A nurse is reviewing client information following the evening change-of-shift report. Which of the following client needs should the nurse address first?

A client who has type 2 diabetes mellitus needs assistance counting the carbohydrates in her meal.

A client who has a new tracheostomy is experiencing coughing episodes.

A client who has a BMI of 17 refuses his dinner tray.

A client awaiting discharge needs to demonstrate colostomy care before leaving.

Answer and Explanation

The Correct Answer is B

A. Assisting a client with counting carbohydrates is important for managing diabetes, but it is not an urgent need that must be addressed immediately.
B. A client with a new tracheostomy who is experiencing coughing episodes may indicate a risk for airway obstruction or other complications, making this the most urgent situation that requires immediate intervention.
C. A client with a BMI of 17 who refuses dinner could be concerning for nutritional status, but it is not as critical as addressing potential airway issues with the tracheostomy client.
D. While demonstrating colostomy care is essential for discharge readiness, it can wait until more urgent needs are addressed. Ensuring the client with a tracheostomy is stable is the priority.

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Correct Answer is A

Explanation

A. Providing postmortem care is a task that can be delegated to assistive personnel, as it involves following established protocols and does not require clinical judgment.
B. Reinforcing discharge instructions requires clinical knowledge and assessment, making it inappropriate for delegation to an AP.
C. Interpreting deviations in a client's vital signs necessitates nursing judgment and clinical expertise, which an AP does not possess.
D. Inserting an NG tube is a skilled nursing procedure that requires assessment and decision-making, thus it should not be delegated to an AP.

A. Review evidence-based literature to determine best practices in the shift reporting process. B. Organize a task force to review interventions to change the shift reporting process. C. Create a new shift reporting process to present at the next staff meeting. D. Develop a strategy to alert other nurses about the need for changes in the shift reporting process.

Correct Answer is A

Explanation

A. Reviewing evidence-based literature is essential to understand best practices in shift reporting and can inform the development of effective interventions. This foundational step helps ensure that any proposed changes are supported by research and proven methods.
B. While organizing a task force can be beneficial, it should occur after understanding the current best practices, as the task force's efforts would be better guided with existing evidence.
C. Creating a new reporting process without first gathering information or reviewing best practices may result in ineffective or unnecessary changes.
D. Developing a strategy to alert nurses is important, but it should be based on informed decisions derived from literature and data analysis, which should come first.

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A nurse is reviewing client information following the evening change-of-shift report. Which of the following client needs should the nurse address first?

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