指定的護理長正在準備下個班的病人分配。將下列哪位病患委派給實務護理師 (LPN/LVN) 是最安全且最恰當的？
The designated charge nurse is preparing assignments for the upcoming shift. Which client is the safest and most appropriate to delegate to a licensed practical nurse (LPN/LVN)?
- AA client receiving a continuous intravenous infusion of regular insulin for diabetic ketoacidosis.因糖尿病酮酸中毒而接受常規胰島素連續靜脈輸注的病人。
- BA client scheduled for discharge today who requires initial education regarding complex new anticoagulants.預計今日出院且需要關於複雜新型抗凝血藥之初步衛教的病人。
- CA client admitted two hours ago with a suspected acute myocardial infarction requiring continuous cardiac monitoring.兩小時前入院且疑似急性心肌梗塞需持續心臟監測的病人。
- DA client with a chronic, stable tracheostomy requiring routine suctioning and sterile dressing changes.✓ 正解患有慢性穩定型氣管造廔需常規抽吸及無菌敷料更換的病人。
本題測驗委派常規。LPN 負責病情穩定、具備可預期結果的慢性個案，並可執行無菌換藥與常規技術。選項 D 的病患患有慢性氣切且穩定，常規抽痰與換藥完全符合 LPN 的執業範圍。選項 C 剛入院的心肌梗塞病患極度不穩定，屬 RN 專責。選項 A 滴注胰島素需要頻繁評估與劑量調整，禁止給 LPN。選項 B 提供『首次的新藥衛教』是 RN 的專屬核心範圍。
This question tests delegation principles. An LPN is responsible for chronic, stable clients with predictable outcomes and can perform sterile dressing changes and routine procedures. The client in option D has a chronic, stable tracheostomy, and routine suctioning and dressing changes fall completely within LPN scope of practice. The newly admitted myocardial infarction client in option C is highly unstable and is the RN's responsibility. Option A, an insulin drip, requires frequent assessment and dose titration and cannot be delegated to an LPN. Option B, the initial teaching for a new medication, falls within the RN's exclusive scope of practice.
LPN 不能做評估 (Assess) 與衛教 (Teach)，常規的氣切換藥是他們最標準的工作。