An RN from the maternal-newborn unit is being floated to a medical-surgical unit. Which of the following clients should the charge nurse on the medical-surgical unit plan to assign to the RN?
A client who has acute pancreatitis
A client who is one-day postoperative following a total abdominal hysterectomy
A client who had a stroke and is to be admitted
A client who has terminal end-stage renal disease
The Correct Answer is B
Rationale:
A. Acute pancreatitis may require specialized medical management that might be beyond the RN’s experience from a different unit.
B. A client one-day postoperative following a total abdominal hysterectomy is appropriate for an RN with general surgical experience, as it involves standard postoperative care.
C. A client who had a stroke may require more specialized neuro care and assessment than the RN might be familiar with.
D. Terminal end-stage renal disease requires specialized care and experience in managing complex chronic conditions.
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Correct Answer is D
Explanation
Rationale:
A. Palpate for possible bladder distention is a task that requires nursing assessment skills and should be done by the nurse.
B. Observe the incision site is a nursing task that involves assessing for signs of complications.
C. Change the abdominal dressing requires sterile technique and should be done by a nurse to prevent infection and ensure proper care.
D. Obtain vital signs is within the AP’s scope of practice and is a task that can be delegated. It is important for monitoring the client’s status and identifying potential issues.
Correct Answer is B
Explanation
Rationale:
A. A client who was administered erythromycin for acute glomerulonephritis and reports reddish-brown urinary output requires assessment for possible drug reaction or hematuria, but this may not be immediately life-threatening compared to hypoglycemia.
B. A client who was administered glipizide for type 2 diabetes mellitus and has a blood glucose of 68 mg/dL is at risk for hypoglycemia, which requires prompt assessment and intervention to prevent severe complications.
C. A client who was administered adalimumab for Crohn's disease, has a serum calcium level of 10 mg/dL, and reports a headache should be assessed, but the calcium level and headache are less urgent compared to immediate treatment needs for hypoglycemia.
D. A client who was administered acyclovir for cellulitis reports pain in the affected leg may require assessment for infection or medication side effects, but this is less critical than addressing hypoglycemia.
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