Delegation And Assignment - NCLEX Rn

1. On an acute care unit, an RN is delegating to an LPN and a UAP. A 52-year-old client is 6 hours postoperative after an uncomplicated appendectomy and is stable; the client has a new order to advance diet as tolerated. Which delegation decision by the RN requires reconsideration?
   Answer: Ask the UAP to assess bowel sounds and decide whether the diet can be advanced This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, prohibiting UAPs from performing assessments or making clinical decisions. The correct answer, asking the UAP to assess bowel sounds and decide on diet advancement, requires reconsideration because assessment and judgment are RN responsibilities. The distractors represent common delegation errors by being appropriate: UAPs can assist with positioning and report symptoms; LPNs can administer oral analgesics; and LPNs can monitor dressings. Effective delegation postoperatively ensures tasks align with recovery protocols. RNs must verify readiness for advancements like diet. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
2. In a long-term care facility, the RN is supervising an LPN and a UAP while caring for multiple residents. Which delegation decision by the RN requires reconsideration for an 82-year-old resident with diabetes who reports new numbness and a small blister on the right foot?
   Answer: Assign the UAP to perform a full foot assessment and apply a dressing to the blister This question tests delegation and assignment principles by identifying inappropriate delegation decisions. The key principle is recognizing tasks that exceed the UAP's scope of practice. Assigning the UAP to perform a full foot assessment and apply a dressing (option C) requires reconsideration because assessment is a nursing function that cannot be delegated to UAPs, and wound care requires nursing judgment. Options A (obtaining vital signs) and B (LPN administering oral medications) are appropriate delegations within their respective scopes, while option D represents appropriate RN prioritization but not a delegation error. The decision-making principle is that assessment, evaluation, and tasks requiring nursing judgment cannot be delegated to UAPs, especially for high-risk clients like those with diabetes and potential complications. When supervising delegation, always verify that the task matches the team member's education, training, and legal scope of practice, particularly avoiding delegation of assessment to unlicensed personnel.
3. In a long-term care facility, an RN supervises an LPN and a UAP. A 90-year-old resident has a stage 2 pressure injury on the coccyx with a prescribed dressing change. The RN should assign which task to the LPN?
   Answer: Change the prescribed dressing and document the wound appearance, reporting any concerns to the RN This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating stable wound care to LPNs. The correct answer, changing the dressing and documenting while reporting concerns, properly applies delegation principles as LPNs are trained for routine wound procedures. The distractors represent common delegation errors: initial assessments and determinations are RN responsibilities; debridement requires advanced skills; and developing plans is RN-led. Effective delegation in wound care relies on clear reporting protocols. RNs should oversee and evaluate healing progress. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
4. In a community health immunization clinic, an RN is working with an LPN and a UAP. A 28-year-old client is scheduled for an influenza vaccine and reports no current illness. Which delegation decision by the RN requires reconsideration?
   Answer: Ask the UAP to administer the intramuscular influenza vaccine because the client is healthy This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, prohibiting UAPs from administering vaccines. The correct answer, asking the UAP to administer the vaccine, requires reconsideration because vaccine administration is a licensed skill for LPNs or RNs. The other decisions are appropriate: a UAP can hand out the vaccine information statement, an LPN can give the vaccine once screening is complete, and the RN keeps the assessment of allergies and contraindications. Effective delegation in clinics follows immunization protocols. RNs must ensure competency and oversight. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
5. On an acute care unit, the RN is caring for four clients with assistance from an LPN and a UAP. The RN is planning assignments. The RN should assign which task to the LPN for a 60-year-old client with pneumonia who is improving and has stable vital signs?
   Answer: Administer prescribed oral antibiotics and evaluate the client for expected side effects Assign the LPN the task that fits LPN scope for a stable, improving client. Administering prescribed oral antibiotics and evaluating the client for expected side effects is within LPN scope: LPNs can give oral medications and watch for common, anticipated responses under RN supervision. Completing the initial admission assessment and creating the comprehensive plan of care requires the RN's comprehensive assessment and care-planning authority. Providing initial teaching on incentive spirometry technique and goals for pneumonia recovery is also an RN responsibility; an LPN may reinforce teaching, not initiate it. Interpreting arterial blood gas results and notifying the provider of deterioration in respiratory status requires interpreting diagnostic data and determining clinical significance, which is beyond LPN scope. Therefore, the assignment that matches LPN scope for this client is administering the oral antibiotics and monitoring for expected side effects.
6. On a medical-surgical unit, an RN is delegating care to an LPN and a UAP. A 58-year-old client with a urinary tract infection is stable and has an order for a midstream clean-catch urine specimen. Which task can the RN delegate to the UAP?
