LPN delegation on NCLEX-RN

[nuberianne_RN]

I purchased a delegation book yesterday, and I have been going through the questions. Some of the answers have me puzzled. I have always been taught that RNs always perform steps of the nursing process including assessments and evaluation. However, some answers say that LPNs can:

*look for signs of improvement after initiating med treatment

*check for signs of infection

Isn't that assessment?

*collect data about a patient's response to treatment

*observe a patient to ensure an intervention is done correctly

Isn't that evaluation?

I know that LPNs can auscultate breath sounds for example, as long as it is not for an initial assessment (admission). However, in the above situations I am a bit confused.

[suzanne4, RN]

An assessment is supposed to be done by an RN each and every shift.

Who ever is licensed and administering meds can evaluate if they are working or not, if there is a decrease in pain, or what ever else was being observed. The RN assesses the patient, the LPN can make observations, that is different between the two. Checking to see if skin is reddened or an IV site is inflamed can be done by the LPN, it is an observation when they are doing it.

And education is done by the RN all of the time, one can see how they are walking with crutches or how they are feeding themselves, or something else like that, and again it is anobervation. The actual evaluation is done by the RN and documented as such.

Listening to the breath sounds or even heart tones is acceptable to be done by the LPN as they are caring for the patient, and they are observing what they sound like and then reporting to you, as the RN you are the one that is in charge of the patient.

Some of the rules are a little stickier, such as the RN is the only one that can delegate. If an assignment is made to a specific CNA but they are unable to do something for whatever reason, legally they are supposed to report back to the RN and not just ask a co-worker to do something for them, though that is not what is always done. But per the BONs, this is what is supposed to be done.

Hope that this helps.

[nuberianne_RN]

Thanks Suzanne. Your answer helps a lot. I am a nervous wreck because I take the NCLEX on July 15.

[suzanne4, RN]

You are quite welcome.

[december2905]

In SATA, if they ask for the task to be assigned to the LPN, should i also check the one that CNA does like ambulating the patient, turning, ADLs? i understand that everything that the CNA can do can also be done by the LPN..please help! thanks!

[ChristineN, BSN, RN]

In SATA, if they ask for the task to be assigned to the LPN, should i also check the one that CNA does like ambulating the patient, turning, ADLs? i understand that everything that the CNA can do can also be done by the LPN..please help! thanks!

Normally the practice q's I've had say something like "you have an RN, LPN, and CNA...." in that case, no, I would not include the ADL's, vital signs, etc in the LPN's assignment. I'd give the LPN the pt needing a dressing change, or on traction, cast care, something with a clear cut goal.

[kscuba]

i have a question regarding this topic... i had a practice question that asked which of the following would cause the nurse to be concerned (aka which is wrong) the patient was depressed

one of the choices was that an lpn was teaching a depressed client how to deep breathing anouther choice was that the lpn gave dalmane... i though it would be that the lpn was teaching, cause i have learned just as suzzane said rns must do the teaching, however, the correct answer was the choice with the med becuase this med is know to cause dependence and should only be used as a last resort.....im confused what do you guys think, maybe i am just looking too into the question urrrggg cant wait unitl nclex is over...any ideas on how i should look at this question? thanks!

[ChristineN, BSN, RN]

i have a question regarding this topic... i had a practice question that asked which of the following would cause the nurse to be concerned (aka which is wrong) the patient was depressed

one of the choices was that an lpn was teaching a depressed client how to deep breathing anouther choice was that the lpn gave dalmane... i though it would be that the lpn was teaching, cause i have learned just as suzzane said rns must do the teaching, however, the correct answer was the choice with the med becuase this med is know to cause dependence and should only be used as a last resort.....im confused what do you guys think, maybe i am just looking too into the question urrrggg cant wait unitl nclex is over...any ideas on how i should look at this question? thanks!

perhaps they are saying that the side effects from the medication and what to expect, how to measure the drug is working, has an expected goal that the lpn can evaluate. the lpn should know what to expect with giving dalmane, whereas with teaching you don't know what each pt's specific needs will be.

[RNFutureRN]

I'm right there with you, I too was under the impression that LPNs cannot assess, teach, or evaluate, however I have done numerous practice questions in which the answers involve the LPNs assessing or teaching. It does seem that the LPN may be able to teach about basic things such as deep breathing, MDI use ect. I am still a bit confused though, because I did a question that indicated the LPN can do neurovascular assessments for a patient with a casted extremity, I thought that was the RNs job, I guess they are implying this is data collection, something a LPN can do

[suzanne4, RN]

Use a particular piece of equipment can be taught by the LPN, but it needs to be evaluated by the RN. Same way that the LPN can do assessments on their patien to review what is going on with them, but there must be one every shift done by the RN, and if there are any issues with what the LPN has come across, it needs to be reported to the RN immediately.

[kscuba]

so an LPN can teach deep breathing and relaxation?

[puglove86]

i know LPN's can "reinforce" what has already been taught...

luckly i didn't get any delegation questions on my test!