NCLEX Delegations Questions

[S.A.H]

I'm studying for my NCLEX-RN in a few weeks and I'm always getting questions on what to delegate to the LPN and CNA wrong. Having worked as both a CNA and an LVN (LPN), it's hard to just forget my personal knowledge and experience. Things that are in my scope of practice as an LVN are said not to be in the question rationals and things I was explicitly taught NOT to do as a CNA seem to be allowed in NCLEX Hospital. Any advice on the best way to approach these questions or ideas of a study resoure that summarizes what LPN's and CNA's are allowed to have delgated to them? Much appreciated :)

[Lunah, MSN, RN]

I moved your post to the NCLEX forum to ensure maximum responses. Good luck!

[HeySis, BSN, RN]

I feel ya! Just took my NCLEX last Tuesday and I was in the same boat, working as an LPN for over 20 years, pretty sure I was assigned things outside my scope of practice, so it was sometimes hard because I was like... yep, use to do that all the time.

I'd recommend Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination, 3e by LaCharity PhD RN, Linda A.

It has good explanations when it comes to delegation and lots of questions about it.

The other thing I learned from my live Kaplan review was RN's cannot delegate "EAT" which stands for

Education

Assessment

Teaching

So if I looked at the assignments and took away any that needed those three things it narrowed things considerably.

And always give the most stable patients to CNA's, LPN's or RN's that are floating over from other speciality. (so look for procedures that don't vary, and for clues like chronic in the wording)

Good Luck!

[S.A.H]

Thank you! Very helpful :)

[S.A.H]

:) Thank you! (I missed the NCLEX forum as an option)

[S.A.H]

Thank you! (I missed the NCLEX forum as an option.)

[cocoa_puff]

Just remember that CNAs can do routine, uncomplicated procedures (vitals, bed baths, ROM, ambulating, feeding, but only on stable patients, also collecting samples - stool, urine). However, they cannot do any part of the nursing process or teach patients. They also cannot do the initial ambulation (new admit, post-op). You would want to delegate routine tasks to the CNA, such as an uncomplicated bed baths or toileting stable patients.

LPNs can do more invasive procedures (foleys, NG tubes, dressing changes), administer medications (except IV), perform secondary assessments, reinforce teaching...they cannot do the initial admission assessment, discharge teaching (except to reinforce), administer blood products, or change the plan of care without the RN. They can also do everything a CNA can do. You would want to delegate care of stable patients with predictable outcomes to the LPN (a COPD patient with a SpO2 of 91% and who is on 2L NC). LPNs can delegate to other LPNs and CNAs.

RNs can do all the above, in addition to the nursing process, unstable patients, IV meds, blood products, initial assessments, perform discharge teaching and the initial education, and alter the plan of care. In the NCLEX world, it's really only the RN who can make clinical judgments and critically think (which we know is not true). Do NOT delegate the first feeding for a CVA patient to the CNA, or a patient with black tarry stools, decreased H&H, bleeding gums, and who is on a Heparin drip to the LPN.

When delegating to CNAs or LPNs, consider what would be more efficient. If you have four patients (plus an LPN and CNA), one Pt needs an NG tube placed, one needs a bath, one is 24hrs post-op from an appendectomy and needs vitals taken, and one needs discharge teaching about insulin administration, which Pt(s) should you delegate to the LPN and the CNA, and which Pt(s) would you take for yourself?

Hope this helps!

[LadyFree28, BSN, LPN, RN]

Using the LaCharity book was essential in helping me understand the delegation process. I struggled with this during nursing school as a LPN by day and nursing student on week nights and weekends; I was able to be very comfortable with these questions while I was still in the program, with the occasional slip-up, but that was mostly due to this book.

Depending on the NCLEX, you may or may not get these questions, however, you will get a question based on delegation that may satisfy one of the four components of being an entry level nurse:

1.Safe, effective care

2. Health Promotion

3. Physiological Integrity

4. Psychosocial Integrity

The LaCharity book serves as a framework into these types a questions as well; once you mastered this source, look into finding additional questions related to delegation, especially if this is you threatens weakness; as well as keep reviewing questions that can prepare you; don't forget to take mock exams to build up endurance in case you get hit with the maximum.

Best wishes.