The nurse is working in the medical-surgical unit. Which client should the nurse assess first?

Effective delegation requires clinical judgment to differentiate between stable and unstable outcomes. Unlicensed personnel perform non-complex tasks involving functional activities or routine data collection. The nurse remains legally accountable for assessing patients, interpreting vital signs, and performing any invasive clinical interventions.

Rationale:

A. Postoperative patients require advanced assessment by the registered nurse during their first mobilization. Initial ambulation carries risks of orthostatic hypotension or prosthesis dislocation. The nurse must evaluate the patient's balance, weight-bearing tolerance, and neurological status before delegating subsequent walks to assistive personnel.

B. The process of discharge teaching involves complex pedagogical strategies and evaluation of learner readiness. Only the licensed nurse can provide education or clarify medical instructions. UAPs can assist with packing personal belongings but cannot explain medications, follow-up care, or signs of complications.

C. Collecting physiological data for a patient in a stable condition is a standard UAP competency. While the patient receives medication, the measurement of blood pressure and heart rate is a repetitive, objective task. The nurse must still interpret these values for potential adverse reactions.

D. Patients who are 48 hours post-hysterectomy are typically considered physiologically stable for routine activity. Assisting a recovering patient with mobility is within the UAP scope of practice once the initial assessment is complete. This helps prevent venous thromboembolism and promotes bowel motility.

E. Inserting peripheral venous catheters is an invasive procedure requiring sterile technique and clinical expertise. Such tasks are strictly outside the scope of unlicensed personnel. The nurse must perform the venipuncture and then assess the patient's response to any administered analgesic medications.

A surgical ophthalmic care environment requires prioritization based on nursing scope of practice, task delegation principles, patient acuity, and educational versus technical interventions, ensuring the RN performs complex assessment, teaching, and postoperative clinical judgment functions while delegating routine tasks appropriately within a team-based model.

Rationale:

A. This involves postoperative education requiring clinical assessment of understanding, reinforcement of discharge instructions, and evaluation of potential complications after cataract surgery. RN-level responsibility is appropriate because it requires critical thinking and individualized teaching based on surgical outcomes.

B. This task involves basic nursing care that is procedural and repetitive, such as applying an eye patch. It can be delegated to assistive personnel. It does not require RN assessment or clinical judgment, making it inappropriate for RN assignment in team-based care.

C. This task involves medication administration requiring knowledge of ocular pharmacology, correct instillation technique, and monitoring for adverse effects such as intraocular pressure changes or irritation. RN responsibility is appropriate due to required clinical competency and safety monitoring.

D. This involves patient education for self-administration of ophthalmic drops, requiring evaluation of learning readiness, demonstration return, and correction of technique. RN-level critical thinking is needed to ensure safe long-term self-management and adherence to therapeutic regimen.

E. This involves preoperative teaching, which is an RN responsibility; however, in team assignment prioritization, it is less acute than immediate postoperative teaching or medication administration. While appropriate for RN scope, it is not prioritized over higher acuity postoperative needs.