   Answer: Instruct the client on clean-catch technique and collect the specimen per policy This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating specimen collection instructions to UAPs for stable clients. The correct answer, instructing on clean-catch technique and collecting the specimen, properly applies delegation principles as it involves routine procedural guidance within UAP scope. The distractors represent common delegation errors: interpreting results and changing treatments is RN judgment; assessing for progression requires RN skills; and administering antibiotics with monitoring is for RNs or LPNs. Effective delegation for infections ensures accurate collection. RNs must verify results and plan accordingly. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
7. In an acute care unit, an RN is supervising an LPN and a UAP. A 56-year-old client with type 2 diabetes is stable and has a new order for pre-meal capillary blood glucose checks and sliding-scale insulin. Which delegation decision by the RN requires reconsideration?
   Answer: Assign the UAP to teach the client how to recognize signs of hypoglycemia This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, avoiding delegation of teaching to UAPs. The correct answer, assigning the UAP to teach signs of hypoglycemia, requires reconsideration because teaching is outside UAP scope and requires clinical knowledge. The distractors represent common delegation errors by being appropriate: UAPs can obtain blood glucose if trained; LPNs can administer insulin per protocol; and RNs should verify high-risk medications like insulin. Effective delegation for diabetes management prioritizes education by qualified staff. RNs must oversee protocols and correct improper assignments. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
8. In a long-term care facility, the RN is assigning tasks to an LPN and a UAP for multiple residents. Which delegation decision by the RN requires reconsideration for a 79-year-old resident with a new onset of confusion and a temperature of $38.3^\circ\text{C} (101^\circ\text{F})$?
   Answer: Assign the LPN to perform the initial focused assessment of the change in mental status This question tests delegation and assignment principles by identifying inappropriate delegation for a client with acute changes. The key principle is recognizing that new onset confusion with fever indicates a potentially serious condition requiring nursing assessment. Assigning the LPN to perform the initial focused assessment (option D) requires reconsideration because initial assessment of acute changes, especially involving mental status changes, must be performed by the RN to establish baseline and determine urgency. Options A (UAP rechecking temperature), B (LPN administering scheduled medications), and C (UAP encouraging fluids) are all within their respective scopes but don't address the priority need for RN assessment. The decision-making principle is that initial assessment of acute changes, particularly involving mental status, requires RN-level clinical judgment and cannot be delegated to LPNs. When a resident experiences acute changes, the RN must perform the initial assessment before determining appropriate delegation of follow-up tasks.
9. On a medical-surgical unit, an RN is caring for four clients with an LPN and a UAP. A 64-year-old client with pneumonia is improving and needs incentive spirometry coaching every hour while awake. The RN should assign which task to the LPN?
   Answer: Reinforce teaching and coach the client on correct use of the incentive spirometer The RN must decide which task fits the LPN's scope. LPNs can reinforce teaching that an RN has already initiated and can coach a stable client in correct skill performance, so reinforcing teaching and coaching the client on correct use of the incentive spirometer is the appropriate delegation. The other options involve RN-only functions: developing the plan of care and setting respiratory goals requires the RN's care-planning authority; interpreting arterial blood gas results and notifying the provider of oxygenation trends requires RN analysis and clinical judgment; and performing the initial respiratory assessment and establishing baseline findings is the RN's responsibility before delegation. Although the LPN may assist with aspects of monitoring and reinforcement, these tasks require assessment, interpretation, and planning that cannot be delegated.
10. On a medical-surgical unit, an RN is caring for clients with an LPN and a UAP. A 66-year-old client has a peripheral intravenous catheter with maintenance fluids and reports pain and swelling at the site. Which client care task requires RN intervention?
    Answer: Assess the intravenous site for infiltration or phlebitis and take appropriate action per policy This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person while requiring RN intervention for IV complications. The correct answer, assessing the IV site for infiltration or phlebitis, requires RN intervention because it involves clinical judgment and potential actions like discontinuation. The distractors represent common delegation errors: UAPs should not apply treatments without assessment; LPNs can document but not assess; and UAPs can obtain vital signs. Effective delegation for IV care prioritizes RN evaluation of issues. RNs must act to prevent further complications. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
11. In the emergency department, the RN is supervising an LPN and a UAP. Which task can the RN delegate to the UAP for a 30-year-old client with nausea and vomiting who is alert, ambulatory, and awaiting laboratory results?
