When teaching J.P.’s boyfriend about what to expect during recovery from a head injury, which statement is most accurate?

Managing Care of Multiple Patients

You are working on the medical-surgical unit and have been assigned

to care for the following 5 patients. You have 1 LPN/VN and 1 UAP

on your team to help you.

Discussion Questions

1. Priority Decision: After receiving report, which patient

should you see first? Provide a rationale.

2. Collaboration: Which tasks could you delegate to UAP?

(select all that apply)

a. Explain discharge instructions to M.C.

b. Change the dressing on M.Y.’s left hip.

c. Obtain vital signs on M.C. before discharge.

d. Sit with J.P. while the safety sitter takes a break.

e. Assess J.K.’s ability to swallow before feeding her

breakfast.

3. Priority and Collaboration: When you enter the room to

assess S.W., you find her diaphoretic with a flushed face

and pale extremities. Her BP is 200/102 mm Hg. Which 2

initial actions would be most appropriate?

a. Ask the UAP to obtain a stat bladder scan.

b. Have the LPN administer her oral antihypertensive

meds stat.

c. Elevate the head of the bed while assessing for any

noxious stimuli.

d. Ask the LPN to stay with S.W. while you stat page

S.W.’s provider.

e. Insert rectal suppository after applying lidocaine to the

area around the rectum.

Case Study Progression

S.W.’s bladder scan showed 700 mL of urine. After you have the LPN

catheterize her using a local anesthetic gel, her symptoms subside.

You take this time to further teach S.W. about the manifestations of

autonomic dysreflexia and the need to report any symptom as soon

as it appears. You discuss bladder training strategies and how to

avoid bladder distention. S.W. is grateful for the information and

your caring attitude. Just as you are finishing, the UAP tells you that

M.Y. has pulled out his Hemovac drain.

4. What should be your initial intervention for M.Y.?

a. Reinsert the Hemovac drain.

b. Assess the incision site for a hematoma.

c. Notify M.Y.’s provider that the drain was removed.

d. Apply pressure to the incisional site where the drain had

been placed.

5. Which intervention would be most appropriate in caring

for J.K.?

a. Place her left arm in a sling for support.

b. Arrange the food tray so that all foods are on the right

side.

c. Position her left leg so that the ankle is lower than the

knee.

d. Call the provider to get an order of warfarin to prevent

VTE.

6. When teaching J.P.’s boyfriend about what to expect

during recovery from a head injury, which statement is

most accurate?

a. “You can tell by how great she looks physically that she

will ultimately function well at the home.”

b. “One good thing that will come out of this injury is that

her seizures should occur less frequently.”

c. “Most patients are transferred out of the hospital for

acute rehabilitation management to prepare them for

going home.”

d. “She can expect a full recovery without any chronic

problems, but it may take a few months to achieve that

goal.”

7. Priority Decision: You receive the morning laboratory

data. Which finding should you report to the provider

immediately?

a. J.K. has a platelet level of 170,000 µ/L.

b. M.C.’s INR after his first dose of warfarin is 1.4.

c. M.Y.’s WBC has increased from 7000 yesterday to 10,800.

d. S.W. who is receiving enteral nutrition, has a glucose

level of 142 mg/dL.

8. Management Decision: As you enter M.C.’s room to

discuss his discharge plans, you find him all packed up

and ready to go. He tells you the UAP already told him

what he needed to do. What is your best initial action?

a. Ask M.C. if he has any further questions.

b. Call the UAP to M.C.’s room to find out what she told

him.

c. Review discharge instructions with M.C. to ascertain

correct understanding.

d. Give M.C. a telephone number to call in case he has any

concerns when he gets home.

 

 

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