# Review the charge nurse's shift updates and determine how the changing acuity should affect assignment and delegation decisions. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393508&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question Review the charge nurse's shift updates and determine how the changing acuity should affect assignment and delegation decisions. | Time | Data | | --- | --- | | 0700 | Team: charge RN, 2 RNs, 1 LPN/LVN, and 1 UAP. Original assignments are based on stable overnight reports. | | 0715 | One RN begins scheduled discharge teaching for a stable client. The UAP starts routine morning weights. | | 0730 | A client 6 hours after thyroidectomy develops new inspiratory stridor, restlessness, and oxygen saturation 89% on room air. | | 0740 | Another client remains stable and needs a routine daily weight and assistance setting up the breakfast tray. | Q1. Which update most strongly requires immediate revision of the assignment? The stable client is ready for scheduled discharge teaching The UAP has started routine morning weights The postoperative client develops stridor and oxygen saturation 89% Q2. What should the charge nurse do first after the 0730 update? Send an experienced RN to assess and activate the emergency response while redistributing stable tasks Keep the original assignments so every planned task is completed on time Ask the UAP to assess the airway while the RNs finish scheduled care Q3. Which task remains appropriate to delegate to the UAP after assignments are revised? Determine whether the stridor is caused by airway edema Obtain and report the routine daily weight of the stable client Decide whether a change in weight requires a diuretic adjustment ## Explanation Assignments must be revised when a client's condition changes. New stridor after thyroidectomy is an airway emergency and is the update that most strongly changes the plan. The charge nurse should send an experienced RN to assess and activate emergency response while redistributing stable tasks. A routine daily weight for a stable client can be delegated to the unlicensed assistive person, with the RN retaining responsibility to interpret and act on the result. Initial assessment, clinical judgment, and care of an unstable client cannot be delegated. ## In-depth explanation Trend to recognize The assignment that was reasonable at 0700 is no longer safe after a client develops stridor. Management of care requires reassessment as acuity and staff availability change. Priority response Place an experienced RN at the bedside, activate the emergency pathway, and redistribute predictable care for stable clients. The charge nurse may need to take a direct-care role while preserving oversight of the unit. Delegation rule Delegate the task, not the nursing judgment: stable and predictable work may move; assessment and instability stay with the RN. Why the alternatives fail Discharge teaching and routine weights matter, but they do not outrank an airway emergency. An unlicensed assistive person may collect a routine weight but does not interpret fluid-status changes or assess stridor. Keeping the original assignment despite a major acuity change ignores supervision responsibility. Source 12026 NCLEX-RN Test Plan: Management of Care 2NCSBN Delegation Resources ## Clinical scenario Setting A medical-surgical charge nurse is coordinating care with two registered nurses, one licensed practical or vocational nurse, and one unlicensed assistive person. 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