Scope of Practice: RN vs LPN vs UAP for NCLEX

Scope of practice defines what each level of nursing personnel can legally and safely perform. On the NCLEX, scope and delegation questions are high-yield — you must know which tasks belong to the RN, which can be assigned to the LPN, and which can be delegated to UAPs. When in doubt, assume the RN handles the most complex assessments, decisions, and interventions.

Overview

Scope of practice is determined by each state's Nurse Practice Act. For NCLEX purposes:

• RN — broadest scope; complex assessment, planning, and interventions.
• LPN — narrower scope; care of stable patients with predictable outcomes.
• UAP — narrowest scope; routine tasks under RN supervision.

Quick Comparison: RN vs LPN

RN Scope

• Performs the initial assessment and develops the care plan (e.g., admission head-to-toe assessment).
• Evaluates outcomes and performs complex interventions (e.g., titrating a heparin infusion based on labs).
• Delegates tasks appropriately but remains accountable.
• Cannot delegate assessment, diagnosis, planning, evaluation, or critical judgment.

LPN Scope

• Collects data and reports findings; does not perform the initial assessment (e.g., measures vital signs and reports abnormalities).
• Cares for stable patients with predictable outcomes (e.g., routine post-op care without complications).
• Administers oral, IM, subcutaneous, and some IV medications. On the NCLEX, assume the RN performs IV push meds.
• Reinforces teaching; does not create care plans.
• Does not hang blood or titrate continuous infusions.

UAP Scope

• Performs routine tasks: bathing, feeding, ambulating, and obtaining vital signs on stable patients.
• May perform blood glucose checks if trained and allowed by facility policy — assess scenario details carefully.
• Cannot administer medications or perform invasive procedures.
• Can report patient statements but cannot assess, interpret, or intervene.
• Must be supervised by the RN for all delegated tasks.

Patient Assignment Priorities

• Unstable patients → RN (e.g., chest pain, airway compromise, active bleeding).
• Acute or unexpected changes → RN (e.g., new confusion, fever, decreased urine output).
• Stable patients with predictable outcomes → LPN (e.g., patient preparing for routine discharge).
• UAPs are assigned tasks, not full patient care (e.g., hygiene or ambulation for a stable patient).

Common NCLEX Traps

• Don't confuse LPN and RN responsibilities — the LPN cannot perform initial assessments or independently create care plans.
• Assume the RN administers IV push medications and blood products unless stated otherwise.
• Never delegate medication administration or clinical judgment to a UAP.
• Always assign unstable or newly admitted patients to the RN. Unexpected findings also require RN evaluation.
• If a delegated situation becomes unsafe, the RN must reassess rather than continue delegation.

Key takeaways

• The RN owns assessment, diagnosis, planning, evaluation, and critical thinking — these cannot be delegated.
• The LPN cares for stable patients, reinforces teaching, and gives most meds, but does not perform initial assessments, push IV meds, hang blood, or titrate drips on NCLEX.
• The UAP performs basic ADLs and vitals on stable patients; no medications, no assessments, no invasive procedures.
• Assign unstable, acute, or unexpected patients to the RN; stable, predictable patients to the LPN.
• When unsure, default to the RN for any task involving judgment, complexity, or instability.