When planning delegation of tasks to assistive personnel (AP), a nurse considers the five rights of delegation. Which of the following should the nurse consider when using one of the five rights of delegation?

The AP’s rapport with clients

The AP’s ability to complete the task without assistance

The AP has the knowledge and sail to perform the task

The AP’s ability to prioritize

Answer and Explanation

The Correct Answer is C

A. The AP’s rapport with clients:
While a positive rapport with clients is valuable, it is not a direct factor in determining whether an AP is suitable for a specific task based on the five rights of delegation.

B. The AP’s ability to complete the task without assistance:
The ability to complete a task without assistance is relevant but does not guarantee that the AP has the necessary knowledge and skill for the task. The focus should be on competence rather than independence.

C. The AP has the knowledge and skill to perform the task
When considering the five rights of delegation, one of the crucial factors is ensuring that the assistive personnel (AP) has the knowledge and skill necessary to perform the delegated task safely and effectively. Delegated tasks should align with the AP's competence and training to maintain the safety and well-being of the client.

D. The AP’s ability to prioritize:
Prioritization skills are important for healthcare providers, but the focus of delegation, as per the five rights, is on the AP's competence to perform the specific task.

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Correct Answer is C

Explanation

A. Close the fire doors on the unit:
Closing fire doors is a safety measure to contain smoke and flames, but activating the fire alarm is the priority to ensure a swift and comprehensive response.

B. Use a fire extinguisher to put out the fire:
While using a fire extinguisher is an important action, it should come after activating the fire alarm. The fire alarm alerts everyone to the emergency, and then the appropriate personnel can use fire extinguishers as needed.

C. Move any clients in the immediate vicinity:

Priority action during a fire: The priority in any fire situation is to ensure the safety of individuals in the immediate area. The acronym RACE is commonly used in healthcare settings to outline the steps to take in the event of a fire:

Rescue anyone in immediate danger.
Alarm: Activate the fire alarm.
Contain the fire by closing doors.
Extinguish the fire if it is small and safe to do so, or Evacuate the area if necessary.

D. Activate the fire alarm
This is also important but comes after rescuing or moving clients in immediate danger.

A. Prepare to administer a sedative B. Assess for indications of pulmonary embolism. C. Administer oxygen via face mask. D. Prepare for mechanical ventilation

Correct Answer is C

Explanation

A. Prepare to administer a sedative:
Administering a sedative is not the priority in this situation. The client is experiencing shortness of breath, tachycardia, and hypoxemia, indicating a respiratory issue that needs immediate attention. Sedation can further depress the respiratory drive and exacerbate the hypoxemia.

B. Assess for indications of pulmonary embolism:
While the client's symptoms could be related to a pulmonary embolism, the priority at this moment is to address the immediate respiratory distress. Administering oxygen is crucial before further diagnostic assessments can take place. Once the client is stabilized, additional assessments can be performed to explore the cause of the symptoms.

C. Administer oxygen via face mask:
This is the correct and priority intervention. The client is hypoxic (SaO2 86%) with a low PaO2 and high respiratory rate. Administering oxygen via a face mask aims to improve oxygenation and relieve the hypoxemia associated with the respiratory distress.

D. Prepare for mechanical ventilation:
Mechanical ventilation may be considered if the client's respiratory distress is severe and not responsive to oxygen therapy. However, the immediate step is to administer oxygen via a face mask. If the client's condition does not improve with oxygen therapy, mechanical ventilation may be the next step.

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When planning delegation of tasks to assistive personnel (AP), a nurse considers the five rights of delegation. Which of the following should the nurse consider when using one of the five rights of delegation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

Correct Answer is C

Explanation

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