A charge nurse is assigning client care on a medical-surgical unit with a registered nurse (RN) and licensed practical/vocational nurse (LPN/VN).
Which of the following clients should be assigned to the RN?
A charge nurse is assigning client care on a medical-surgical unit with a registered nurse (RN) and licensed practical/vocational nurse (LPN/VN).
Which of the following clients should be assigned to the RN?
A. a client 8 hours postoperative following open cholecystectomy, with a PCA pump and stable vitals
[11%]
B. a client receiving IV antibiotics for cellulitis, who has a newly developed widespread maculopapular rash
[80%]
C. a client with dementia who requires daily dressing changes for a chronic venous ulcer
[3%]
D. a client with COPD on 2L nasal cannula oxygen and reporting increased fatigue over the last two days
[6%]
Statistics
Subject/Lesson
Subject
Leadership & Management
Lesson
Assignment/Delegation
Client Need
Test Plan
Management of Care
Related Topic
Assignment, Delegation and Supervision
Item Type
Item Type
Analysis
Explanation
Choice B is correct. A new maculopapular rash during IV antibiotic therapy may indicate a developing hypersensitivity or allergic reaction, requiring the RN’s ability to assess the severity, stop the infusion if indicated, monitor for progression (e.g., anaphylaxis), and initiate emergency protocols. This client presents the highest priority and complexity, requiring RN-level assessment, intervention, and potential provider notification.
Choice A is incorrect. A stable post-op client on a PCA pump is within the LPN's scope as the client is stable and the PCA is already initiated and does not require titration.
Choice C is incorrect. Managing a chronic wound for a client with dementia is suitable for an experienced LPN. Wound care that is routine and not associated with active infection or surgical sites can often be delegated.
Choice D is incorrect. A client with COPD with gradual fatigue over two days requires evaluation but does not show acute changes (e.g., no dyspnea, hypoxia, or respiratory distress). The LPN could monitor and report to the RN if the status worsens.
Learning Objective
Determine which client requires RN-level care based on acuity, clinical instability, and potential for rapid deterioration or complex interventions.
Related Videos
6 Key Topics
Five Rights of Delegation
15.7 Delegation
LPN Delegation
15.7 Delegation
RN Delegation
15.7 Delegation
Additional Info
✓ Assign clients with new, changing, or potentially life-threatening symptoms (e.g., drug reactions) to the RN.
✓ LPNs can care for stable clients with chronic conditions, administer most medications (except IV push), and reinforce teaching.
✓ High-difficulty delegation questions often require prioritizing the most unstable or unpredictable client, not just the one requiring the most tasks.
