Chapter 19 Effective Delegation and Supervision

Chapter 19  Effective Delegation and Supervision

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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.
unlicensed assistive personnel (UAP).
d.
all levels of staff, because the information is about the past and cannot change.

ANS: A
Correct: Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.
Incorrect:
b. The assessment must be completed and signed by the RN; however, some components may be delegated to the LPN/LVN.
c. UAPs are not licensed, and only an RN can perform the initial assessment.
d. The assessment includes present symptoms and treatments, as well as those reported from the past, and the RN must complete the initial patient assessment.

DIF: Application REF: p. 353

2. 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
Correct: 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.
Incorrect:
a. Each state determines the scope of practice of the LPN/LVN.
b. Specific tasks and roles cannot be delegated except to another RN who has received the training required to perform the task or role.
d. 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.

DIF: Application REF: p. 350

3. 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
Correct: 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.
Incorrect:
b. 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.
c. Only an RN can develop the patient’s plan of care, although others may assist in updating information.
d. The task of teaching is limited to RNs.

DIF: Analysis REF: p. 354; Box 19-3

4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading?
a.
RN
b.
LPN/LVN
c.
Unlicensed assistive personnel (UAP)
d.
Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

ANS: A
Correct: The patient’s condition is not stable; therefore, the skills of an RN are required.
Incorrect:
b. The assessment expertise of an RN is needed because of the unstable nature of the patient’s condition.
c. Obtaining a baseline set of vital signs for an unstable patient would be considered high-risk delegation for a UAP.
d. 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.

DIF: Application REF: p. 354; Box 19-3