The registered nurse is serving as the charge nurse in the intensive care unit and assigning clients for the shift. Which client should the charge nurse assign to the graduate nurse (GN) who just completed orientation?
The client diagnosed with amyotrophic lateral sclerosis on a ventilator who is dying and whose family is at the bedside.
The client diagnosed with a closed head injury and increasing intracranial pressure receiving IV mannitol.
The client diagnosed with a C-5 spinal cord injury who is experiencing spinal shock and is on dopamine.
The client, diagnosed with a seizure disorder who has been experiencing status epilepticus for the past 24 hours
The Correct Answer is A
Safe delegation and assignment in critical care necessitate matching the clinical complexity of the client with the competency level of the practitioner. Graduate nurses (GNs) require stable assignments with predictable outcomes to consolidate their skills without the risk of rapid physiological deterioration. Avoiding clients requiring titratable vasopressors or complex neurological monitoring is essential for maintaining patient safety and ensuring the GN’s professional development is not compromised by high-acuity emergencies.
Rationale:
A. This client is the most appropriate for a GN because the clinical status is predictable and stable, despite the terminal nature of the illness. Caring for a dying client on a ventilator focuses on palliative care and family support, which are fundamental nursing competencies. It avoids the high-stress, rapid decision-making required for managing acute hemodynamic instability or intracranial emergencies.
B. Managing increased intracranial pressure (ICP) requires advanced skills in neurological assessment and the careful administration of osmotic diuretics like mannitol. Clients with brain injuries are at extreme risk for herniation syndromes, which can occur with very subtle clinical changes. A GN lacks the specialized experience to detect the minute deviations in cerebral perfusion that indicate a life-threatening crisis.
C. A C-5 spinal cord injury experiencing spinal shock is highly unstable and requires intensive monitoring of autonomic dysfunction. The use of dopamine, a potent vasopressor, necessitates frequent hemodynamic titration based on mean arterial pressure (MAP) and cardiac output. This level of pharmacologic complexity is unsuitable for a new graduate and requires the expertise of a seasoned critical-care nurse.
D. Status epilepticus is a medical emergency characterized by continuous seizure activity that can lead to permanent neuronal damage or respiratory failure. Managing a client who has been in this state for 24 hours requires expert knowledge of anticonvulsant protocols and advanced airway management. The high potential for metabolic exhaustion and status recurrence makes this assignment far too complex for a nurse who has just completed orientation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E"]
Explanation
Disaster triage prioritizes surge capacity through the discharge of hemodynamically stable patients or those with deferred procedures. Discharge criteria include minimal nursing care needs and absence of life-threatening physiological imbalances or pending emergent interventions.
Rationale:
A. Spontaneous pneumothorax requires continuous chest tube monitoring for air leaks or lung re-expansion. Discharging an adolescent within 24 hours of admission is unsafe due to the high risk of recurrence. This client remains physiologically unstable.
B. Diabetic ketoacidosis presenting with an acidic pH indicates ongoing metabolic derangement requiring intravenous insulin. These patients are at risk for cerebral edema and fatal electrolyte shifts. Discharge is contraindicated until the anion gap closes.
C. This client is medically stable and awaiting an elective procedure that is not immediately life-saving. Surgery can be rescheduled to accommodate victims of the wildfire disaster. Preoperative status allows for safe discharge to home.
D. Intubated clients require mechanical ventilation and intensive nursing care for survival. Acute respiratory failure carries a high mortality rate without continuous hemodynamic and airway support. This client is ineligible for transfer or discharge.
E. A patient 3 days following an appendectomy with stable vitals has likely transitioned to oral intake. This client meets criteria for routine discharge as the postoperative risk for immediate hemorrhage or sepsis has significantly decreased.
Correct Answer is D
Explanation
A critical pathway is a multi-professional standardized map that outlines the sequence and timing of clinical interventions for specific diagnoses. By integrating evidence-based protocols, these tools streamline the delivery of care and minimize variations in treatment. They serve as a primary mechanism for managing utilization review and ensuring cost-effective, high-quality outcomes within a predetermined timeframe.
Rationale:
A. The PICOT framework is a specialized tool used to formulate clinical questions during the initial stages of research or evidence discovery. While it helps nurses identify knowledge gaps, it is not a direct guide for the daily delivery of interdisciplinary bedside care. PICOT focus is on inquiry structure rather than the operational coordination of a client’s treatment plan.
B. The hierarchy of evidence is a grading system used to evaluate the methodological quality and reliability of research findings. It assists clinicians in determining which studies provide the most robust data for clinical decision-making. However, it functions as a theoretical framework for research appraisal, not a practical clinical tool for coordinating team-based care activities.
C. Qualitative research is a scientific method used to explore subjective experiences, perceptions, and social phenomena through non-numerical data. While it provides deep insights into the human response to illness, it does not provide a structured timeline for medical and nursing interventions. It lacks the prescriptive nature required to guide a synchronized interdisciplinary care plan.
D. A critical pathway is the priority tool for guiding interdisciplinary care as it defines milestone achievements for a specific client population. It facilitates communication across departments by identifying the optimal sequence of nursing, medical, and rehabilitative actions. This tool is essential for identifying variances and ensuring the team meets established clinical benchmarks efficiently.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.