Paper Writing Service http://StudyHub.vip/20140910-RN-LPN-Delegation-Discussion-O 👈

1. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
NUR 265 Integrated Clinical I, LPN to BSN September 10, 2014
Nursing Delegation
Chengyi Wang, BSN, RN.
Lourdes University
Learning Objectives
Through explanation of the Ohio Administrative Code and American Nurses Association’s
principle of delegation, students will develop basic understanding of different responsibilities
of RN and LPN, and able to apply delegation principles in the practice scenarios.
Learning Outcomes:
After participating in the discussion and quiz activity, students will be:
1. Define delegation.
2. Describe the responsibilities of RNs and LPNs in nursing process and delegation.
3. Identify different levels of nursing tasks.
4. Become familiar with NCLEX exam type of questions and develop confidence.

2. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
Introduction
What is delegation?
American Nurses Association (ANA) defines delegation as “the transfer of responsibility for
the performance of an activity from one person to another while retaining accountability for
the outcomes.”
National Council of State Boards of Nursing (NCBSN) defines delegation as “transferring to a
competent individual the authority to perform a selected nursing task in a selected situation,
and the nurse retains accountability for the delegation.”
Ohio Board of Nursing defines delegation as “the transfer of responsibility for the
performance of a selected nursing task from a licensed nurse authorized to perform the task to
an individual who does not otherwise have the authority to perform the task.”
Who performs delegation and receive delegation?
Ohio Administrative Code 4723-4-06(D) explains that licensed nurses may delegate nursing
tasks to dialysis technicians, community health workers, certified medication aids, licensed
nurses, and unlicensed person if the tasks are with their scope of practice.
What is ANA “Five Rights of Delegation”?
Right Task: appropriate activities, predictable results, and minimal potential risk.
Right Circumstances: patients’ health status, staffing, available equipment, supplies.
Right Person: competent assigned staff operates under State’s scope of practice
Right Directions and Communication: oral/written instruction of specific activities, expected
outcomes and potential complications.
Right Supervision and Evaluation: proper authority to monitor outcomes and intervene as
necessary, provides feedback, and ensures clear documentation.
What cannot be delegated to other licensed nurses?
Nursing Process; some elements within the process may be delegated with delegator’s
supervision if such elements are with delegate’ scope of practice.

3. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
Ohio Administrative Code 4723-4-06(O) includes this description: Only a registered nurse
shall supervise or evaluate the practice of nursing performed by other registered nurses and
licensed practical nurses.
Both RNs and LPNs use nursing process, what is the difference in Ohio?
RNs apply the nursing process, and LPNs contribute to the nursing process.
Nursing process LPN RN
Assessment Collect, document, report Collect and document
Diagnosis Not applicable Analyze and interpret the data;
Establish a nursing diagnosis;
Report to interdisciplinary team
Planning Communicate to others Develop nursing plan of diagnosis,
patient outcomes, interventions;
Communicate to interdisciplinary team
Intervention Provide interventions;
Collect and report data;
Administer medications;
Perform treatments;
Provide basic nursing care;
Collaborate and delegate
Execute nursing regimen;
Implement current valid orders;
Provide education, knowledge, skills,
and abilities;
Assist and collaborate with others;
Delegate
Evaluation Document and communicate Evaluate, document, report;
Re-assess, establish or modify care plan
Data to collect; Information to analyze; Knowledge to apply; Wisdom to verify.
What patient care activities may be delegated?
Direct Patient Care Activities
Vital Signs: BP, Respiration rate, Temperature, Pulse, Daily weight, cardiac monitor,
12-lead ECG, Chest compression during CPR.
Intake and Output: collect specimens; measure and record I/O

4. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
Activities of Daily Living: Bed bath, Perineal care, Shave, Hair washing, Mouth care,
Change linen and make beds.
Nutrition: Feed the patients; calculate and record calories intake.
Skin Care: Perform skin prep for operative procedure; Prepare skin for testing
procedures; back care.
Activity and Mobility: Assist position, turning, transfer, AROM/PROM and
ambulation
Respiratory Support: Set up equipment; Assist patient use incentive spirometer; Assist
patient with coughing and deep breathing exercises; Perform oral suctioning using an
oral suction device
Procedures: Set up patient room and calibrate hemodynamic monitoring equipment;
Obtain supplies procedure; Orient patient to room; Discontinue peripheral intravenous
catheter; Perform postmortem care
Indirect Patient Care Activities
Cleaning
Errands
Obtain and deliver blood products
Clerical Tasks
What patient care activities may not be delegated?
Nursing activities that may not be delegated include:
o Performing an initial patient assessment and subsequent assessments or nursing
interventions that require specialized nursing knowledge, judgment, and/or skill
o Formulating a nursing diagnosis
o Identifying nursing care goals and developing the nursing plan of care in
conjunction with the patient and/or family
o Updating the patients plan of care
o Providing patient education to patient and/or family
o Evaluating a patient’s progress, or lack thereof, toward achieving desired goals
and outcomes
o Discussing patient issues with physician

5. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
o Communicating with physicians or implementing orders from physician
o Documenting the patients assessment, response to therapeutic interventions, in the
patient’s plan of care
o Administering medications
o Providing direct nursing care
How is delegation skill related to NCLEX-RN exam?
National Council of State Boards of Nursing (NCSBN) develops exams to verify entry-level
nurses’ competency and ability to provide safe care to the public. Since delegation is an
important skill to nurses, NCLEX-RN exam includes delegation questions in the “Safe and
Effective Care Environment” test section. It is necessary to learn delegation skills to become a
competent RN, and to pass the exam.

6. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
Practice Quiz
The following multiple-choice questions were selected from NCLEX exam prep book, focusing on
nursing delegation; some of the questions might have multiple correct responses.
1. You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP?
A. Assisting the patient with oral hygiene
B. Observing the patient's response to feedings
C. Facilitating expression of grief or anxiety
D. Initiating daily weighing
2. As the nurse manager in a public health department, you are implementing a plan to reduce
the incidence of infection with human immunodeficiency virus (HIV) in the community.
Which nursing action will you delegate to health assistants working for the agency?
A. Supplying injection drug users with sterile injection equipment such as needles and
syringes
B. Interviewing patients about behaviors that indicate a need for annual HIV testing
C. Teaching high-risk community members about the use of condoms in preventing HIV
infection
D. Assessing the community to determine which population groups to target for education
3. The client's nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which
action related to fluid management should be delegated to a UAP?
A. Administering IV fluids as prescribed by the physician
B. Providing straws and offering fluids between meals
C. Developing a plan for added fluid intake over 24 hours
D. Teaching family members to assist the client with fluid intake
4. After a client has a seizure, which action can you delegate to the UAP?
A. Documenting the seizure
B. Performing neurologic checks
C. Taking the client's vital signs
D. Restraining the client for protection
5. These activities are included in the care plan for a 78-year-old patient admitted to the hospital
with anemia caused by possible gastrointestinal bleeding. Which activity can you delegate to
an experienced UAP?
A. Obtaining stool specimens for fecal blood test slides
B. Having the patient sign a colonoscopy consent form

7. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
C. Giving the prescribed polyethylene glycol electrolyte solution
D. Checking for allergies to contrast dye or shellfish
6. You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing
interventions apply to the nursing diagnosis Risk for Falls. Which intervention should you
delegate to the UAP?
A. Identifying environmental factors that increase risk for falls
B. Monitoring gait, balance, and fatigue level with ambulation
C. Collaborating with the physical therapist (PT) to provide the patient with a walker
D. Assisting the patient with ambulation to the bathroom and in the halls
7. When a client is being prepared for a colonoscopy procedure, which task is most suitable to
delegate to the UAP?
A. Explaining the need for a clear liquid diet 1 to 3 days before the procedure
B. Reinforcing "nothing by mouth" status 8 hours before the procedure
C. Administering laxatives 1 to 3 days before the procedure
D. Administering an enema the night before the procedure
8. A patient has newly-diagnosed type 2 diabetes. Which task should you delegate to a UAP?
A. Arranging a consult with the dietitian
B. Assessing the patient's insulin injection technique
C. Teaching the patient to use a glucometer to monitor glucose at home
D. Reminding the patient to check glucose level before each meal
9. The plan of care for a diabetic patient includes all of these interventions. Which intervention
should you delegate to a UAP?
A. Checking to make sure that the patient's bath water is not too hot
B. Discussing community resources for diabetic outpatient care
C. Teaching the patient to perform daily foot inspection
D. Assessing the patient's technique for drawing insulin into a syringe
10. For a patient with hyperthyroidism, which task will you delegate to an experienced UAP?
A. Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or
chest pain
B. Monitoring the apical pulse, blood pressure, and temperature every 4 hours
C. Drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine,
and thyroxine
D. Teaching the patient about side effects of the drug propylthiouracil

8. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
11. A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you
delegate to a UAP?
A. Reminding the patient to change positions slowly
B. Assessing the patient for muscle weakness
C. Teaching the patient how to collect a 24-hour urine sample
D. Revising the patient's nursing plan of care
12. You are providing nursing care for a 24-year-old female patient admitted to the unit with a
diagnosis of cystitis. Which intervention should you delegate to the UAP?
A. Teaching the patient how to secure a clean-catch urine sample
B. Assessing the patient's urine for color, odor, and sediment
C. Reviewing the nursing care plan and add nursing interventions
D. Providing the patient with a clean-catch urine sample container
13. You are working with a UAP to care for a client who has had a right breast lumpectomy and
axillary lymph node dissection. Which nursing action can you delegate to the UAP?
A. Teaching the client why blood pressure measurements are taken on the left arm
B. Elevating the client's arm on two pillows to promote lymphatic drainage
C. Assessing the client's right arm for lymphedema
D. Reinforcing the dressing if it becomes saturated
14. You are assigned to provide nursing care for a patient receiving mechanical ventilation.
Which action should you delegate to an experienced nursing assistant?
A. Assessing the patient's respiratory status every 4 hours
B. Taking vital signs and pulse oximetry readings every 4 hours
C. Checking the ventilator settings to make sure they are as prescribed
D. Observing whether the patient's tube needs suctioning every 2 hours
15. Which task could be appropriately assigned to the UAP working with you at the obstetric
clinic?
A. Checking the blood pressure of a patient who is 36 weeks pregnant and reports a
headache
B. Removing the adhesive skin closure strips of a patient who had a cesarean section 2
weeks ago
C. Giving community resource information and emergency numbers to a prenatal patient
whom you suspect is experiencing domestic violence
D. Dispensing a breast pump with instruction to a lactating patient having trouble with
milk supply 4 weeks postpartum

9. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
16. When care assignments are being made for patients with alterations related to gastrointestinal
cancer, which patient would be the most appropriate to assign to an LPN/ LVN under the
supervision of a team leader RN?
A. A patient with severe anemia secondary to GI bleeding
B. A patient who needs enemas and antibiotics to control GI bacteria
C. A patient who needs preoperative teaching for bowel resection surgery
D. A patient who needs central line insertion for chemotherapy
17. You are preparing to admit a client with a seizure disorder. Which actions can you delegate to
an LPN/ LVN?
A. Completing the admission assessment
B. Setting up oxygen and suction equipment
C. Placing a padded tongue blade at the bedside
D. Padding the side rails before the client arrives
18. After undergoing a modified radical mastectomy, a client is transferred to the post-anesthesia
care unit (PACU). Which nursing action is best to delegate to an experienced LPN/ LVN?
A. Monitoring the client's dressing for any signs of bleeding
B. Documenting the initial assessment on the client's chart
C. Communicating the client's status report to the charge nurse on the surgical unit
D. Teaching the client about the importance of using pain medication as needed
19. The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an
appropriate action to delegate to the experienced LPN under your supervision?
A. Observe how well the patient performs pursed-lip breathing
B. Plan a nursing care regiment that gradually increases activity intolerance
C. Assist the patient with basic activities of daily living
D. Consult with the physical therapy department about reconditioning exercises
20. Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on
your patient care team?
A. Evaluating the patient's complaint of chest pain
B. Monitoring laboratory values for changes in oxygenation
C. Assessing for symptoms of respiratory failure
D. Auscultating the lungs for crackles
21. You are caring for a client who has just had a squamous cell carcinoma removed from the face.
Which activity can you delegate to an experienced LPN/ LVN?
A. Teaching the client about risk factors for squamous cell carcinoma
B. Showing the client how to care for the surgical site at home

10. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
C. Monitoring the surgical site for swelling, bleeding, or pain
D. Discussing the reasons for avoiding aspirin use for a week after surgery
22. You are employed as the charge nurse in a long-term care (LTC) facility that employs RNs,
LPNs/ LVNs, and UAPs. When you are planning care for a resident with a stage III sacral
pressure ulcer, which nursing intervention is best to delegate to an LPN/ LVN?
A. Choosing the type of dressing to be used on the ulcer
B. Using the Norton scale to assess for pressure ulcer risk factors
C. Assisting the client in changing position at frequent intervals
D. Cleaning and changing the dressing on the ulcer every morning
23. The nursing care plan for the client with dehydration includes interventions for oral health.
Which interventions are within the scope of practice for an LPN/ LVN being supervised by a
nurse? (Select all that apply.)
A. Reminding the client to avoid commercial mouthwashes
B. Encouraging mouth rinsing with warm saline
C. Observing the lips, tongue, and mucous membranes
D. Providing mouth care every 2 hours while the client is awake
E. Seeking a dietary consult to increase fluids on meal trays
24. An experienced LPN/ LVN, under the supervision of the team leader RN, is providing nursing
care for a patient with a respiratory problem. Which actions are appropriate to the scope of
practice of an experienced LPN/ LVN? (Select all that apply.)
A. Auscultating breath sounds
B. Administering medications via metered-dose inhaler (MDI)
C. Completing in-depth admission assessment
D. Checking oxygen saturation using pulse oximetry
E. Developing the nursing care plan
F. Evaluating the patient's technique for using MDIs
25. The health care provider prescribes these actions for a client who was admitted with acute
sub-sternal chest pain. Which actions are appropriate to delegate to an experienced LPN/ LVN
who is working with you in the ED? (Select all that apply.)
A. Attaching cardiac monitor leads
B. Giving heparin 5000 units IV push
C. Administering morphine sulfate 4 mg IV
D. Obtaining a 12-lead electrocardiogram (ECG)
E. Asking the client about pertinent medical history
F. Having the client chew and swallow aspirin 162 mg

11. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
26. Which tasks are appropriate to delegate to an LPN/ LVN who is functioning under the
supervision of an RN? (Select all that apply.)
A. Assessing the sexual implications for a client with oculogenital-type Chlamydia
trachomatis infection
B. Administering sulfacetamide sodium 10% (Sulf-10 Ophthalmic) to a child with
conjunctivitis
C. Reviewing hand-washing and hygiene practices with clients who have eye infections
D. Showing clients how to gently cleanse eyelid margins to remove crusting
E. Assessing nutritional factors for a client with age-related macular degeneration
F. Reviewing the health history of a client to identify risk for ocular manifestations
G. Performing a routine check of a client's visual acuity using the Snellen eye chart
27. Which pediatric pain patient should be assigned to a newly-graduated RN?
A. Adolescent who has sickle cell disease and was recently weaned from morphine
delivered via a patient-controlled analgesia device to an oral analgesic; he has been
continually asking for an increased dose
B. Child who needs premedication before reduction of a fracture; the child has been
crying and is resistant to any touch to the arm or other procedures
C. Child who is receiving palliative end-of-life care; the child is receiving narcotics
around the clock to relieve suffering, but there is a progressive decrease in alertness
and responsiveness
D. Child who has chronic pain and whose medication and nonpharmacologic regimen has
recently been changed; the mother is anxious to see if the new regimen is successful
28. The charge nurse is making assignments for the next shift. Which patient should be assigned
to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit?
A. A 58-year old on airborne precautions for tuberculosis (TB)
B. A 68-year old just returned from bronchoscopy and biopsy
C. A 72-year old who needs teaching about the use of incentive spirometry
D. A 69-year old with COPD who is ventilator dependent
29. You are supervising an RN who floated from the medical-surgical unit to the emergency
department. The nurse is providing care for a patient admitted with anterior epistaxis
(nosebleed). Which directions would you clearly provide to the RN? (Select all that apply.)
A. Position the patient supine and turned on his side.
B. Apply direct lateral pressure to the nose for 5 minutes.
C. Maintain standard body substance precautions.
D. Apply ice or cool compresses to the nose.
E. Instruct the patient not to blow the nose for several hours.

12. Lourdes University NUR 265 Nursing Delegation Discussion CHENGYI WANG
30. You are acting as preceptor for a newly graduated RN during her second week of orientation.
You would assign the new RN under your supervision to provide care to which patients?
(Select all that apply)
A. A 38-year old with moderate persistent asthma awaiting discharge
B. A 63-year old with a tracheostomy needing tracheostomy care every shift.
C. A 56-year old with lung cancer who has just undergone left lower lobectomy
D. A 49-year old just admitted with a new diagnosis of esophageal cancer.
Reference
Ohio Administrative Code 4723, Chapter 4, Standards of Practice Relative to Registered Nurse or
Licensed Practical Nurse. Retrieved from http://codes.ohio.gov/oac/4723-4.
American Nurses Association. (2006). Principles for Delegation. Retrieved from
https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf.
American Association of Critical-Care Nurses. (2004). AACN Delegation Handbook, 2/e. Retrieved
from http://www.aacn.org/wd/practice/docs/aacndelegationhandbook.pdf.
LaCharity, L. A.; Kumagai, C. K.;& Bartz, B. (2013). Prioritization, Delegation, and Assignment
Practice Exercises for the NCLEXExamination. Elsevier Health Sciences