A nurse has received change-of-shift report for a group of clients. Which of the following clients should the nurse see first?

Rationale:
A. Asking the client’s family to contact the insurance provider may delay timely resolution. While insurance approval may be necessary, coordinating delivery is the responsibility of the healthcare team to ensure client safety.

B. Contacting social services may help with long-term arrangements, but it is not the immediate priority when the client requires oxygen for safe discharge. Social services can assist in arranging resources, but the provider must first be informed.

C. Notifying the provider about the delayed oxygen tank delivery is the appropriate action. The provider needs to be aware because the client cannot be safely discharged without the prescribed oxygen, and alternative arrangements, such as delaying discharge or providing temporary in-hospital oxygen, may be required. This ensures client safety and adherence to discharge orders.

D. Sending an oxygen tank from the facility home with the client is not allowed. Hospital oxygen tanks are for facility use and are regulated; transferring them offsite is unsafe and typically prohibited by policy and law.

Rationale:

A. A client who has sickle-cell anemia and is requesting water is stable and does not have acute complications at this moment. Measuring vital signs and providing oral fluids are within the scope of practice of an assistive personnel (AP). The AP can safely perform these routine tasks under the nurse’s supervision.

B. A client who has just returned from the PACU requires frequent monitoring, assessment for postoperative complications, and nursing judgment. Vital signs in this case may indicate instability, so an RN must perform the assessment.

C. A client reporting acute chest pain requires immediate assessment, intervention, and possible activation of emergency protocols. Delegating vital signs to an AP would delay urgent care.

D. A client with a closed head injury and increased intracranial pressure is at high risk for rapid deterioration. Vital signs and neurological assessments require nursing judgment and continuous monitoring, so an AP cannot safely perform these assessments.