state's nurse practice act. Accountability remains with the RN who delegated the task. NAPs are responsible for accepting tasks for which they are competent to perform, but accountability remains with the RN. 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. The RN should: 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. ANS: C If the nurse practice act lacks clarity, the state board of nursing can provide guidance. The state nursing association is not the authority on the scope of practice. The LPNs may be performing tasks that are not within the scope of practice and the RN is accountable for all tasks assigned. Nurse practice acts vary from state to state. 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 is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3. ANS: C Risk of falling is great in later stages of Huntington's disease due to chorea movements. Mixing regular and NPH insulin is within the scope of practice of an RN and all insulin should be checked by an RN prior to administration, reducing the risk of a medication error. Simple dressing changes are within the scope of practice for an LPN/LVN. An experienced nurse from an oncology unit would be familiar with care of immunocompromised patients. Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.) a. Nursing assistive personnel (NAPs) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion. d. NAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the NAP, but the delegator retains accountability. ANS: A, B, C The statement "NAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN. The RN can delegate this responsibility if the patient is stable and the competence of the NAP has been established. Accountability remains with the person who is delegating, but when the NAP accepts the assignment, responsibility After delegating the task of administering oral medications to a licensed practical nurse (LPN), the registered nurse (RN) ensures that the LPN is supervised until the task is accomplished. Which right of delegation does the scenario reflect? 4 Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply. 245 The nurse manager is delegating tasks to the healthcare team to care for a client who underwent brain surgery. Which individuals on the team share accountability during delegation? Select all that apply. 24. A delegator working in a rural setting has to handle a task of managing care for clients in that area. Which crucial step should the delegator take to develop a productive strategy in delegating tasks to a delegatee? 4 A licensed practical nurse (LPN) was hired recently. Which strategy should be applied by the registered nurse (RN) to open lines of communication between them? 3 A registered nurse teaches a student nurse about delegation. Which statement made by the student nurse indicates appropriate learning? 4 Which right of delegation would the nurse describe as most instrumental in shaping quality and safety outcomes according to Anthony and Vidal? 4 The registered nurse is evaluating the statements made by a student nurse after teaching Hersey’s situational leadership model regarding core competencies of a situational leader. Which statement made by the student nurse indicates a need for correction? 2 Which hospital care setting is most appropriate for a case manager to perform tasks as a delegatee? 4 Which element of the healthcare system is the registered nurse (RN) practicing when the delegator shares accountability with the RN? 1 A nurse manager delegates the task of phlebotomy to the members of a healthcare team who are caring for a client with diabetes. Which individual on the team can be delegated to perform the task of phlebotomy? Cross trained Which individual is categorized as one who would be considered as "dependent status"? LPN The registered nurse is teaching the student nurse about the concepts of delegation. Which response given by the student nurse indicates the need for further teaching? 2 The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply. 124 Which component of delegation is considered a "two way process"? 3 A registered nurse (RN) delegates the task of foot care for a client to an unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task, but was recently hired and is unfamiliar with the client’s condition. What should the RN do in this situation? 3 What order should the nurse follow during the delegation decision-making process when delegating client care? 1.Assessing the health needs exhibited by the client 2.Assessing the abilities demonstrated by unlicensed personnel 3.Seeking client care issues 4.Ensuring the stability of the client 5. Monitoring the task 6.Providing feedback to unlicensed personnel The delegation process starts with assessing the health needs of the client and the skills of unlicensed personnel (UNP). The key component of delegation decision-making is assessing the UNP's ability to perform the work, including, safety, critical thinking, stability, and time. It is also vital to make client care decisions at the same time. The nurse has to make sure that the client is stable and steady to ensure the best care. The greater the stability of a client, the more likely the UNP can provide safe client care. The nurse should then monitor the task being performed by the UNP. The nurse should also maintain an open line of communication with the UNP to seek client care updates and limitations. The nurse should always provide direct feedback to the UNP for professional growth and development to improve client care outcomes. The registered nurse (RN) is delegating tasks to several health care team members caring for a client with a bacterial infection and high fever. Which statements by the registered nurse would be most appropriate for the licensed practical nurse (LPN)? Select all that apply. Correct1 "You should administer an antipyretic after the meal." 2 "You should assess the client's condition." 