A nurse is caring for four clients. Which of the following tasks can the nurse delegate to an assistive personnel?

A.Planning a more "reasonable" job assignment assumes the workload was too high, but bathing four clients and taking vital signs is a standard workload for an AP during a shift. The issue in the scenario is a lack of prioritization and communication rather than an impossible volume of work. Reducing the assignment without addressing the time-management issues does not improve the nurse's delegatory skills or the team's efficiency. The nurse must focus on the process of delegation.

B. Co-assign a more qualified individual to assist the AP: While sharing tasks can help in the moment, it does not address the underlying issue of unrealistic workload planning. Relying on additional staff each time may not be feasible and does not improve delegation skills for future assignments.

C.Setting a clear time frame for each task is the most appropriate strategy for more effective delegation. By providing a "due by" time, the nurse helps the AP prioritize their workload and allows for early identification of barriers to completion. Without specific deadlines, the AP may follow a sequence that does not align with the unit's flow, such as delaying baths that are required before a client can participate in physical therapy. Clear expectations reduce ambiguity and improve clinical accountability.

D. Volunteer to give the baths for the AP: Completing tasks for the AP undermines delegation principles and does not address the need for effective planning. It shifts the workload back to the nurse rather than improving future delegation and efficiency.

Rationale for correct choices

• Hypoxemia: The client has an oxygen saturation of 88% on room air and 89% on 2 L/min via nasal cannula, which indicates inadequate oxygenation. Hypoxemia is immediately life-threatening if not addressed promptly and takes priority over infection, hyperglycemia, or dehydration. Correcting oxygenation helps prevent tissue hypoxia and supports organ function.

• Oxygen saturation: The oxygen saturation measurement directly reflects the client’s hypoxemic status. Continuous monitoring of oxygen saturation is critical to evaluate the effectiveness of supplemental oxygen therapy and guide adjustments. This parameter is an objective indicator of respiratory compromise and provides the most immediate evidence for urgent intervention.

Rationale for incorrect choices

• Infection: The client has pneumonia evidenced by fever, productive cough with yellow sputum, and elevated WBC count. While infection requires prompt antibiotic therapy, it is not more immediately life-threatening than hypoxemia. Addressing oxygenation takes precedence before managing the underlying infection.

• Type 2 diabetes mellitus: The client’s blood glucose is elevated at 195 mg/dL, reflecting hyperglycemia. Although this requires monitoring and potential insulin therapy, it is not an immediate threat to oxygenation or organ perfusion. Hyperglycemia management is important but secondary to correcting hypoxemia.

• Dehydration: The BUN is slightly elevated at 25 mg/dL, which may indicate mild dehydration. The client is receiving IV fluids to support hydration. While fluid balance should be monitored, dehydration is not the most urgent issue compared with the client’s low oxygen saturation.

• BUN level: BUN elevation provides indirect evidence of fluid status or renal function but does not indicate immediate risk to tissue oxygenation. It is important for ongoing assessment but does not guide the initial urgent intervention.

• Blood glucose: Blood glucose reflects the client’s diabetic status and hyperglycemia. It is important to monitor and manage over time, but it does not provide the immediate evidence of hypoxemia that requires urgent correction.

• WBC count: Elevated WBC indicates infection and systemic inflammation. While this guides antibiotic therapy and monitoring, it does not address the immediate risk posed by hypoxemia. Prompt oxygen therapy takes priority.