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.