Delegation and Scope of Practice (28 Questions)

1. You are the charge nurse on a surgical unit. You are working with an experienced Licensed Practical Nurse (LPN/Infirmière auxiliaire) and a PAB (Préposé). You have a patient, Mrs. Tremblay, who returned from hip replacement surgery 4 hours ago. She has an IV of normal saline running. She rings the bell and reports pain rated 8/10. The surgeon has ordered Morphine 2 mg IV push PRN. The LPN offers to administer the medication to help you, stating she has seen it done many times.

Question:
According to the scope of practice defined by the OIIAQ and OIIQ, what is the appropriate response? *
2. You are caring for Mr. Gagnon, a 78-year-old patient admitted with a CVA (stroke) three days ago. He has right-sided hemiparesis and dysphagia (difficulty swallowing). The speech-language pathologist has just upgraded his diet from "NPO" to "Pureed with thickened liquids." It is his first meal since the stroke. The PAB (Orderly) asks, "Shall I go feed Mr. Gagnon his lunch now?"

Question:
What is your decision regarding this delegation? *
3. You are working with a Nursing Extern (a nursing student who has completed two years of study and has a specific permit). You ask the Extern to check the capillary blood glucose (CBG) for a diabetic patient. The Extern reports back that the result is 2.8 mmol/L (Hypoglycemia). The patient is conscious but drowsy.

Question:
How should you proceed with the delegation of the treatment (administering orange juice/glucose)? *
4. You are the primary nurse for Mrs. Lefebvre, who has a complex abdominal wound requiring a sterile wet-to-dry dressing change. An LPN (Infirmière auxiliaire) is working with you today. Mrs. Lefebvre’s wound has been healing well, but today she complains of increased pain and the dressing is saturated with green, foul-smelling drainage.

Question:
Can you delegate this dressing change to the LPN? *
5. You are working in a home care setting. You are visiting Mr. Roy, who requires insulin injections twice a day. His daughter plans to take over this task so he can remain at home. She asks you to teach her how to give the injection.

Question:
Before allowing the daughter to administer the insulin independently, what is your primary legal and professional obligation? *
6. You are the triage nurse in the Emergency Department. It is extremely busy. An experienced LPN approaches you and says, "There is a patient in the waiting room, Mr. Caron, who looks very pale and is holding his chest. Should I go take his blood pressure and ECG?"

Question:
What is the appropriate response regarding scope of practice and delegation? *
7. You are caring for a patient who requires "Continuous Bladder Irrigation" (CBI) following a TURP procedure. The drainage is bright red with clots. The flow rate of the irrigation fluid needs to be adjusted frequently to keep the urine pink. The LPN working with you asks if she can monitor the patient for your break.

Question:
Is it appropriate to delegate the management of the CBI to the LPN in this condition? *
8. You are working in a long-term care center (CHSLD). A resident, Mrs. Dubé, falls in the hallway. You (RN) and the LPN rush to the scene. Mrs. Dubé is conscious but complains of hip pain.

Question:
How should the roles be divided between the RN and the LPN? *
9. A novice nurse (CEPI – Candidate for the Profession) comes to you, the Charge Nurse, with a medication error. She administered 50 mg of Metoprolol to a patient with a heart rate of 52 bpm, and the patient is now bradycardic (HR 45). She is crying and says, "I didn't check the pulse first."

Question:
As the supervisor, you intervene to ensure patient safety. Regarding the CEPI's liability, which statement is true? *
10. You are the RN working in a clinic. A mother calls and asks for advice because her child has a fever of 39°C. You are busy with an emergency. You consider asking the LPN to take the call.

Question:
Can the LPN handle this telephone triage? *
11. You are the precepting RN working on a pediatric surgical unit. You are supervising a CEPI (Candidate for the Profession of Nursing). A 4-year-old patient, admitted for a fractured femur, is crying and reporting pain rated 8/10. There is a standing medical order for "Morphine 1 mg SC every 4 hours PRN for pain." The CEPI prepares the medication correctly and asks, "Can I go give this injection to the child?"

Question:
According to the regulations governing the practice of a CEPI, what is the correct response? *
12. You are the RN team leader on a medical unit. An LPN (Infirmière auxiliaire) is caring for Mr. Lavoie, who has a history of angina. There is a standing medical order on the file: "Nitroglycerin spray 0.4 mg SL PRN for chest pain. Notify MD if no relief after 3 doses." The LPN comes to the nursing station and informs you: "Mr. Lavoie rang for chest pain rated 6/10. I assessed his BP (130/80), administered one puff of his PRN Nitroglycerin, and I am going back to re-assess him in 5 minutes."

Question:
Has the LPN acted within her scope of practice? *
13. You are the RN charge nurse on a medical unit. An LPN (Infirmière auxiliaire) approaches you. She has an order for a new admission, Mr. Tremblay, which reads: "Start peripheral IV line #20G and infuse Normal Saline (0.9% NaCl) at 100 mL/hr." The LPN states, "I have my certification for IV therapy. I will go start the IV and hang the bag."

Question:
Is this activity within the LPN’s authorized scope of practice in Quebec? *
14. You are an RN working the night shift in a Long-Term Care facility (CHSLD). You are the only RN in the building. A resident requires a blood transfusion for severe anemia. The blood product has arrived from the hospital bank. Standard protocol requires two nurses to verify the blood product at the bedside. The only other staff member available is an experienced LPN.

Question:
Can the LPN function as the second verifier for the blood transfusion? *
15. You are the RN coordinator at a CLSC vaccination clinic. It is flu season, and the waiting room is full. You have an LPN working with you who is trained in immunization. A healthy 30-year-old patient presents for his annual Influenza vaccine. There is a standing order (collective prescription) for the vaccine.

