A nurse is caring for a client who is experiencing warfarin toxicity. Which of the following medications should the nurse administer?

Delegation in nursing involves assigning appropriate tasks to assistive personnel while maintaining accountability for patient outcomes. When an assistive personnel refuses an assignment, the nurse must assess the reason for refusal before taking corrective or punitive action. Effective delegation requires communication, clarification of expectations, and evaluation of competency or safety concerns. The goal is to ensure patient safety while maintaining a functional and collaborative team environment.

Rationale:
A. Reporting the AP to the risk manager is inappropriate as an immediate response because refusal may be due to legitimate concerns such as lack of training or unsafe assignment. Risk management involvement is reserved for unresolved or repeated issues after assessment and communication. Immediate escalation without understanding the cause does not support effective problem-solving.

B. Assigning the task to another AP may resolve the immediate workload issue but does not address the underlying reason for refusal. This approach may perpetuate unsafe practice if the task is inappropriate for assistive personnel or if multiple staff have similar concerns. Proper delegation requires evaluating appropriateness rather than simply reassigning tasks.

C. Performing the task on behalf of the AP is not appropriate as a routine response because it undermines delegation principles and may lead to nurse workload imbalance. While patient safety is always a priority, the nurse should first determine why the task was refused. Direct replacement should only occur if the task is urgent and cannot be safely delegated.

D. Discussing the AP’s concerns is the correct first action because it allows the nurse to identify whether the refusal is based on lack of competency, misunderstanding, workload issues, or safety concerns. In effective delegation systems, communication is essential to ensure tasks are appropriate and safely assigned. This aligns with principles of delegation and teamwork in nursing practice, including safe delegation to Assistive personnel.

The client underwent surgical intervention (right salpingostomy), which carries risks such as hemorrhage, hypovolemic shock, infection, and adverse anesthetic effects. Postoperative assessment findings must be carefully evaluated for early signs of deterioration. Hypotension combined with bradycardia, hypothermia, and cool clammy skin suggests potential shock or significant hemodynamic instability, which requires urgent intervention to prevent cardiovascular collapse.

Rationale for correct choices:

• Blood pressure 90/60 mm Hg: A blood pressure of 90/60 mm Hg indicates hypotension, which is a major postoperative warning sign for possible hemorrhage or shock following ectopic pregnancy surgery. Given the vascular nature of reproductive structures and recent surgical intervention, internal bleeding is a significant concern. This drop in perfusion pressure can rapidly progress to organ hypoperfusion and cardiovascular collapse if not addressed immediately. It is the most urgent abnormal finding requiring immediate follow-up.

• Heart rate 60/min: Bradycardia in the postoperative setting may indicate worsening hemodynamic instability, especially when combined with hypotension. While opioids or anesthesia may contribute, the presence of low blood pressure makes this finding more concerning for circulatory compromise. It may represent a late or atypical response in shock states where compensatory mechanisms are failing. Continuous is essential.

• Temperature 35.3° C (95.5° F): Hypothermia after surgery may result from anesthesia effects, environmental exposure in the operating room, or impaired thermoregulation. However, in combination with hypotension and bradycardia, it may indicate poor perfusion and early shock. Reduced core temperature can impair coagulation, increasing the risk of postoperative bleeding. This finding supports the concern for systemic instability rather than isolated temperature variation.

• Skin cool and moist to touch: Cool, moist skin is a classic sign of peripheral vasoconstriction and sympathetic activation seen in shock states. It reflects the body’s attempt to preserve blood flow to vital organs at the expense of peripheral circulation. When combined with hypotension, it strongly suggests decreased tissue perfusion. This finding supports the likelihood of postoperative hemorrhage or circulatory compromise requiring immediate intervention.

Rationale for incorrect findings:

• Pain rating 1/10: A pain score of 1/10 is an expected and reassuring postoperative finding following laparoscopic surgery. It indicates effective pain control and no evidence of acute complications such as severe internal bleeding or peritoneal irritation. In postoperative monitoring, significant worsening pain would be more concerning for complications. Therefore, a low pain score is a normal and non-alarming finding in this scenario.

• Neurological status: drowsy but easy to arouse: Mild drowsiness is common after anesthesia and opioid administration in the postoperative period. The client is easily arousable and responsive. This suggests intact airway protection and no immediate neurological emergency. In the absence of worsening confusion or unresponsiveness, this finding is expected and not the priority concern.