Question 1

A nurse has the reputation of delegating tasks that are time-consuming or distasteful. What should the nurse manager consider before addressing this situation?
A) Misuse of delegation is an ethical issue.
B) One of the privileges of loyalty to the hospital is being able to delegate distasteful tasks to others.
C) Doing distasteful tasks is part of the learning process for new nurses.
D) The nurse reserves the right to delegate any task he or she wishes.

Accepted Answer

Rationale 1: The difference between delegating and "dumping" of distasteful tasks is a primary ethical issue that arises with delegation and supervision.
Rationale 2: Inappropriate delegation is an issue regardless of the nurse's seniority.
Rationale 3: There is no truth in this statement even though it is often used as an excuse for inappropriate delegation.
Rationale 4: Some tasks, such as care planning, cannot be delegated.

Question 2

A newly hired nursing assistant can work only when under direct supervision by a registered nurse. In which way can this assistant provide care?
A) The nursing assistant charts care in the patient's medical record and the nurse reviews that charting on a regular basis.
B) The nursing assistant provides hygienic care according to protocols approved by the nurse.
C) The nurse and the nursing assistant work together to provide care to a team of six patients.
D) The nurse is available on the unit while the nursing assistant provides care.

Accepted Answer

Rationale 1: While this is a method of supervision, it is not direct supervision.
Rationale 2: The nurse has provided direction and will likely review the assistant's work, but is not directly supervising the work.
Rationale 3: Direct supervision is provided when the delegator is actually present, observes, works with, and directs the persons being supervised.
Rationale 4: The nurse is available for supervision and direction but is not providing direct supervision.

Question 3

A nurse has delegated the task of ambulating a patient to two nursing assistants. Despite the patient's appearance, assistance of two people is needed for safe ambulation. The nurse discovers the patient being ambulated by only one aide. What nursing actions are indicated?
A) Scold the second aide for not carrying through with the delegated task.
B) Determine why only one person is ambulating the patient.
C) Assume that something important must have taken the second assistant away from this task.
D) Assist the aide in completion of the ambulation.
E) Notify the patient's physician of the incident.

Accepted Answer

Rationale 1: Scolding an adult is not likely to be an effective method of discipline.
Rationale 2: Part of an effective discipline plan includes investigating all facts and circumstances leading to the action for which discipline is being considered.
Rationale 3: The nurse should not assume anything about this situation.
Rationale 4: Providing for patient safety is always the priority, so the nurse should assist with completion of the ambulation.
Rationale 5: There is no indication that the patient was harmed in any way during this ambulation. There is no need to notify the physician regarding the incident.

Question 4

The charge nurse has delegated a task to another staff member. Who assumes accountability for the task?
A) It is held jointly by the charge nurse and the person performing the task.
B) It can be imputed to either the charge nurse or the person performing the task.
C) The charge nurse retains the accountability.
D) Accountability is transferred to the person performing the task.

Accepted Answer

Rationale 1: Accountability is not shared in this situation.
Rationale 2: The accountability is held specifically by one of these two people. It is not an either/or decision.
Rationale 3: While the person performing the task is responsible for his or her own actions, the accountability is always retained by the one who delegates.
Rationale 4: The person performing the task is responsible for his or her own actions but does not assume accountability for the task.

Question 5

The unit is extremely busy when the physician orders that a urinary catheter be inserted in a patient. The patient's assigned nurse is new, has seen the procedure done, but has never done it independently. How should the charge nurse handle this situation?
A) The charge nurse should assist the new nurse with the procedure.
B) The charge nurse should ask the new nurse to try the procedure alone.
C) The charge nurse should assign the task to a different nurse.
D) The charge nurse should do the procedure to save time.

Accepted Answer

Rationale 1: Two things are taken into account in this situation. The task needs to be done efficiently and safely. The new nurse needs to have experience in doing this common task. The most logical way to assure both those needs are filled is for the charge nurse to assist the new nurse with the procedure.
Rationale 2: If the charge nurse asks the new nurse to do the procedure alone, the charge nurse may end up having to do it anyway or the patient outcomes might be compromised.
Rationale 3: Assigning the task to a different nurse takes that nurse away from assigned patients and does not fulfill the need to help the new nurse learn the skill.
Rationale 4: If the charge nurse does the insertion, a valuable teaching opportunity for the new nurse has been missed.

Question 6

A nurse working in the intensive care unit (ICU) notes that a patient is more confused and agitated than yesterday. Which nursing actions are evidence of patient advocacy?
A) The nurse assesses for common causes of confusion and agitation.
B) Tell the family that confusion and agitation frequently occur after ICU admission.
C) The nurse contacts the patient's primary care provider regarding the confusion.
D) The nurse documents findings and actions in the medical record.
E) Ask for assistance from the nurse manager if necessary.

