Clinical study guides / Management of care, delegation and patient rightsManagement of care, delegation and patient rights Practice prioritization, safe delegation, communication and patient rights. Apply nursing judgment and the requirements of the care setting.
Practice this collection Delegate within the right circumstance Which client's vital signs can usually be delegated to assistive personnel?
The assistive personnel (AP) have validated competence in measuring vital signs.
Response and reasoning Those of a stable client with predictable needs; the RN keeps accountability and reviews the results.
A stable client with predictable needs fits the right circumstance for delegation.
Client stability is the gatekeeper for delegation.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept What stays with the nurse Which parts of care cannot be delegated?
An AP reports an abnormal reading and asks what to do.
Response and reasoning Clinical reasoning, nursing judgment and critical decision-making, such as interpreting a finding and deciding the response.
Interpreting a new finding and deciding the response is nursing judgment.
Tasks can be delegated; judgment cannot.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept When a delegated client changes What happens when a client's condition changes during a delegated task?
An AP is measuring vital signs on a client who was stable this morning.
Response and reasoning The AP reports the change, and the RN reassesses the client and whether delegation is still appropriate.
The RN reassesses when a delegated client's condition changes.
Delegation depends on a stable circumstance.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Right person for the task What should an AP do when asked to perform a task they have not been validated to do?
The task is in the job description, but the AP has not been checked off.
Response and reasoning Decline and tell the nurse or nursing leadership; competence must be validated before delegation.
The RN performs the task when the delegatee is not validated.
Validated competence comes before delegation.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Accountability after delegating Who stays accountable for the client after a task is delegated?
An AP has completed a delegated walk after the RN assessed and cleared the client.
Response and reasoning The delegating nurse keeps overall accountability and follows up on the task and the client's outcome.
Following up with both and evaluating the outcome is the delegator's role.
Delegate the task, keep the follow-up.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Routine care for assistive personnel What kind of care fits an AP's routine assignment?
The clients involved are stable.
Response and reasoning Routine care within validated AP competence and local law/policy, such as hygiene and measuring intake and output; not assessment, evaluation or teaching.
Hygiene for a stable client is routine care within AP training. Measuring and recording intake and output is routine AP care.
Routine and stable fits; judgment and teaching stay with the nurse.
NCSBN/ANA · National Guidelines for Nursing Delegation · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Choose the first client to see Which finding moves a client to the top of the list?
Four clients on a medical unit need attention at the same time.
Response and reasoning A sudden new neurologic deficit, such as slurred speech, because stroke care is time-sensitive.
Sudden trouble speaking is a stroke warning sign needing immediate action.
Sudden new deficits outrank expected or stable findings.
CDC · Signs and symptoms of stroke · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Airway threats come first Which new symptom after a medication dose signals an emergency?
A client received a first dose of an IV antibiotic 15 minutes ago.
Response and reasoning A hoarse or whispered voice, tongue or throat swelling, or wheezing can signal anaphylaxis and needs immediate action.
A new hoarse voice and itching after a first dose can signal anaphylaxis.
A changing voice can mean a closing airway.
MedlinePlus · Anaphylaxis · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Finish SBAR with a request What belongs in the R of SBAR?
The nurse is calling a provider about a client who is getting worse.
Response and reasoning A specific request with a timeframe that matches urgency (for acute deterioration, now), then repeat back the response.
A recommendation states what is needed and when; new hypoxemia and tachypnea need bedside review now, not a fixed wait.
Say what you need and when.
AHRQ TeamSTEPPS · SBAR · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Consent requires understanding Who explains a procedure's risks for informed consent?
The client is about to sign a surgical consent form.
Response and reasoning The provider explains the problem, the treatment, risks, benefits and alternatives; unanswered questions go back to the provider.
The provider explains risks; unclear understanding is referred back before signing.
A signature without understanding is not informed consent.
