Nursing Prioritization Delegation Assignment Q 17
The clinical instructor directed the student nurse to care for a client whose potassium is 6.7 mEq/L. Which intervention is delegated correctly to the student nurse?
A. Give potassium 10 mEq orally
B. Give sodium polystyrene sulfonate (Kayexalate) 15 g orally
C. Give spironolactone (Aldactone) 25 mg orally
D. Assess the electrocardiogram (ECG) strip for tall T waves
Correct Answer: B. Give sodium polystyrene sulfonate (Kayexalate) 15 g orally
Delegation, supervision. The normal range for potassium is 3.5 to 5 mEq/L. The client’s potassium level is high. Kayexalate eliminates potassium from the body through the gastrointestinal system. The right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job.
Option A: Giving additional potassium may further increase the serum potassium level. The registered nurse determines and analyzes all of the health care needs for a group of clients; the registered nurse delegates care that matches the skills of the person that the nurse is delegating to.
Option C: Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The delegating registered nurse remains accountable for all client care despite the fact that some of these aspects of care can, and are, delegated to others.
Option D: The beginning nursing student does not have the skill to assess ECG strips. Some client needs are relatively predictable; and other patient needs are unpredictable based on the changing status of the client. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routine and without the need for high levels of professional judgment and skill.