A healthcare professional is preparing to delegate client care tasks to an assistive personnel (AP). Which of the following tasks should the healthcare professional delegate?

Correct Answer: A

Rationale: The correct answer is option A: 'Confirming that a client's pain has decreased after receiving an analgesic.' This task involves assessing the effectiveness of the medication, which can be delegated to the assistive personnel. Options B, C, and D involve skills that should be performed by licensed healthcare professionals due to their complexity and potential risks if not done correctly. Ambulating a postoperative client requires monitoring for signs of distress or complications, inserting a urinary catheter involves an invasive procedure with infection risks, and demonstrating the use of medical devices like an incentive spirometer requires specialized knowledge to ensure correct usage.

Correct Answer: A

Rationale: The correct answer is A because the 2010 Institute of Medicine report recommended that nurses practice to the full extent of their education, which includes utilizing advanced practice nurses. This supports the efficient delivery of healthcare services. Choice B is incorrect as it focuses on the relationship between advanced practice nurses and physicians rather than a reason for increasing their use. Choice C is not a direct reason for increasing the use of advanced practice nurses but rather a statement about the terminal degree for nurse practitioners. Choice D is incorrect as advanced practice nurses do possess the skills necessary to diagnose and provide advanced care.

Correct Answer: B

Rationale: The correct answer is **B: Assessment** because it is the foundational step in any nursing process, especially when addressing ethical dilemmas. Ethical dilemmas in nursing often involve complex, nuanced situations where multiple perspectives, values, and potential outcomes must be carefully considered. Assessment involves gathering all relevant information—medical, psychosocial, cultural, and ethical—to fully understand the context of the dilemma. This includes reviewing the patient’s medical history, their expressed wishes (if possible), the family’s concerns, legal considerations, and institutional policies. Without a thorough assessment, any subsequent actions could be misguided, ineffective, or even harmful. Ethical decision-making frameworks, such as the Four-Box Model (medical indications, patient preferences, quality of life, and contextual features), rely on comprehensive data collection first. Only after this can the nurse proceed to analyze, plan, and implement a solution. **A: Planning** is incorrect because it is a premature step if the nurse has not yet assessed the full scope of the dilemma. Planning involves developing a strategy to address the problem, but without a clear understanding of the patient’s condition, values, and the ethical conflict at hand, any plan would lack a solid foundation. For example, if the dilemma involves end-of-life care, the nurse cannot plan whether to advocate for palliative measures or continued treatment without first assessing the patient’s prognosis, advance directives, and family dynamics. Planning without assessment risks imposing solutions that do not align with the patient’s best interests or legal/ethical standards. **C: Evaluation** is incorrect because it occurs after actions have been taken, not at the outset of addressing an ethical dilemma. Evaluation involves reviewing the outcomes of implemented interventions to determine their effectiveness. In this scenario, no interventions or decisions have yet been made, so evaluating at this stage would be illogical. For instance, if the dilemma involves a family’s disagreement over a patient’s treatment, evaluating outcomes before even understanding the conflict would skip critical steps like clarifying misunderstandings or consulting ethics committees. Evaluation is essential but belongs at the end of the process, not the beginning. **D: Implementation** is incorrect because it assumes the nurse already has a clear course of action, which is impossible without first assessing the situation. Implementation involves executing a plan, but in an ethical dilemma, the plan itself must be carefully constructed based on gathered data. Jumping to implementation could lead to actions that violate patient autonomy, professional ethics, or legal standards. For example, if a family insists on a treatment the patient previously refused, implementing their demands without assessing the patient’s documented wishes or capacity would be unethical. Implementation relies on prior steps—assessment, analysis, and planning—to ensure the action is justified and appropriate. In summary, assessment is the critical first step because it ensures the nurse has all necessary information to navigate the ethical dilemma thoughtfully and systematically. Skipping this step undermines the integrity of the entire decision-making process, potentially leading to poor outcomes for the patient and family. The other choices—planning, evaluation, and implementation—are vital components of the nursing process but are only effective when built upon a thorough assessment.

Correct Answer: B

Rationale: Confidentiality is the ethical principle that requires healthcare professionals to protect patient information from unauthorized disclosure. In this scenario, the RN has a duty to safeguard the senator's medical details, even in casual conversations with friends. The Health Insurance Portability and Accountability Act (HIPAA) legally enforces this principle, prohibiting sharing identifiable health information without consent. The RN must avoid confirming the senator's hospitalization or disclosing any specifics about their condition, as doing so would violate professional and legal obligations to maintain patient privacy. **Fidelity** involves keeping promises and maintaining trust in professional relationships. While fidelity is important in nursing, it is not the central issue here. The RN did not make any explicit promises to the senator about secrecy, nor is this about upholding an agreement—rather, it is about the inherent duty to protect private health information. Fidelity applies more broadly to reliability and commitment to patient care, not specifically to confidentiality breaches. **Veracity** refers to truthfulness in communication. While the RN should not lie to friends, the situation does not demand a truthful disclosure about the senator’s condition—it demands silence. The ethical obligation is to withhold information, not to provide truthful or deceptive answers. Veracity would be more relevant if the RN were directly asked by the senator’s family or another healthcare provider in a professional context, where honesty is required. **Accountability** means taking responsibility for one’s actions and decisions. While the RN must account for any breaches of confidentiality, the question focuses on the immediate ethical principle guiding the response, not accountability after the fact. Accountability would come into play if the RN had already disclosed information and needed to answer for that mistake, but the scenario emphasizes preventing disclosure in the first place. Thus, confidentiality is the overarching principle, as it directly addresses the protection of patient information in all settings, including social interactions. The RN must recognize that personal curiosity does not override the legal and ethical duty to keep patient details private, regardless of the patient's public status. The other principles, while valuable, are either secondary or irrelevant to this specific situation.

Correct Answer: D

Rationale: A violation of the nurse practice act falls under the category of tort. Tort refers to civil wrongs that cause harm or loss to another person, and a violation of the nurse practice act can result in a civil lawsuit against the nurse for negligence or malpractice. Choices A, B, and C are incorrect because a violation of the nurse practice act does not fall under juvenile offenses, felonies, or misdemeanors, but rather under civil wrongs known as torts.