3 "You should change the bed sheets and dress the client every day." Correct4 "You should administer prescribed antibiotics to the client twice a day." Correct5 "You should collect data that can be used in the assessment of client's condition." The delegator can delegate tasks such as administration of antipyretic for the client who has fever. This particular task should be delegated only to the licensed nursing personnel, such as LPN. The delegator can delegate the task such as administration of antiallergic medication to the licensed professional, such as LPN. The RN is responsible for all the assessments performed, but the UAP or LPN can collect the data that can be used for the assessment. The RN is responsible for assessing the client's condition. The RN should delegate basic tasks such as changing the bed sheets and dressing the client to unlicensed nursing personnel. Which client's care can the registered nurse (RN) safely delegate to unlicensed nursing personnel (UNP) based on the given data? Correct1 Client A, with chronic hypertension and stable vitals 2 Client B, with drainage from diabetic foot 3 Client C, with myocardial infarction due to atherosclerosis 4 Client D, with foot ulcers from peripheral vascular disease Care of client A can be safely delegated because the chronic hypertension with stable vitals is not generally associated with any complications. Client B with drainage from diabetic foot is at a risk of aggravating foot issues, so this client's care cannot be safely delegated. Client C with myocardial infarction due to atherosclerosis is at a risk of cardiovascular instability and care should not be delegated. Client D has a risk of foot ulcers due to peripheral heart disease so this client's care also cannot be safely delegated to the UNP. The nurse is delegating someone to care for a client with diabetes mellitus. Which instruction given by the nurse better explains the selling relationship with the delegatee? 1 "Record the client's blood glucose level each morning." 2 "You may approach me for further assistance and questions. Thank you." 3 "I will guide and assist you while you learn how to check the client's blood glucose." Correct4 "You will take complete care of the client with diabetes and make sure to record the blood glucose level." Selling includes ongoing relationships with an explanation of the delegated new task. This is better explained in the statement, "You have to take complete care of the client with diabetes and make sure that you record the blood glucose level." Telling is ordering the delegate to record the client's blood glucose level each morning. Delegation, involving established relationships and expertise, is better explained by, "You may approach me for further assistance and questions. Thank you." Participation is mutual involvement to accomplish the task. It is better explained by the statement, "I will guide and assist you while you learn how to check the client's blood glucose." The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction? 1 Asking questions about the client's respiratory rate 2 Asking the client to perform breathing exercises regularly 3 Administering oxygen to the client with shortness of breath Correct4 Providing constructive feedback about client care management The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The registered nurse (RN) is caring for a client who has severe abdominal pain. The RN plans to work with the assistance of an unlicensed nursing personnel (UNP). The RN starts the client care. What should the RN consider during the process of active delegation? Select all that apply. Correct1 Assessing the level of the client's abdominal pain Correct2 Directing the UNP to assist the client while toileting 3 Advising the client to take pain medication when needed Correct4 Ensuring that the UNP is accountable for successful completion of the task 5 Explaining to the client about the reason and cause of abdominal pain In active delegation the RN assesses the client's situation to ensure the client is stable enough to be handed over to the UNP. The RN can then delegate specific basic tasks to the UNP such as oral care and toileting. The RN then holds the UNP accountable for successful completion of the task. It is within the scope of practice of the RN to advise the client to take pain medication in accordance with the primary health care provider's prescription. Likewise, the RN can explain the reason and cause of the condition diagnosed by the primary health care provider. These tasks are considered passive delegation. A nurse is assisting another registered nurse in the intensive care unit who is caring for a client with uncontrolled blood pressure. Which action on the part of the nurse indicates "offering" during delegation decisions? 