During a time-out procedure before surgery, what should the nurse do if there is a discrepancy?

Choice A rationale
Feeding a stroke client who has difficulty in swallowing is a task that requires careful attention to prevent aspiration and choking. While this task is important, it can be delegated to a trained nursing assistant or a licensed practical nurse (LPN) under the supervision of an RN. The RN should focus on tasks that require higher levels of clinical judgment and expertise.
Choice B rationale
Completing a sterile dressing change to a pressure ulcer is a task that requires the expertise and clinical judgment of an RN. Sterile dressing changes involve maintaining a sterile field, assessing the wound, and applying appropriate dressings. This task is critical for preventing infection and promoting wound healing, making it appropriate for the RN to perform.
Choice C rationale
Reapplying a condom catheter for a client with urinary incontinence is a routine procedure that can be delegated to a trained nursing assistant or an LPN. This task does not require the advanced clinical skills and judgment of an RN, allowing the RN to focus on more complex and critical tasks.
Choice D rationale
Reinforcing teaching with a client who is learning how to administer insulin is an important task, but it can be delegated to an LPN under the supervision of an RN. The RN should prioritize tasks that require higher levels of clinical expertise and judgment, such as sterile dressing changes and complex assessments.

Choice A rationale
The right circumstance refers to the appropriate setting and resources being available for the task to be delegated. It ensures that the situation is suitable for delegation, considering factors such as the patient’s condition and the complexity of the task. However, this is not the focus of the question, which is about the nurse’s demonstration during delegation.
Choice B rationale
The right communication involves clear, concise, and complete instructions given to the assistive personnel. It ensures that the delegatee understands the task, the expected outcomes, and any specific instructions or precautions. This is the correct answer because the nurse is demonstrating effective communication during the delegation process.
Choice C rationale
The right supervision refers to the appropriate monitoring and evaluation of the task being performed by the delegatee. It ensures that the nurse provides guidance, support, and feedback as needed. While important, this is not the focus of the question, which is about the nurse’s demonstration during delegation.
Choice D rationale
The right task refers to the appropriateness of the task being delegated, ensuring it is within the delegatee’s scope of practice and competency level. It ensures that the task is suitable for delegation. However, this is not the focus of the question, which is about the nurse’s demonstration during delegation.