# Stage 6 — Evaluate outcomes. Review the shift trend and select the best evaluation and handoff plan. Improvement does not mean that Patient A's PE or Patient D's delirium risk has resolved.

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> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

Stage 6 — Evaluate outcomes. Review the shift trend and select the best evaluation and handoff plan. Improvement does not mean that Patient A's PE or Patient D's delirium risk has resolved.

| Time | Data |
| --- | --- |
| 0700 handoff | A: sudden dyspnea, SpO2 89 percent RA, HR 110, RR 24, BP 138/86, new unilateral calf findings. D: oriented to person and place instead of documented baseline times three, unsafe bed-exit attempts. |
| 0715 coordinated response | RN stays with A, stops ambulation, applies prescribed oxygen, starts continuous monitoring, and activates provider and urgent-response pathways. UAP provides immediate safety presence for D once directed. |
| 1000 after workup | A: CT confirms acute PE with mild RV strain; BP 130/80, HR 92, SpO2 95 percent on 2 L/min; therapeutic anticoagulation initiated after bleeding assessment. D: acute confusion reported and evaluated; no fall. |
| 1500 outcomes | A: monitored-unit transfer, BP 128/78, HR 88, SpO2 95 percent on 2 L/min, no bleeding. B: medication and teaching reinforcement completed and RN-evaluated. C: pain 3/10 and I&O completed. D: no fall or line removal; delirium assessment continues. |

Q1. How should the RN evaluate the priority and delegation strategy?

Effective initial management with improved physiology and completed stable-client care, but PE and delirium risks still require follow-up
Completely successful because all active diagnoses and safety risks resolved before handoff
Ineffective because any use of delegation during a critical event abandons the unstable client

Q2. What information has the highest priority in handoff?

Patient A's confirmed PE, oxygen and anticoagulation plan, bleeding and deterioration triggers, plus Patient D's acute cognitive change and safety follow-up
Only Patient B's completed discharge paperwork because scheduled tasks define shift success
A request that the oncoming RN repeat every assessment without receiving current findings
Only the fact that no falls occurred, because current cognitive status no longer needs evaluation

## Explanation

Outcome evaluation
The strategy was effective but requires continued follow-up. Patient A's oxygenation and heart rate improved after prompt recognition, escalation, confirmed PE diagnosis, and anticoagulation, but right ventricular strain and bleeding risk require monitored care. Patient D had no fall or line removal after safety support, yet the acute mental-status change still requires ongoing delirium evaluation. The handoff must communicate both active risks and the outcomes of delegated care for every client remaining on the unit.

## In-depth explanation

Step 1 — Evaluate goals, not task completion alone
Patient A improved physiologically, Patient B's established plan was completed and evaluated, Patient C's pain improved, and Patient D remained safe. These findings support effective coordination.

Step 2 — Identify unresolved risk
Acute PE with right ventricular strain still requires hospitalization, anticoagulant surveillance, and monitoring for deterioration. Absence of a fall does not resolve Patient D's acute confusion or its cause.

Step 3 — Handoff the active problems
Communicate Patient A's oxygen, anticoagulation, bleeding, hemodynamic, and respiratory plan and Patient D's cognitive baseline change, evaluation, and safety plan. Include pending follow-up for Patient C and any client not discharged.

NCLEX rule
Evaluation asks what improved, what remains unsafe, and what the next nurse must continue.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
The RN reviews physiologic, safety, pain, teaching, and delegation outcomes before handoff.

Clinical judgment target
Distinguish successful initial management from complete resolution and hand off unresolved risks.

## Key concepts

- **PE clinical trajectory** — Serial oxygenation, heart rate, blood pressure, symptoms, right ventricular status, and treatment complications used to detect improvement or deterioration.
- **Delirium follow-up** — Ongoing assessment of an acute cognitive change and its reversible causes even when immediate fall-prevention measures are effective.
- **Continuity-of-care handoff** — Communication of active diagnoses, treatment, response, unresolved risks, pending work, and contingency triggers to the receiving nurse.

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