Accepted Answer

Rationale 1: Assessment allows the nurse to make comparisons between current status and previous status. This is the first step of collecting information to advocate for the patient's care.
Rationale 2: Assuming this patient's confusion and agitation is related solely to being in the ICU does not exemplify advocacy.
Rationale 3: This nurse had taken action to treat the patient which is an example of patient advocacy.
Rationale 4: Advocacy also includes documenting actions taken and response to actions.
Rationale 5: Assisting other nurses and seeking this assistance as necessary is a means of advocating for quality nursing care.

Question 7

The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient's death. Does the preceptor hold any liability in this case?
A) Yes, but only because the event resulted in patient demise.
B) Yes, the preceptor is responsible for delegating appropriately and supervising completion of tasks.
C) No, since the new nurse has a license, all liability is retained by the new nurse.
D) No, since the new nurse is employed by the medical facility, all liability is corporate.

Accepted Answer

Rationale 1: The fact that the event resulted in patient demise is not the deciding factor is whether the preceptor holds liability.
Rationale 2: Since the nurse in this case was newly licensed and the task delegated was complex, the preceptor does share liability. It could be shown that the task was delegated inappropriately and that the preceptor did not supervise the task correctly.
Rationale 3: The person delegating tasks must be certain that the person being delegated to is competent to perform the task.
Rationale 4: Nurses are liable for their actions.

Question 8

The registered nurse has delegated the task of ambulating a patient to two nursing assistants. The patient appears to ambulate without assistance, but must be ambulated with two assistants due to a history of unexpected fall. What is the most important aspect of delegating this task?
A) The aides understand the importance of walking with the patient.
B) The patient is comfortable walking with the aides.
C) The aides understand the patient is to be ambulated twice daily.
D) The patient understands the need for assistance.

Accepted Answer

Rationale 1: Based on the five rights of delegation, the most important aspect is that the aides are given the correct directions and communications about keeping this patient safe.
Rationale 2: Patient comfort is very important, but is not the most important aspect of this delegation.
Rationale 3: The frequency of ambulation is not the most important part of this delegation.
Rationale 4: Ideally the patient will understand the importance of this instruction, but this concept has nothing to do with delegation to the assistants.

Question 9

The nurse is searching for information about nurses' responsibility and accountability for appropriate delegation of tasks. Where should this nurse look for this information?
A) State nurse practice acts
B) ANA Code of Ethics for Nurses
C) State medical association bylaws
D) ANA Nursing Scope and Standards of Practice
E) Nursing rules and regulations as promulgated by the state

Accepted Answer

Rationale 1: Nurse practice acts address delegation.
Rationale 2: The ANA Code of Ethics for Nurses (2001) states that nurses have an obligation to delegate tasks appropriately.
Rationale 3: State medical associated bylaws do not provide direction about delegation in nursing.
Rationale 4: The ANA Nursing: Scope and Standards of Nursing Process has specific mandates regarding delegation practices.
Rationale 5: States develop specific rules and regulations in addition to the general statements provided in the nurse practice act.

Question 10

The nurse would correctly state that an assignment had been made in which situation?
A) The nurse says to the charge nurse, "Please watch my patients while I run down and pick up some lunch from the hospital cafeteria."
B) The nurse says to the UAP, "Please take all of the vital signs before you begin to deliver breakfast trays."
C) The charge nurse divides the patient load into one team for each staff nurse who works the shift.
D) The nurse asks a housekeeper to clean a bed quickly for a new admission.

Accepted Answer

Rationale 1: This situation is an example of upward transfer of responsibility and accountability (from staff nurse to charge nurse).
Rationale 2: The person with the accountability for monitoring vital signs and assuring the patients are fed (the nurse) has delegated the tasks to the person responsible for their completion (the UAP). This is delegation.
Rationale 3: Dividing the patient load into a team for each staff nurse is an example of downward (charge nurse to staff nurse) transfer of responsibility and accountability and is assignment. This is frequently referred to as "making assignments."
Rationale 4: The person accountable for assuring that patients have clean beds (the nurse) delegates the task to the person responsible for its completion (the housekeeper). This is delegation.

Question 11

The nurse has recently assumed the position of chief nurse in a long-term care facility with a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities?
A) Fire any nurse who does not meet established standards of care.
B) Firmly enforce the standards of care guiding the facility.
C) Set variable standards of care depending upon the nurse's previous experience.
D) Establish a discipline system that is progressive.
E) Encourage supervisors to be consistent in applying discipline.

Accepted Answer

Rationale 1: Unless a particular employee is doing something illegal, immoral, or dangerous to patients, it would be better not to fire the employee until the nurse has more information and has set the tone of the care expectations.
Rationale 2: Standards of care should be upheld and communicated to all those providing care.
Rationale 3: Standards of care should be the same for all.
Rationale 4: Progressive discipline is generally the fairest process. It will likely be the most effective in a facility that has not been previously disciplined.
Rationale 5: Consistency is a very important aspect of effective discipline.

Question 12

In which scenario is the nurse providing indirect supervision of a nursing assistant?
A) The nursing assistant and nurse work on the same team, jointly providing care to inpatients.
B) The nurse is easily contactable by pager but is not present in the care environment.
C) The nurse makes rounds on the patient care units, observing the nursing assistant's work, at least every two hours.
D) The nursing assistant receives constant instruction regarding patient care from the nurse.

