A nurse is planning to delegate a task to an assistive personnel (AP). Which of the following actions should the nurse plan to take?

Rationale:

A. A client who reports pain as 4 on a scale of 1 to 10 at 0800 now reports pain as 6 needs pain management, but this is less urgent compared to potential signs of hypotension.

B. A client whose wound drainage at 0800 was sanguineous and now it is serosanguineous indicates normal progression of wound healing; thus, it is less critical.

C. A client who has a prescription for insulin and his premeal capillary blood glucose was 110 mg/dL and his post-meal capillary blood glucose is now 160 mg/dL needs blood glucose management, but this is less urgent than assessing for potential hypovolemia or shock.

D. A client whose blood pressure at 0800 was 138/86 mm Hg and at 1200 is 106/60 mm Hg is experiencing a significant drop in blood pressure, which could indicate hypovolemia or shock. This requires immediate assessment and intervention to prevent complications.

A. Nonmaleficence: By completing a critical care and emergency nursing course before transferring to the ICU, the nurse is ensuring they are adequately prepared to care for critically ill clients. This action minimizes the risk of harm caused by a lack of knowledge or skill, demonstrating adherence to the principle of nonmaleficence.

B. Veracity: Veracity refers to truthfulness and honesty in interactions with clients and colleagues. While important, this scenario does not focus on providing truthful information.

C. Autonomy: Autonomy refers to respecting a client's right to make decisions about their care. This scenario does not involve supporting or promoting client decision-making.

D. Fidelity: Fidelity refers to being faithful to commitments and promises made to clients or the profession. While the nurse is demonstrating professional responsibility, this scenario aligns more closely with nonmaleficence than fidelity.