Question:
Can the LPN administer this vaccine independently? *
16. An LPN is doing rounds in the dining room of a long-term care center. Suddenly, a resident, Mr. Roy, begins gasping for air and clutching his chest. His lips are turning blue (cyanosis). The LPN calls out for help, but the RN and Physician have not yet arrived. The oxygen tank is next to the resident.

Question:
What is the appropriate action regarding oxygen administration? *
17. You are the RN working on an oncology unit. Mrs. Paquette has a Peripherally Inserted Central Catheter (PICC line) in her right upper arm for chemotherapy. It is time for the weekly sterile dressing change and cap change. The LPN (infirmière auxiliaire) on your team, who is very experienced and skilled in sterile technique, offers to perform the dressing change.

Question:
Is the LPN authorized to perform this task? *
18. Mrs. Paquette has completed her chemotherapy treatment, and the physician has written an order to discontinue (remove) her PICC line. The LPN states, "I am free right now, I will go remove the catheter and apply the pressure dressing."

Question:
Is the LPN authorized to remove this specific type of catheter? *
19. You are working on a surgical unit. Mr. Giroux underwent an abdominal laparotomy yesterday. The surgeon has just completed rounds, removed the initial surgical dressing to inspect the incision, and stated, "The wound looks perfect, well-approximated, no redness. Please apply a new sterile dressing now." The surgeon leaves. The LPN asks if she can apply the new dressing.

Question:
Is the LPN permitted to change this first postoperative dressing? *
20. You are the RN in a private medical-aesthetic clinic. An LPN is working with the team. A client comes in for cosmetic Botox (Botulinum toxin) injections for wrinkles. The physician has examined the client, marked the specific injection sites on the face, and prescribed the specific dosage for each site. The physician asks the LPN to perform the injections.

Question:
Is the LPN authorized to administer these injections? *
21. You are the RN working in the Operating Room. You are circulating for a complex case. The Anesthesiologist asks for a specific IV antibiotic to be administered immediately. You are currently busy assisting the surgeon. An experienced LPN (Infirmière auxiliaire) is present in the room assisting the team. You ask the LPN, "Can you please reconstitute (mix) that vial of Cefazolin with saline? I will hang and administer it as soon as I’m done here."

Question:
Is the LPN authorized to reconstitute (mix) this intravenous medication in this specific context? *
22. You are the RN working in a long-term care facility. An LPN (Infirmière auxiliaire) is caring for Mr. Caron, a patient with a permanent tracheostomy. While the LPN is performing care, Mr. Caron coughs violently, and the entire tracheostomy tube is accidentally expelled (decannulation). Mr. Caron begins to gasp for air, and his oxygen saturation drops rapidly. The LPN calls for help, but the RN and physician are occupied in another wing and are not immediately available.

Question:
Is the LPN authorized to attempt to reinstall the cannula in this specific situation? *
23. You are the Head Nurse of a psychiatric unit. You have posted a job opening for a nurse to join the multidisciplinary team. An LPN (Infirmière auxiliaire) applies for the position. A staff RN expresses concern, stating, "I didn't think LPNs were allowed to work in mental health because they can't assess mental status."

Question:
According to the regulations and scope of practice in Quebec, is the LPN authorized to work in a mental health setting? *
24. You are the RN Charge Nurse in the Operating Room. A surgery is concluding. The team consists of the Surgeon, the Anesthesiologist, an LPN (Infirmière auxiliaire) acting as the Scrub Nurse, and a second LPN acting as the assistant Circulator (under your general supervision). The surgeon asks for the final sponge and instrument count. You are currently occupied with a complex specimen labeling issue in the corner of the room. The two LPNs proceed to perform the audible count together.

Question:
Is it within the scope of practice for two Licensed Practical Nurses (LPNs) to perform the surgical count together? *
25. You are working on a geriatric unit. An LPN (Infirmière auxiliaire) is caring for Mrs. Gagnon, who has developed a mild fever and a headache. The LPN calls the on-call physician to report the symptoms. The physician gives a telephone order: "Administer Acetaminophen (Tylenol) 650 mg per rectum now." The LPN accepts the order, writes it in the file, and reads it back to the physician.

Question:
Was the LPN authorized to receive this telephone order? *
26. It is the end of the evening shift on a busy medical unit. You are the RN. The LPN (Infirmière auxiliaire) assigned to the team has been administering the medications for her patients. She approaches you with the narcotic cupboard keys and the count sheet. She says, "I have completed the end-of-shift narcotic count with the incoming LPN. Everything is correct. Here is the signature sheet."

Question:
Is the LPN authorized to hold the narcotic keys and perform the shift count? *
27. You are working in an outpatient blood collection center (Test Center). The waiting room is full. An experienced LPN (Infirmière auxiliaire) is working in the cubicle next to you. A patient, Mr. Roy, sits in her chair with a requisition for a CBC, Electrolytes, and TSH. The LPN applies the tourniquet and prepares to perform the venipuncture.

Question:
Is the LPN authorized to perform this blood draw? *
28. You are the RN in the Emergency Department. Mr. Tremblay is in severe respiratory distress with a history of COPD. The physician orders an "Immediate Arterial Blood Gas (ABG)" to check his pH and pCO2 levels. You are currently performing CPR on another patient. An LPN offers to go draw the blood from Mr. Tremblay’s radial artery to help out.

Question:
Is the LPN authorized to perform an arterial blood draw? *