    Answer: Collect a clean-catch urine specimen after providing instructions and label it per policy The task that fits UAP scope is collecting a clean-catch urine specimen after receiving simple instructions and labeling it per policy. UAPs can perform routine specimen collection and standard labeling. Starting a peripheral IV and beginning a fluid bolus is an invasive, IV-therapy procedure that licensed personnel must perform. Assessing the client for dehydration and determining severity is a nursing assessment that requires clinical judgment, not a task that can be delegated to a UAP. Administering an IV antiemetic is medication administration outside UAP scope, and reassessing the client is also an assessment requiring a licensed nurse. When delegating in the emergency department, assign UAPs to specimen collection, vital signs, and comfort measures; keep invasive procedures, medication administration, and assessments with licensed staff.
12. In the emergency department, an RN is working with an LPN and a UAP. A 67-year-old client with chest discomfort is moved to a monitored bed and appears pale and diaphoretic. Which delegation decision by the RN requires reconsideration?
    Answer: Assign the UAP to obtain a 12-lead electrocardiogram because it is a routine procedure This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, avoiding delegation of specialized procedures like ECGs to UAPs. The correct answer, assigning the UAP to obtain a 12-lead ECG, requires reconsideration because ECGs require trained personnel like technicians or LPNs. The distractors represent common delegation errors by being appropriate: UAPs can obtain vital signs; LPNs can apply monitoring; and RNs perform assessments. Effective delegation in cardiac emergencies prioritizes rapid, skilled responses. RNs must coordinate urgent care. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
13. In a long-term care facility, an RN oversees an LPN and a UAP. An 83-year-old resident with dementia is ambulatory but has a high fall risk and needs toileting every 2 hours. Which task can the RN delegate to the UAP?
    Answer: Implement the toileting schedule and assist the resident to the bathroom using prescribed safety measures. Delegation to a UAP is appropriate for routine, low-risk tasks that follow an established plan without requiring independent nursing judgment. Implementing the toileting schedule and assisting the resident to the bathroom with prescribed safety measures is exactly that kind of task: the UAP follows the schedule and safety measures already set for the resident. The option about assessing the resident's gait changes and updating the fall prevention plan cannot be delegated because interpreting findings and revising the care plan require the RN's clinical judgment. The option about evaluating a newly started sedative medication cannot be delegated because UAPs cannot independently judge whether a medication is effective; that is an RN responsibility. The option about teaching the family strategies to reduce agitation and wandering also cannot be delegated because patient and family education requires the RN's assessment of learning needs and licensed nursing judgment. The correct delegation is the uroap activity that can be done safely under clear direction and supervision.
14. In the emergency department, an RN is working with an LPN and a UAP. A 30-year-old client arrives with vomiting and diarrhea for 24 hours and appears mildly dehydrated; vital signs are stable. Which situation requires RN follow-up?
    Answer: The UAP obtains orthostatic vital signs and reports lightheadedness upon standing This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person while ensuring RN intervention for signs of instability like orthostatic changes. The correct answer is the UAP's report of lightheadedness on standing: obtaining orthostatic vital signs is an appropriate UAP task, but the finding needs RN follow-up to assess for worsening dehydration. The distractors represent common delegation errors by being appropriate: LPNs can administer oral antiemetics; UAPs can provide basins and measure output; and LPNs can start IVs if competent per policy. Effective delegation in emergencies prioritizes RN oversight for assessment findings. RNs must act on reports to guide further care. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
15. In a community health setting, an RN is coordinating care with an LPN and a UAP for an older adult. A 74-year-old client with newly diagnosed hypertension needs education on home blood pressure monitoring. The RN should assign which task to the LPN?
    Answer: Reinforce instructions on how to use the home blood pressure cuff and document return demonstration The correct delegation assigns the LPN to reinforce blood pressure cuff technique and document the client's return demonstration. LPNs can reinforce previously taught skills, but they cannot provide initial comprehensive teaching, which requires RN knowledge of pathophysiology and complications. Similarly, assessing for target-organ damage requires advanced assessment and judgment, an RN responsibility, and developing an individualized care plan is an RN leadership function. The RN must retain tasks that involve assessment, planning, and evaluation. By choosing the task that falls within LPN scope, you apply the right task and right person principles of delegation.
16. On a medical-surgical unit, an RN is working with an LPN and a UAP. A 60-year-old client with heart failure is stable and has a daily weight order. Which task can the RN delegate to the UAP?
