A registered nurse (RN) is preparing to delegate tasks during a busy shift on a medical-surgical unit.
The team includes a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). Which tasks can the RN appropriately delegate based on scope of practice and the principles of safe delegation?

Choice A rationale

Pain management is a high priority for patient comfort and can influence physiological stability, but it falls under the category of psychosocial or secondary physiological needs in Maslows hierarchy compared to immediate life threats. While an 8/10 pain level is significant and requires intervention, it does not supersede an active airway or breathing crisis. The nurse should address the patients pain after ensuring the stability of patients with compromised ABC parameters or critical physiological imbalances.

Choice B rationale

A blood glucose of 210 mg/dL is elevated above the normal fasting range of 70 to 99 mg/dL or postprandial range under 140 mg/dL. However, for a diabetic patient awaiting discharge, this level is not an acute, life-threatening emergency like a respiratory or circulatory collapse. Discharge instructions are a low priority when compared to patients experiencing acute physiological distress. The nurse can address this teaching and glucose management once more unstable patients are properly assessed and stabilized.

Choice C rationale

This patient is the highest priority because they demonstrate signs of respiratory distress and potential hypoxia. A respiratory rate of 32 breaths/min is significantly higher than the normal range of 12 to 20 breaths/min. Confusion in a patient with pneumonia often indicates inadequate cerebral oxygenation. Following the ABC framework, breathing takes precedence over pain or routine discharge. Failure to assess this patient immediately could lead to respiratory failure, making them the most critical individual to see first.

Choice D rationale

A potassium level of 3.4 mEq/L is slightly below the normal range of 3.5 to 5.0 mEq/L. While hypokalemia can eventually cause cardiac dysrhythmias, a level of 3.4 is usually considered mild and does not represent an immediate threat to life compared to a patient with a respiratory rate of 32. Assisting a patient to the bathroom is a safety and mobility need that can be delegated or delayed until the nurse assesses the most unstable patient.

Choice A rationale

The patient exhibiting chest pain radiating to the left arm accompanied by diaphoresis is demonstrating classic symptoms of an acute myocardial infarction. This represents a life-threatening circulatory emergency that requires immediate assessment and intervention to prevent cardiac muscle necrosis. Using the airway, breathing, and circulation priority framework, this patient is the most unstable. Prompt evaluation is critical to initiate emergency protocols, such as administering oxygen, nitroglycerin, or obtaining an electrocardiogram to identify cardiac ischemia.

Choice B rationale

Although a pain rating of 9/10 is significant and requires timely intervention, pain is generally considered a psychosocial or physiological priority that falls below immediate life-threatening circulatory or airway issues. The nurse must address the pain after assessing more unstable patients. While postoperative hip replacement patients are at risk for complications, the acute symptoms of a potential heart attack in another patient take precedence over musculoskeletal pain management in a stable postoperative patient.

Choice C rationale

A blood glucose level of 260 mg/dL is elevated, as the normal fasting range is typically 70 to 99 mg/dL. While this requires the administration of insulin per sliding scale or provider orders, it does not constitute an immediate life-threatening emergency like a myocardial infarction. Chronic hyperglycemia is serious but lacks the urgency of acute chest pain. The nurse should check on this patient after addressing higher-priority respiratory or circulatory distress to prevent diabetic ketoacidosis or other complications.

Choice D rationale

For a patient with chronic obstructive pulmonary disease, an oxygen saturation of 92 percent is often within the expected target range, as these patients often compensate for chronic hypercapnia. While the patient is short of breath, this is a common baseline finding for their condition. Unless the oxygen saturation drops significantly below their personal baseline or 90 percent, they are considered more stable than a patient experiencing active cardiac ischemia. This patient requires monitoring but not the highest priority.