一位40歲女性病患在闌尾切除術後第二天，抱怨突然發生尖銳的胸痛並伴隨呼吸急促。她的呼吸為每分鐘 28 次，心跳 115 次，室溫下血氧濃度 91%。註冊護理師 (RN) 將監測生命徵象的任務交辦給無照護佐 (UAP)，並指派證照實務護理師 (LPN) 為另一位病患施打表定的靜脈注射抗生素。隨後 RN 專注於處理該名術後病患。請評估此交辦的適當性。
A 40-year-old female client, 2 days post-appendectomy, complains of sudden, sharp chest pain and shortness of breath. Her RR is 28 bpm, HR 115 bpm, and SpO2 91% on room air. The RN delegates vital sign monitoring to the UAP and assigns the LPN to administer a scheduled IV antibiotic for another client. The RN then focuses on the post-appendectomy client. Evaluate the appropriateness of this delegation.
- AInappropriate; the LPN is strictly forbidden from administering any form of intravenous medications across all jurisdictions.不適當；LPN在所有司法管轄區嚴格禁止給予任何形式的靜脈藥物
- BAppropriate; however, the RN should have instructed the UAP to also perform a rapid respiratory assessment before calling the physician.適當；然而，RN應指示UAP在呼叫醫師前也進行快速的呼吸評估
- CInappropriate; the UAP is never legally allowed to check vital signs on a client experiencing acute physiological distress.不適當；UAP在法律上永遠不被允許為經歷急性生理困擾的病人測量生命徵象
- DAppropriate; the RN rapidly triaged and securely handled the unstable, life-threatening pulmonary embolism risk while correctly utilizing the LPN and UAP within their scopes.✓ 正解適當；RN迅速分診並妥善處理不穩定且危及生命的肺栓塞風險，同時在範圍內正確利用LPN和UAP
本題測驗交辦與監督 (Delegation and Supervision) 以及優先順序的雙重概念。當病患出現突發胸痛與血氧下降（高度懷疑致命的肺栓塞 Pulmonary Embolism），這名病患屬於極度不穩定（unstable）狀態，必須由 RN 親自評估與介入。RN 將常規生命徵象交辦給 UAP、將穩定的靜脈給藥交辦給 LPN（在許多州 LPN 可執行特定常規 IV 藥物），同時親自接手最危險的病患，這是完美的資源分配與交辦。選項 C 錯誤：UAP 可以協助測量不穩定病患的生命徵象以提供數據，但不能『評估/判讀』這些數據的意義。選項 A 錯誤：雖然 LPN 不能給予高危險 IV 推注（IV push）或靜脈輸血，但多數地區允許他們給予常規的 IV 點滴抗生素（Piggyback）。選項 B 錯誤：UAP 絕對不能執行『生理評估 (Assessment)』，這是 RN 的專屬職責。
This item tests the dual concepts of delegation/supervision and prioritization. When the client develops sudden chest pain with falling oxygen saturation (highly suspicious for a life-threatening pulmonary embolism), she is in an extremely unstable condition that must be personally assessed and managed by the RN. The RN delegates routine vital signs to the UAP and delegates a stable IV medication to the LPN (in many states LPNs may administer certain routine IV medications), while personally taking on the most critical client -- this is appropriate resource allocation and delegation. Option C is incorrect: UAPs may obtain vital signs in unstable clients to provide data, but they may not assess or interpret that data. Option A is incorrect: although LPNs cannot administer high-risk IV push medications or blood transfusions, in most jurisdictions they are permitted to hang routine IV piggyback antibiotics. Option B is incorrect: UAPs may never perform physiological assessment, which is an exclusive RN responsibility.
美國 NCLEX 考試極度強調 RN, LPN/LVN, UAP 的交辦界線。而在台灣，沒有 LPN 這個層次，護理師通常親自執行從發藥到評估的所有事務，護佐只負責生活照護，因此這是台灣考生最容易出錯的盲區。