HESI Case Study- Management of a Medical Unit
Which client situation requires the most immediate intervention by the charge nurse?
New onset ST segment elevation is observed on the telemetry monitor of a client admitted with angina.
What action should Mr. Young take?
Request that another staff RN obtain the report.
How should the charge nurse respond to this situation?
Remain with he client who has angina and assign a PN to monitor the confused client while the UAP obtains a bed alarm.
Who should the charge nurse assign to care for this client?
The newly licensed nurse and staff nurse preceptor.
How should the charge nurse respond?
What concerns do you have about your pregnancy and this client care situation?
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When adhering to the ethic of caring in a leadership role while still maintaining client safety, what is the best action for the charge nurse to implement?
Assign another PN to care for the client and reassign the pregnant PN to other clients.
Which diagnosis and upcoming procedure can best be assigned to this PN, rather than an RN? A client with:
Osteoporosis scheduled for a bone mineral density test that day.
Which task can be delegated to the UAP who is assisting the PN and RN in the care of these 4 clients?
Deliver and prepare the meal tray of the client who is in isolation with MRSA-induced pneumonia.
Which action should the respiratory therapist take?
Increase the rate of oxygen being administered.
Mr. Young consults with the case manager about which aspect of the client’s care?
Initiating a referral for durable medical equipment and home health care.
It is best for the newly licensed RN to collaborate with which team member to ensure that the dosage is adjusted correctly?
The RN who is precepting the newly licensed nurse.
When changing client care assignments, Mr. Young knows that it is important to assign the client on which medication/solution to the care and expertise of another RN rather than a PN?
An insulin/potassium infusion to treat diabetic ketoacidosis (DKA)
Which one of the RN’s cients can best be assigned to the PN?
A 56-year-old female client with anemia due to long-term chronic renal failure who is scheduled for a hemodialysis treatment that afternoon.
How many mL should be added to the 500 mL bag?
Which instruction should the nurse convey to the UAP?
Report any changes in mental status, such as disorientation.
Which action should the nurse implement?
Assist the client in returning to a supine position in the bed.
In reviewing the situation with the UAP and RN assigned to the client, Mr. Young needs to emphasize which problem?
Insufficient instruction and supervision by the RN.
The client with which telemetry pattern is best to consider for transfer?
Sinus arrhythmia with rate fluctuation during respiration.
After identifying the client that is the safest to transfer from the telemetry area, what action should Mr. Young take next?
Contact the healthcare provider for a prescription to remove the telemetry and transfer the client.
It is most important for the preceptor to supervise which nursing intervention performed by the newly licensed RN?
Interpretation of the cardiac rhythm.
What is the best response by the preceptor?
Because observation of the procedure will help you provide better care, I will manage our assigned clients while you go.
In planing a cient care assignment independent of the preceptor for the next day, which client is best to assign to the new RN?
Experiencing dysphagia following a CVA, which necessitates the use of total parenteral nutrition via a central line.
To ensure that all the staff are competent in the use of the new equipment, which action is most important for Mr. Young to implement?
Schedule time for each nurse on the unit to practice using the insulin pens.
How should Mr. Young respond?
Offer to repeat a demonstration and allow the PN additional practice time.
Which action should MR. Young implement first?
Go with the nurse to observe the difficulty the clients are experiencing with the pens.
In preparing a study of this problem, which goal statement is best for the team to identify?
All clients using insulin pens will measure an accurate dose 100% of the time.
What additional information is most important for the quality improvement team presenting a recommendation to the administration about teaching clients how to use insulin pens?
The inability of these clients to measure an accurate dose with a syringe.
In preparing the recommendation, it is most valuable to obtain input from which member of the healthcare team?