MedlinePlus · Informed consent (adults) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Respect an informed refusal Can a client with decision-making capacity refuse a recommended treatment?
The client understands the condition, the options and the risks of refusing.
Response and reasoning Yes. A capable client may refuse; the nurse confirms understanding, notifies the provider and documents.
A capable, informed client has the right to refuse treatment.
Capacity plus understanding supports the right to refuse.
MedlinePlus · Informed consent (adults) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Consent in an emergency Is informed consent required when delay would be dangerous?
The client is unresponsive and needs immediate treatment.
Response and reasoning Treatment can proceed without consent in an emergency when delay would be dangerous, unless a known refusal or directive applies; state law details vary.
Consent is not needed in an emergency when delay would be dangerous.
In a true emergency without known contrary wishes, treatment does not wait for consent.
MedlinePlus · Informed consent (adults) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept When the health care agent decides When does a named health care agent make decisions?
The client named an adult child as health care agent.
Response and reasoning Only when the client cannot make their own health care decisions; the document gives no legal or financial authority.
A capable client makes their own decisions; the agent's role has not begun.
A capable client speaks for themselves.
MedlinePlus · Advance care directives · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept What a DNR order covers Does a DNR order stop other treatments such as pain medicine?
A client with a DNR order develops a new treatable problem.
Response and reasoning No. A DNR order is specific to CPR; other treatments continue unless separately declined.
DNR is specific to CPR; other prescribed treatment continues.
DNR does not mean 'do not treat.'
MedlinePlus · Do-not-resuscitate order · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Advance directives at admission What must hospitals do about advance directives at admission?
An adult is being admitted as an inpatient.
Response and reasoning Give written information about the right to make decisions and create directives, and document whether one exists; care is not conditioned on having one.
Care cannot be conditioned on a directive, and information must be offered.
Ask, inform and document; never condition care on a directive.
eCFR · 42 CFR 489.102 (advance directives) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Sharing information with family present When may a nurse discuss a client's care with a friend or relative who is present?
The client has decision-making capacity.
Response and reasoning When the client agrees or, given the chance, does not object.
Sharing is permitted when the capable client agrees or does not object.
Ask the client first.
HHS · HIPAA FAQ: sharing with family and friends · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Family updates when the client cannot be asked Can relevant information be shared with family when the client cannot be asked?
The client is unconscious after an accident.
Response and reasoning After verifying the caller per facility procedure, share relevant information if professional judgment finds it is in the client's best interest.
Professional judgment permits relevant sharing when the client cannot be asked.
Professional judgment guides sharing when the client cannot decide.
HHS · HIPAA FAQ: sharing with family and friends · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept No patient images on social media Is a patient photo posted without a name a privacy breach?
The nurse wants to share a 'great recovery' story online.
Response and reasoning Yes. Other details can still identify the patient, and nurses may not transmit patient-related images.
Patient-related images are prohibited, and details can still identify the client.
Removing the name does not make a post private.
NCSBN · A Nurse's Guide to the Use of Social Media · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Clients may access their records What right does a client have to their own health information?
A client asks for a copy of their test results and notes.
Response and reasoning To inspect and obtain a copy; the organization generally must act within 30 days, with one possible extension.
Individuals may inspect and obtain copies, with action generally within 30 days.
Access is the client's right, routed through the facility process.
eCFR · 45 CFR 164.524 (right of access) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Screen for partner violence privately How should intimate partner violence screening be done?
A pregnant client arrives with her partner.
Response and reasoning Ask directly in a safe, private setting, and connect a positive screen to ongoing support services.
Screening is best done directly in a safe, private setting.
Privacy makes disclosure possible.
USPSTF · Intimate partner violence screening (2025) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize forms of elder abuse Which situations can be forms of elder abuse?
An older adult depends on a caregiver.
Response and reasoning Physical, sexual or emotional abuse, neglect of basic needs, and improper use of the person's money or property.
