Question set B: NGN delegation and assignment items
Four empty response frames stacked to exact proportion: a six-by-three matrix grid, a five-slot ordered-response ladder with numbered receiving boxes, an inline text block with three shaded drop-down wells, and an empty bowtie skeleton with a center hexagon and two receiving boxes on each side.
SIX ITEMS, FOUR FORMATS
Item 9 · Matrix. Facility policy at this hospital permits the LPN/LVN to insert indwelling urinary catheters and to administer enteral feedings, and does not permit the LPN/LVN to administer intravenous push medication. Assign each task to the least-licensed person who may perform it under that policy. One tick per row.
| Task | RN only | LPN/LVN | Assistive personnel |
|---|---|---|---|
| 1. Complete the admission assessment on a client admitted twenty minutes ago | ☐ | ☐ | ☐ |
| 2. Reinforce incentive spirometer instructions the RN taught this morning | ☐ | ☐ | ☐ |
| 3. Insert an indwelling urinary catheter in a stable client | ☐ | ☐ | ☐ |
| 4. Total the intake and output for a stable client | ☐ | ☐ | ☐ |
| 5. Give an intravenous push dose of an ordered analgesic | ☐ | ☐ | ☐ |
| 6. Walk a stable client to the bathroom who walked this morning without incident | ☐ | ☐ | ☐ |
Item 10 · Ordered response. One hour ago the nurse reported a client's worsening shortness of breath to the provider and no orders were given. The client's work of breathing has increased since that call. Place the five actions in the order the nurse should perform them. A) Document the calls, the findings, and the responses received. B) Call the provider again using situation, background, assessment, and a specific recommendation with a time frame. C) Reassess the client at the bedside and gather current findings. D) Notify the charge nurse that the report produced no orders and the client is worse. E) Activate the rapid response team.
Item 11 · Drop-down in text. Complete the delegation. The client walked in the hallway earlier today without incident and is stable. "The nurse directs the [1] to walk the client the length of the hallway once before noon, to stop and call the nurse immediately for [2], and to report the distance walked [3]." Blank 1: assistive personnel / charge nurse / respiratory therapist. Blank 2: anything unusual / new shortness of breath or chest pain / a request to sit down. Blank 3: immediately after the walk / at the end of the shift / at the next handoff.
Item 12 · Select all that apply. Which four statements about supervision are accurate? 1) Supervision includes directing, monitoring, and evaluating delegated work. 2) Once a task is delegated, accountability for the outcome transfers to the person performing it. 3) The nurse states what to report and when to report it before the task begins. 4) Supervision may be direct or indirect depending on the task and the client's condition. 5) Evaluating whether the delegated task achieved the intended result is part of the delegation. 6) A task may go to anyone whose role includes it, whether or not that person has performed it here. 7) Supervision ends when the assistive personnel reports the task is complete.
Item 13 · Bowtie. A client on the second day after total hip arthroplasty calls out with sudden shortness of breath and sharp chest pain that worsens on inspiration. The client is anxious, breathing rapidly, and the oxygen saturation has fallen from the value recorded this morning. Action to take first: raise the head of the bed and apply oxygen per protocol / ambulate the client / give the ordered oral analgesic / apply a warm compress to the calf / recheck in fifteen minutes. Two parameters to monitor: oxygen saturation / respiratory rate and work of breathing / bowel sounds / incision drainage / appetite. Condition most likely occurring: pulmonary embolism / wound infection / hypoglycemia / urinary retention.
Item 14 · Trend. Three snapshots of the same four clients.
| Client | 0800 | 1000 | 1200 |
|---|---|---|---|
| Room 10, cellulitis | Afebrile, walking to the bathroom alone | Unchanged | Unchanged |
| Room 12, COPD | Speaking in full sentences on room air | Pausing mid-sentence to breathe | Using neck muscles to inhale, will not lie flat |
| Room 14, post-operative day three | Tolerating diet, walking in hallway | Unchanged | Unchanged |
| Room 16, awaiting placement | Stable, no complaints | Unchanged | Unchanged |
At 0800 the shower assist for room 12 was delegated to assistive personnel. Which client's assignment must change, and at which snapshot?
Rationale strip
Item 9 — Answers: 1 RN only, 2 LPN/LVN, 3 LPN/LVN, 4 assistive personnel, 5 RN only, 6 assistive personnel. Row 1 is initial assessment and never leaves the RN. Row 2 is reinforcement, not initial teaching. Rows 3 and 5 are resolved only by the policy stated in the stem, because both vary by state.
Item 10 — Answer: C, B, D, E, A. Assess before you report, report with a specific ask, involve the charge nurse when the ask fails, activate rapid response when the client keeps declining, and document last. Documenting first is the classic wrong sequence.
Item 11 — Answers: assistive personnel; new shortness of breath or chest pain; immediately after the walk. "Anything unusual" is the vague option that gate four exists to reject. Naming the findings and the reporting time closes the loop.
Item 12 — Answers: 1, 3, 4, 5. Option 2 is false because accountability for the outcome stays with the delegating RN. Option 6 is false because role never substitutes for demonstrated competence. Option 7 is false because supervision ends with evaluation, not with a completion report.
Item 13 — Answers: raise the head of the bed and apply oxygen per protocol; oxygen saturation and respiratory rate with work of breathing; pulmonary embolism. Sudden pleuritic pain with dyspnea and a falling saturation on the second day after joint replacement is embolic until ruled out. Ambulating or waiting fifteen minutes are both harmful here.
Item 14 — Answer: room 12, at the 1000 snapshot. The client stopped being stable when the speech pattern changed, which is before the accessory muscle use at 1200. A changing client cannot be delegated, so the shower assist comes back to the RN at 1000, not at 1200.
Margin notethese formats score partially. Half-right beats blank.
Watch outrows 3 and 5 of item 9 are scope claims. Scope of practice is set by your state Nurse Practice Act and by facility policy.
Takeawayin these formats you are graded on the whole pattern of decisions, not on one choice.
→ BOOK 02 · P4 for how partial credit is calculated.