    Answer: Obtain the client's weight using the same scale and time each morning and report significant changes This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating routine monitoring like weights to UAPs for stable clients. The correct answer, obtaining daily weights consistently and reporting changes, properly applies delegation principles because it involves standardized measurement and reporting within UAP scope. The distractors represent common delegation errors: assessing crackles and holding medications requires RN judgment; teaching restrictions is an RN or LPN role; and titrating oxygen involves RN assessment. Effective delegation in heart failure management ensures accurate data collection. RNs must interpret trends and adjust care. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
17. During a high-volume shift in the emergency department, the RN is working with an LPN and a UAP. Which task should the RN assign to the LPN for a 45-year-old client with a simple laceration to the forearm after the provider has completed suturing and the client is stable?
    Answer: Apply a sterile dressing to the sutured wound and document the dressing change This question tests delegation and assignment principles in the emergency department setting. The key principle is identifying tasks within the LPN's scope of practice for a stable client with completed treatment. Applying a sterile dressing and documenting the change (option C) is correct because LPNs can perform sterile procedures and documentation under RN supervision for stable clients. Option A (discharge teaching) requires comprehensive assessment and evaluation skills reserved for RNs, option B (initial triage assessment) involves complex decision-making and prioritization that requires RN judgment, and option D (interpreting ECGs) requires advanced assessment and critical thinking beyond LPN scope. The decision-making principle is that LPNs can perform technical skills and routine procedures on stable clients but cannot perform initial assessments, complex teaching, or interpretation of diagnostic results. When assigning tasks to LPNs, focus on technical skills, medication administration (except IV push), and routine care for stable clients while reserving assessment, teaching, and evaluation for the RN.
18. In an acute care medical-surgical unit, an RN is caring for four clients with the help of one licensed practical nurse (LPN) and one unlicensed assistive personnel (UAP). One client is a 68-year-old with chronic obstructive pulmonary disease who is stable on 2 L/min nasal cannula and needs assistance with morning hygiene. Which task can the RN delegate to the UAP?
    Answer: Assist the client with a bed bath and oral care while monitoring for shortness of breath This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, ensuring tasks match the UAP's scope of practice for stable clients with predictable needs. The correct answer, assisting with a bed bath and oral care while monitoring for shortness of breath, properly applies delegation principles because it involves routine hygiene assistance and observation of obvious signs, which UAPs are trained to perform and report. The distractors represent common delegation errors: teaching pursed-lip breathing requires educational skills beyond UAP scope; assessing lung sounds and adjusting oxygen involves clinical judgment reserved for RNs; and administering bronchodilators is a medication task typically for LPNs or RNs. Effective delegation involves evaluating the client's stability and the task's complexity before assigning. RNs must supervise and follow up on delegated tasks to ensure safety. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.
19. In a long-term care facility, an RN is supervising an LPN and a UAP during the morning medication pass. A 79-year-old resident with hypertension is stable and has a new prescription for an oral antihypertensive started yesterday. Which client care task requires RN intervention?
    Answer: The UAP reports the resident feels dizzy when standing and has a blood pressure of 88/54 mm Hg The LPN reinforcing prior teaching about changing positions slowly is a follow-up task within the LPN's scope, so the RN does not need to intervene. The LPN administering scheduled oral medications to residents whose conditions are unchanged is also a routine medication pass within LPN scope. The UAP recording a resident's intake and output is a standard UAP assignment. None of these actions presents a new, unstable condition requiring the RN's judgment. The UAP reporting that the resident feels dizzy when standing and has a blood pressure of 88/54 mm Hg is the task that calls for RN action. This resident has just started an oral antihypertensive; dizziness on standing and that low a blood pressure suggest orthostatic hypotension or a possible adverse drug effect. The RN must assess the resident, evaluate the medication, and decide whether to hold it or notify the provider.
20. On an acute care telemetry unit, an RN is delegating tasks to an LPN and a UAP. A 72-year-old client is 1 day postoperative after a hip replacement and is stable; the client needs assistance ambulating to the chair with a gait belt. Which task can the RN delegate to the UAP?
    Answer: Assist the client to the chair using a gait belt and report any dizziness or increased pain This question tests delegation and assignment principles. The key delegation principle is assigning the right task to the right person, delegating routine mobility assistance to UAPs for stable postoperative clients. The correct answer, assisting to the chair using a gait belt and reporting dizziness or pain, properly applies delegation principles as it involves basic ambulation support and observation within UAP scope. The distractors represent common delegation errors: evaluating pain and requesting medication changes requires RN judgment; performing neurovascular assessments is an RN responsibility; and administering IV opioids is typically for RNs due to monitoring needs. Effective delegation considers the client's postoperative status and task predictability. RNs should provide clear instructions and require immediate reporting of changes. A transferable strategy for safe delegation is to use the five rights of delegation: right task, right circumstances, right person, right direction, and right supervision.

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