Threats that cause fear or distress are emotional abuse. Unauthorized use of an older adult's money is financial abuse. Failing to provide basic needs and medical care is neglect.
Neglect and financial misuse are abuse too; the Eldercare Locator can help find reporting services.
CDC · About abuse of older persons · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Report near misses and unsafe conditions Should events that caused no harm be reported?
The facility uses a confidential safety event reporting system.
Response and reasoning Yes. Near misses and unsafe conditions are reported so the organization can investigate and learn.
Falls are reportable events even without injury. A near miss is reportable so the system can learn from it. An unsafe condition should be reported.
Reporting is for learning, not only for harm.
AHRQ PSNet · Reporting patient safety events · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Restraint is a last resort When may a physical restraint be used in a hospital?
A confused client is pulling at an IV line.
Response and reasoning Only for immediate physical safety, after less restrictive measures prove ineffective, with a practitioner's order (never PRN), ending as soon as possible.
Less restrictive interventions are tried before any restraint.
Try less first, order specifically, release early.
eCFR · 42 CFR 482.13(e) restraint or seclusion · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Call the rapid response team early When can a nurse call the rapid response team?
A client's condition is changing on a medical unit.
Response and reasoning For abnormal vital signs, an acute change in mental status, or significant staff concern, before an arrest occurs.
Abnormal vital signs with an acute mental status change meet typical activation criteria.
Concern is a valid reason to call.
AHRQ PSNet · Rapid response systems · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept START triage categories In START triage, which tag fits a victim with compromised breathing who can be helped quickly?
A mass-casualty scene with adult victims has more victims than responders.
Response and reasoning Immediate (red): needs intervention within minutes; walking wounded are Minor (green).
A respiratory rate of 30/min or more with spontaneous breathing leads to Immediate (red) on the CHEMM chart.
Sort by walking, breathing, perfusion and mental status.
CHEMM (HHS) · START adult triage · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Start discharge planning early When should discharge planning begin for a client likely to need help after discharge?
An older adult who lives alone was admitted after a fall.
Response and reasoning Early in the hospitalization, with the client and caregivers as partners and the client choosing among available providers.
Rules require early identification and involvement of the client and caregivers.
Plan early, and plan with the client.
eCFR · 42 CFR 482.43 (discharge planning) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Organ donation notification Who is notified when a hospitalized client's death is imminent?
A client on life support is not expected to survive.
Response and reasoning The hospital notifies its organ procurement organization in a timely manner; an OPO representative or trained designated requestor approaches the family.
Timely OPO notification of imminent death is required.
Notify per policy; leave the request to trained requestors.
eCFR · 42 CFR 482.45 (organ, tissue and eye procurement) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept What a living will cannot do Does a living will itself name someone to make health care decisions?
A client wants both written wishes and a named decision-maker.
Response and reasoning No. The living will records care wishes; naming a decision-maker is done by appointing a health care agent (health care power of attorney). Forms and rules vary by state, and some advance-directive forms include both.
A client who wants a named agent needs a valid agent appointment under local rules so someone can act when they cannot.
Wishes and decision-makers are different functions.
MedlinePlus · Advance care directives · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Families may be able to call for help Who may activate a rapid response team?
A family member is worried that a client is getting worse.
Response and reasoning Any staff member who meets the criteria or has significant concern, and at some hospitals patients and families too.
Families often notice subtle changes early; knowing the local process speeds help.
Teach families the facility's call process.
AHRQ PSNet · Rapid response systems · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Client choice in post-acute care Who chooses the home health agency or facility after a hospital stay?
A client needs home health care after discharge.
Response and reasoning The client, from available participating providers; the hospital gives a list and may not limit qualified options.
Respecting choice supports autonomy and is required for Medicare-participating hospitals.
Offer the list; let the client choose.
eCFR · 42 CFR 482.43 (discharge planning) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Sources Use these notes to study clinical concepts. In patient care, follow the setting's emergency response and treatment protocols.