# Situation: On the evening shift, a 30-bed adult medical ward has 28 clients. The staff are the charge nurse, a registered nurse (RN) with 6 years of medical ward experience, an RN floated from the operating room who has never worked on a medical ward, and one trained nursing attendant. Which task may the charge nurse delegate to the nursing attendant?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629857  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: On the evening shift, a 30-bed adult medical ward has 28 clients. The staff are the charge nurse, a registered nurse (RN) with 6 years of medical ward experience, an RN floated from the operating room who has never worked on a medical ward, and one trained nursing attendant.

Which task may the charge nurse delegate to the nursing attendant?

## 보기

1. Applying a prescribed cream to a stable client's itchy dermatitis
2. Feeding a client on day 2 after a stroke who coughs when drinking
3. Taking hourly vital signs of a client admitted after vomiting blood
4. Recording intake and output for a stable client on oral furosemide **✔ 정답**

**정답: 4**

## 해설

Safe delegation needs both the right task and the right circumstance. Recording intake and output is a routine, predictable task, and the client is stable, so it may be delegated; the RN interprets the totals. Feeding and vital signs are tasks an attendant can do, but not for a client with signs of aspiration or an unstable new admission, and applying a prescribed cream is medication administration, which is within nursing scope under the Philippine Nursing Act of 2002 (RA 9173) even when the client is stable.

## 심화 해설

Core principle of safe delegation

Delegation to a trained nursing attendant (unlicensed assistive personnel, UAP) is appropriate only when three conditions are met at the same time: the task is routine and predictable, the client is stable, and the outcome can be verified by the registered nurse. The decision to delegate is not only about what the task is, but also about the clinical stability of the client and the level of judgment required at that moment. In this situation, the ward has a charge nurse, one experienced medical RN, one OR RN floated to an unfamiliar unit, and one nursing attendant, so the charge nurse must match each task to the safest available person.

Why option 4 is the correct delegation

Recording intake and output for a stable client on oral furosemide is a routine, measurable task with predictable steps. The client is described as stable, and the task does not require clinical interpretation at the bedside. The nursing attendant can accurately measure and record urine output and fluid intake, while the RN retains responsibility for interpreting the totals and adjusting care based on the diuretic response. This division matches the delegation principle that UAP may collect data, but the RN analyzes and acts on that data. The task is also time-limited and easily supervised, which reduces the risk of error.

Why the other options are unsafe or outside UAP scope

| Option | Task type | Why it cannot be delegated to the nursing attendant |
| --- | --- | --- |
| 1. Applying a prescribed cream to a stable client’s itchy dermatitis | Medication administration | Applying a prescribed topical medication is a nursing responsibility under the Philippine Nursing Act of 2002 (RA 9173). Even when the client is stable and the skin condition appears simple, the act of applying a prescribed cream requires assessment of the skin, knowledge of the drug, and documentation of the therapeutic response. Watch out! Stability of the client does not change the legal scope of practice; medication administration cannot be delegated to UAP. |
| 2. Feeding a client on day 2 after a stroke who coughs when drinking | Feeding with aspiration risk | Feeding is normally a task an attendant can perform, but this client shows a sign of possible dysphagia — coughing when drinking. A client who coughs during oral intake requires swallowing assessment and possibly modified textures or positioning, which is a nursing judgment, not a routine feeding task. Delegating this client to the attendant would place the client at risk for aspiration pneumonia. The RN must first assess swallowing and determine the safe feeding method. |
| 3. Taking hourly vital signs of a client admitted after vomiting blood | Frequent monitoring of an unstable client | Hourly vital signs on a client with a possible upper GI bleed indicate hemodynamic monitoring for shock. This is a new admission with an unstable or potentially unstable condition. Key point! The frequency and clinical significance of the vital signs require the RN to interpret trends and respond immediately to changes. Although measuring vital signs is a task UAP can perform, the unstable context and the need for rapid clinical judgment make this unsafe to delegate. |

Delegation and communication with UAP

Effective delegation to UAP requires clear, specific communication about what to do, what to report, and when to report back. When the RN delegates a task such as intake and output recording, the RN must give the attendant clear parameters — for example, what counts as intake, how to measure urine, and which changes to report immediately, such as a sudden drop in urine output. The RN also verifies that the attendant understands the instructions and can perform the task correctly. This two-way communication reduces errors and improves patient outcomes.

Supervision and accountability

Delegation does not transfer accountability. The RN who delegates remains responsible for the overall nursing care and for ensuring the task was performed correctly. Key point! The RN must follow up after delegation, check the recorded intake and output, and use that data to evaluate the client’s response to furosemide. If the RN fails to supervise or interpret the data, the delegation is incomplete even if the attendant performed the task accurately. In this ward situation, the charge nurse should also consider the floated OR RN’s unfamiliarity with medical ward routines and may need to provide closer supervision or assign that RN to more stable clients while the experienced medical RN handles complex cases.

## 임상 시나리오

Delegation to Nursing AttendantRight task, right client, right supervision
Delegate only when the task is routine and predictable, the client is stable, and the RN can verify the outcome. Recording intake and output for a stable client on oral furosemide meets all three conditions.

The nursing attendant may collect data such as measuring urine output, but the RN must interpret the totals and adjust care based on diuretic response.

CautionDo not delegate medication administration including topical creams, or any task on a client with signs of aspiration or hemodynamic instability such as vomiting blood.

## 핵심 개념

- **Delegation** — Transferring responsibility for a task while retaining accountability; safe only for routine, predictable tasks on stable clients.
- **UAP** — Unlicensed assistive personnel such as nursing attendants; may collect data but cannot assess, interpret, or administer medications.
- **Intake and output** — Measurement of fluids taken in and excreted; data collection task appropriate for UAP when client is stable.
- **Furosemide** — Loop diuretic that increases urine output; requires monitoring of fluid balance and electrolytes by the RN.
- **RA 9173** — Philippine Nursing Act of 2002; defines nursing scope including medication administration as an RN responsibility.

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