A nurse on a medical-surgical unit is assisting with the review of the electronic medical record for a group of clients during a mass casualty event.
Exhibits
Select the 2 clients the nurse should recommend for discharge to make room for clients injured in the disaster.
Client 4
Client 5
Client 3
Client 1
Client 2
Correct Answer : C,E
A. Client 4:
This client has COPD with a fever of 39.5° C and blood-tinged sputum, likely due to an acute infection such as pneumonia. The client is unstable and requires inpatient treatment - not a discharge candidate.
B. Client 5:
This client has diarrhea, dehydration, hypotension (BP 84/50 mm Hg), and tachycardia. These are unstable vital signs and require continued inpatient care - not a discharge candidate.
C. Client 3:
This client is 4 days post–hip arthroplasty, is ambulating well with assistance, and is stable. The client can be discharged with home health or outpatient follow-up to free up a bed during a mass casualty.
D. Client 1:
This client was admitted for chest pain and recently required nitroglycerin for relief. Cardiac instability risk remains, so the client should not be discharged at this time.
E. Client 2:
This client is stable, awaiting elective bariatric surgery the next day. Elective procedures can be postponed, and the client can be discharged during a disaster to make room for critical cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Tell the family member to ask the client's provider for access to the client's medical record:
The provider cannot give records without client authorization; the nurse should not direct them to the provider for access without proper consent.
B. Request identification from the family member before providing the information:
Even with ID, family members cannot access medical records without the client’s written consent.
C. Explain that nurses are not allowed to open the medical records of clients not in their care:
Accessing a medical record for a client not under your care is a HIPAA violation unless you have a legitimate, assigned role in their care.
D. Report the situation to the facility's security personnel:
This would be necessary only if the family member posed a threat or attempted to access records unlawfully; the priority is to refuse access and explain privacy rules.
Correct Answer is A
Explanation
A. A client who requires initial education about blood glucose monitoring:
Initial client teaching requires assessment, knowledge of the learning process, and evaluation - all of which are within the RN’s scope, not LPN or AP.
B. A client who requires an enteral feeding:
An LPN can safely administer an established enteral feeding, so this does not have to be reassigned to an RN.
C. A client who requires tracheostomy suctioning:
Tracheostomy suctioning of a stable patient is within the LPN’s scope of practice. Only unstable airway situations or assessment findings requiring intervention would necessitate an RN.
D. A client who requires irrigation of an indwelling urinary catheter:
LPNs are allowed to irrigate indwelling urinary catheters in most settings, so this task does not require RN reassignment.
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