# A charge nurse is making assignments for the upcoming shift. Which patient assignment should the charge nurse prioritize for the most experienced registered nurse?

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> subject: Next Gen NCLEX

## 문제

A charge nurse is making assignments for the upcoming shift. Which patient assignment should the charge nurse prioritize for the most experienced registered nurse?

## 보기

1. A 45-year-old patient with stable diabetes mellitus requiring routine blood glucose monitoring and insulin administration
2. A 28-year-old patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation requiring frequent assessments and ventilator management **✔ 정답**
3. A 65-year-old patient with chronic heart failure who is stable on oral medications and scheduled for discharge education
4. A 52-year-old patient recovering from an uncomplicated appendectomy on postoperative day 2 with stable vital signs and routine wound care

**정답: 2**

## 해설

Patients with ARDS on mechanical ventilation require the highest level of nursing expertise due to complex care needs and risk of rapid deterioration. Other patients have stable conditions or routine care needs that are less demanding.

## 심화 해설

Understanding the Priority Setting Framework

The charge nurse must consider patient acuity, stability, and the complexity of required nursing care when making assignments. The most experienced registered nurse should be assigned to the patient with the highest risk of rapid deterioration and the most complex, intensive monitoring needs. This principle aligns with triage concepts, where the priority of evaluation and resource allocation is determined by clinical urgency. Undertriage, or the underestimation of a patient's acuity, poses a significant safety risk and can lead to delays in critical interventions [1].

Analysis of Patient Acuity and Nursing Care Requirements

The patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation represents the highest acuity assignment. This patient requires continuous, high-level assessment of respiratory status, hemodynamic monitoring, ventilator waveform analysis, and titration of sedation and vasoactive medications. The potential for life-threatening complications such as ventilator-associated pneumonia, barotrauma, or acute desaturation is significant. This patient's condition is dynamic and unpredictable, demanding a nurse with advanced critical thinking skills, expert clinical judgment, and the ability to intervene rapidly. In the context of triage principles, this patient would be categorized as a high-priority case requiring immediate and intensive resources; assigning them to a less experienced nurse would be a form of clinical undertriage, increasing the risk of adverse outcomes [1,2].

The other patients, while requiring competent nursing care, are clinically stable and have predictable care trajectories. A patient with stable diabetes mellitus requires routine monitoring and medication administration. A patient with chronic heart failure who is stable on oral medications and ready for discharge requires patient education, which is a core competency for all registered nurses. A postoperative appendectomy patient with stable vital signs requires routine wound care and ambulation. These assignments are appropriate for nurses with varying levels of experience and do not necessitate the advanced skill set of the most experienced team member. Accurate assignment matching ensures effective resource utilization and minimizes the risk of care delays for the most critically ill patients .References (research sources)

- [1]Emergency Department Undertriage: Using Multidisciplinary Case Review to Drive Quality Improvement.Research articleMcCollum NL, Chamberlain JM, Williams K, Kappy B, Jones T, Stein L, Thomas A, Alleyne A, Berkowitz DD. (2026) · DOI: 10.1097/pq9.0000000000000878

## 임상 시나리오

Prioritizing Assignment for an Experienced RNMatching patient acuity with nursing competency
The charge nurse must assign the most complex and unstable patient to the most experienced RN. This decision is driven by patient acuity, not just diagnosis. A patient with ARDS on mechanical ventilation requires continuous, high-level assessments and rapid intervention.

Key assessment needs include ventilator waveform analysis, hemodynamic monitoring, and titration of vasoactive drugs and sedation. The risk for life-threatening complications like acute desaturation or barotrauma is high. This dynamic condition demands expert clinical judgment.

CautionAvoid assigning this patient to a novice nurse. Undertriage of patient acuity is a critical safety error that can delay life-saving interventions. Stable patients with predictable outcomes, such as those awaiting discharge or with routine care needs, are appropriate for less experienced staff.

## 핵심 개념

- **Acute Respiratory Distress Syndrome (ARDS)** — A severe, life-threatening lung condition causing fluid buildup in the alveoli, leading to severe hypoxemia and often requiring mechanical ventilation.
- **Patient Acuity** — A measurement of the intensity of nursing care required by a patient, based on the severity of their condition and complexity of needed interventions.
- **Mechanical Ventilation** — A life-support intervention using a machine to assist or replace spontaneous breathing, requiring continuous monitoring of airway, breathing, and ventilator settings.
- **Nursing Delegation** — The process of transferring responsibility for performing a task to another qualified person while retaining accountability for the outcome.
- **Triage** — A clinical process of sorting patients based on the severity of their condition to prioritize care and allocate resources effectively.

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