1 "Did you check the client's blood pressure this morning?" Correct2 "You can use this stethoscope and sphygmomanometer to take the blood pressure." 3 "Would you fetch me the client's laboratory reports? I'll record the blood pressure." 4 "How is the client doing this morning? Let me look at yesterday's blood pressure report." Offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The statement, "You can use this stethoscope and sphygmomanometer to take the blood pressure," is an example of offering. Asking begins with questions related to the problem or issue regarding client care. "Did you check the client's blood pressure this morning?" is an example of asking. Doing involves demonstrating the specific task or behavior needed to improve client care. "Would you fetch me the client's laboratory reports? I'll record the blood pressure," is an example of doing. "How is the client doing this morning? Let me look at yesterday's blood pressure report," is an example of supervision. Which behavior does the delegator adopt when communicating with the delegatee if the relationship between them is new, the delegatee has limited knowledge, and the delegator does not expect the relationship to be ongoing? Correct1 Telling 2 Selling 3 Delegating 4 Participating According to Hersey's Situational Leadership Model, if the relationship between a delegator and a delegatee with limited knowledge is new and is not going to be ongoing, the delegator's behavior is characterized as "telling." Delegator's behavior is characterized as "selling" if the delegatee and delegator have an ongoing relationship and a new task is being delegated. The delegator's behavior is characterized as "delegating" when the delegatee has expertise and an established relationship with the delegator. If the delegatee has willingness and ability, but the relationship with the delegator is new, then the delegator's behavior is characterized as "participating." Which action in the delegation process represents accountability? 1 Providing open and honest feedback to the delegatee 2 Assisting other registered nurses with delegation decisions Correct3 Monitoring the client care given and determining outcomes 4 Assessing the ability of the delegatee and educating him or her about the task Monitoring client care and determining outcomes represents accountability of the task in case of conflicts. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions when there are safety issues, an urgent need to intervene, or potential negative client outcomes. Assessing the ability of the delegatee and educating him or her about the task indicates responsibility. The client is admitted to the medical unit with a diagnosis of pulmonary edema. The client care is assigned to the registered nurse (RN) by the charge nurse. The RN admits and provides a written plan and assigns the client to a licensed practical nurse. Which healthcare personnel is accountable and responsible for the client if there is development of any complications in the client? 1 Charge nurse 2 Associate nurse Correct3 Registered nurse 4 Licensed practical nurse The registered nurse is responsible and accountable for the client if complications develop. The registered nurse is responsible for the client because he or she delegated client care and wrote the care plan. The charge nurse may be accountable but may not be responsible since the charge nurse gets the task in the absence of the RN. The associate nurse is responsible for the client's condition if the primary nurse's written plan is implemented by the associate nurse. The licensed practical nurse (LPN) is not responsible because the LPN follows the written plan given by the RN. A delegator, working in collaboration with a delegatee, allots responsibilities and explains the various procedures and techniques needed to accomplish the task. Which action is the delegator performing, according to the Hersey model? 1 Guiding and directing 2 Observing or monitoring Correct3 Explaining and persuading 4 Encouraging or problem solving Hersey's model describes the leader's behavior as explaining or persuading, which is characterized as "selling." In this situation, the delegator is assigning the work to the delegatee and explaining the various procedures and techniques to accomplish the specified task. A leader's behavior described as guiding or directing is characterized as "telling," in which the delegate simply assigns the task to the delegatee. The leader's behavior of observing or monitoring is characterized as "delegating," in which the delegator is responsible and accountable for the entire task. A leader's behavior that is encouraging or problem solving is characterized as "participating," in which the delegator establishes a working environment in which to complete the task in the specified time. Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. Correct1 Is the prospective delegatee a willing and able employee? 2 Does the delegatee understand the directions and expected results of the task? 3 Does the delegatee understand how, what, and when to report to the delegator? 4 Is it clear that the delegatee will provide feedback related to the task when appropriate? Correct5 Does the delegatee have the knowledge and experience to perform the specific task safely? The right delegatee is chosen on the basis of the person's willingness