The charge nurse is making assignments for a 15-bed skilled nursing unit with the staff of one nurse, two practical nurses (PN), and two unlicensed assistive personnel (UAP). Which client should be assigned to the PN?

Choice A reason: A child who has had a cold for two days and now is coughing up green sputum is not the most urgent client to assess. The child may have a bacterial infection that requires antibiotics, but the condition is not life-threatening or unstable. The child can be classified as urgent and seen within one hour.

Choice B reason: A male adolescent who has been vomiting for the past 12 hours and describes himself as very weak is not the most urgent client to assess. The adolescent may have dehydration, electrolyte imbalance, or gastroenteritis that requires fluid replacement and antiemetics, but the condition is not life-threatening or unstable. The adolescent can be classified as urgent and seen within one hour.

Choice C reason: A female client with severe right lower abdominal pain who is febrile and vomiting is the most urgent client to assess. The client may have appendicitis, ovarian torsion, ectopic pregnancy, or another serious condition that requires immediate diagnosis and treatment. The client is at risk of perforation, infection, shock, or hemorrhage and needs to be seen as soon as possible. The client can be classified as emergent and seen within 15 minutes.

Choice D reason: An elderly client with peripheral vascular disease who is complaining of severe leg pain when ambulating is not the most urgent client to assess. The client may have intermittent claudication, ischemia, or ulceration that requires analgesics, antiplatelets, or vascular surgery, but the condition is not life-threatening or unstable. The client can be classified as semi-urgent and seen within two hours.

Choice A reason: Telling the healthcare provider the nurse will return the phone call as soon as possible is the best instruction for the nurse to provide the unit clerk. The nurse is responsible for receiving and verifying the prescription from the healthcare provider and cannot delegate this task to the unit clerk. The nurse should prioritize the unstable client and call back the healthcare provider when the situation is stable.

Choice B reason: Remaining with this client and monitoring the vital signs while the nurse takes the call is not the best instruction for the nurse to provide the unit clerk. The nurse should not leave the unstable client unattended and should not rely on the unit clerk to perform the nursing assessment and intervention. The nurse should also not take the call from the healthcare provider without verifying the identity and authority of the caller.

Choice C reason: Asking the healthcare provider to remain on "hold" until the nurse can confirm the prescription is not the best instruction for the nurse to provide the unit clerk. The nurse should not keep the healthcare provider waiting on the phone and should respect the healthcare provider's time and availability. The nurse should also not confirm the prescription without receiving and verifying it from the healthcare provider.

Choice D reason: Being sure to write down what is prescribed and then repeat it back to the healthcare provider is not the best instruction for the nurse to provide the unit clerk. The nurse should not allow the unit clerk to receive and transcribe the prescription from the healthcare provider and should not delegate this task to the unit clerk. The nurse should also not assume that the unit clerk has the knowledge and skills to understand and communicate the prescription.