Accepted Answer

Rationale 1: Since the nurse and the assistant are jointly providing care the nurse is providing direct supervision.
Rationale 2: Indirect supervision occurs when the delegator is easily contactable, but does not directly oversee the interventions or activities being performed.
Rationale 3: This nurse is providing direct supervision every two hours. There is no indication of what kind of supervision, if any, is occurring between observations.
Rationale 4: If the nurse is present to provide constant instruction, direct supervision is occurring.

Question 13

A nurse returning to practice remarks that delegation is much more regulated and complicated than when she last practiced 20 years ago. What rationale would the nurse manager provide for this change?
A) "The shortage of nurses has been the major reason that there are so many rules to follow when delegating."
B) "Since nursing is trying to move back to the team approach to care delegation has become more important."
C) "The introduction of multiple levels of professional staff members increases need for delegation rules and regulations."
D) "The widespread return to primary nursing makes delegation more risky."

Accepted Answer

Rationale 1: The nursing shortage has led to the need to use other licensed and unlicensed personnel to provide patient care that previously may have been performed only by registered nurses. Because this is occurring more frequently in multiple settings, the need for rules and regulations regarding delegation has arisen.
Rationale 2: There is no indication that nursing is trying to move back to a team approach.
Rationale 3: There has been no introduction of multiple levels of professional staff members.
Rationale 4: Delegation is not a component of primary nursing.

Question 14

A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient's vital signs?
A) The licensed practical nurse who has worked on this unit for 5 years
B) The registered nurse who has worked on this unit for 8 months
C) The unlicensed assistive personnel (UAP) who was recently transferred to the unit from an acute care environment
D) The nursing assistant who has worked in this unit for 7 years

Accepted Answer

Rationale 1: The licensed practical nurse is not educationally prepared to assess, diagnose, plan, implement, and evaluate care. This patient requires this level of intervention.
Rationale 2: This patient is receiving potent medication using a rapidly acting route. The actions of this medication are reflected in vital signs. The RN is educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.
Rationale 3: The UAP is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.
Rationale 4: The nursing assistant is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

Question 15

The nurse manager walks in on a conversation in the break room concerning the hospital's plan to employ unlicensed assistant personnel (UAPs) to help relieve a nursing shortage. Which statements would the manager correct?
A) "I can't believe our state board authorized this plan."
B) "I don't want to have these UAPs working under my license."
C) "The hospital will have to assure that the UAPs they hire are competent."
D) "It will be important that the UAPs hired have adequate orientation to our nursing units."
E) "It will be even more important that we follow delegation policy and procedure."

Accepted Answer

Rationale 1: UAPs are not authorized by the state boards.
Rationale 2: UAPs do not work "under" the nurse's license.
Rationale 3: The corporation (hospital) is accountable for documenting competencies for all staff members providing direct patient care.
Rationale 4: An institutional mechanism for orientation of UAPs must exist. Nurses may participate in this orientation.
Rationale 5: The nurses working with UAPs and delegating to them will be responsible for appropriate delegation.

Quiz 16: Delegation and Supervision

A nurse has the reputation of delegating tasks that are time-consuming or distasteful. What should the nurse manager consider before addressing this situation?

A newly hired nursing assistant can work only when under direct supervision by a registered nurse. In which way can this assistant provide care?

A nurse has delegated the task of ambulating a patient to two nursing assistants. Despite the patient's appearance, assistance of two people is needed for safe ambulation. The nurse discovers the patient being ambulated by only one aide. What nursing actions are indicated?

The charge nurse has delegated a task to another staff member. Who assumes accountability for the task?

The unit is extremely busy when the physician orders that a urinary catheter be inserted in a patient. The patient's assigned nurse is new, has seen the procedure done, but has never done it independently. How should the charge nurse handle this situation?

A nurse working in the intensive care unit (ICU) notes that a patient is more confused and agitated than yesterday. Which nursing actions are evidence of patient advocacy?

The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient's death. Does the preceptor hold any liability in this case?

The registered nurse has delegated the task of ambulating a patient to two nursing assistants. The patient appears to ambulate without assistance, but must be ambulated with two assistants due to a history of unexpected fall. What is the most important aspect of delegating this task?

The nurse is searching for information about nurses' responsibility and accountability for appropriate delegation of tasks. Where should this nurse look for this information?

The nurse would correctly state that an assignment had been made in which situation?

The nurse has recently assumed the position of chief nurse in a long-term care facility with a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities?

In which scenario is the nurse providing indirect supervision of a nursing assistant?

A nurse returning to practice remarks that delegation is much more regulated and complicated than when she last practiced 20 years ago. What rationale would the nurse manager provide for this change?

A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient's vital signs?

The nurse manager walks in on a conversation in the break room concerning the hospital's plan to employ unlicensed assistant personnel (UAPs) to help relieve a nursing shortage. Which statements would the manager correct?