Prioritization & Delegation Practice Test #2: Delegation to AP and LPN

Answer: B. Walking in the hallway with a client 2 days after an uncomplicated appendectomy

Rationale: Helping a stable client walk after an uncomplicated surgery is routine, predictable, and within the AP's training. Checking an IV site for complications is an assessment. Feeding a client who had a new stroke and coughs with fluids carries a high aspiration risk and needs the nurse's judgment until a swallow evaluation sets a safe plan. Judging whether a medication worked is evaluation, which stays with the licensed nurse. Delegation rules vary by state nurse practice act and facility policy, but assessment, teaching, and evaluation are not delegated to the AP.

Answer: D. A client with a chronic leg ulcer who needs a scheduled dressing change and routine oral medications

Rationale: The LPN cares for clients whose condition is stable and whose outcome is predictable, using established procedures. A scheduled dressing change and routine oral medications for a chronic, stable wound fit that role. A new admission with diabetic ketoacidosis on an insulin infusion is unstable and needs frequent RN assessment. Initial teaching belongs to the RN; the LPN can reinforce teaching the RN has already done. A client 1 hour after a cardiac catheterization is in the early recovery period, when bleeding and circulation problems are most likely and RN assessment is needed. The exact LPN scope varies by state.

Answer: A. “Take Mr. Lee’s blood pressure and pulse at 1400. Tell me right away if his systolic pressure is below 100 or his pulse is above 110.”

Rationale: Right communication means a clear, specific instruction: which client, what to do, when to do it, and exactly what to report and when. The values in this instruction are limits the RN sets for this particular client based on the assessment; they are not universal cutoffs. The other choices are vague, give no time frame, or let a change go unreported until the end of the shift, when it may be too late to act.

Answer: C. Go to the client’s room and assess the client now

Rationale: A rising respiratory rate with a new change in mental status can signal worsening hypoxia or sepsis. This is a change in condition, so the client is no longer stable and the RN must assess personally and act. The AP collects and reports data; interpreting it and deciding what to do is the nurse’s job. Waiting, delegating more care, or holding the information until rounds delays treatment.

Answer: A. Reinforcing foot care teaching for a client with diabetes whom the RN has already taught

Rationale: Reinforcing teaching the RN has already done is within the LPN’s role but outside the AP’s. Writing the plan of care and doing the initial admission assessment stay with the RN. A bed bath for a stable client can be delegated to the AP, so it does not fit the question. Always check the state nurse practice act and facility job descriptions for the exact scope.

Answer: D. Assessing the skin of a client who has a new stage 2 pressure injury

Rationale: Assessing a new pressure injury requires nursing judgment to stage the wound, describe it, and plan care, so it stays with the licensed nurse. The AP can measure intake and output, obtain a daily weight, and collect a routine specimen, then report the results. The RN reviews those results and acts on them.

Answer: B. Check with the AP and evaluate how the client tolerated the walk

Rationale: Right supervision and evaluation means the RN follows up after delegating: asking the AP how the task went, checking the client’s response, and stepping in if needed. The task can be delegated, but responsibility for the client stays with the RN. Assuming, documenting care the RN has not confirmed, or passing follow-up to another AP leaves gaps in safety.

Answer: C. “I will check this one myself, and I will arrange for you to be trained and checked off on the meter.”

Rationale: The right person to do a task is someone whose training and competency have been checked. When the AP says they have not been trained, the RN should not delegate the task. The RN does it or gives it to someone who is competent, and arranges training and competency validation according to facility policy. Telling the AP to figure it out or reviewing only the result does not protect the client. Whether an AP may check blood glucose at all depends on state rules and facility policy.

Answer: D. Doing the admission assessment and writing the care plan for a client transferred from the intensive care unit

Rationale: A client just transferred from the intensive care unit needs an RN admission assessment and an RN-developed plan of care. The LPN can collect data and contribute to the plan, but the full assessment and the care plan stay with the RN. Scheduled oral medications for stable clients, specimen collection, and monitoring a stable client and reporting changes are appropriate for the LPN.

Answer: A. A client 2 hours after a thoracentesis whose respiratory rate has gone from 18/min to 30/min and who says they feel short of breath

Rationale: New shortness of breath with a sharp rise in respiratory rate after a thoracentesis can signal a pneumothorax, a breathing problem that needs RN assessment right away. A small weight change, a glucose near the client’s recent readings, and moderate pain that is due for scheduled medication all need follow-up but are not immediately life-threatening. The AP’s job is to report; the RN decides who needs to be seen first.