Butte Community CollegeNURSING MISCnr452 All Case Studies.

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CASE STUDY 3 Multiple clients on a medical-surgical unit You are the leader of a team providing care for six clients. Your team includes yourself (an RN), an LPN/LVN, and a newly hired UAP who is un ... dergoing orientation to the unit. The clients are as follows: ● • Mr. C, a 68-year-old with unstable angina who needs teaching for a cardiac catheterization scheduled this morning ● • Ms. J, a 45-year-old experiencing chest pain scheduled for a graded exercise test later today ● • Mr. R, a 75-year-old who had a left-hemisphere stroke 4 days ago ● • Ms. S, an 83-year-old with heart disease, a history of myocardial infarction, and mild dementia ● • Ms. B, a 93-year-old newly admitted from a long-term care facility, with decreased urine output, altered level of consciousness, and an elevated temperature of 99.5° F (37.5° C) ● • Mr. L, a 59-year-old with mild shortness of breath and chronic emphysema ● 1. For which clients should you assign the LPN/LVN to perform nursing care tasks, under your supervision? (Select all that apply.) o 1. Mr. C o 2. Ms. J o 3. Mr. R o 4. Ms. S o 5. Ms. B o 6. Mr. L ● 2. Which client should you assess first? o 1. Mr. C o 2. Ms. J o 3. Ms. B o 4. Mr. L ● 3. Which key point would you be sure to include when teaching the client about the postprocedure care after cardiac catheterization? o 1. “There are no restrictions after the procedure.” o 2. “We will get you out of bed within 2 hours after the procedure.” o 3. “You will have to stay almost flat in bed with limited position changes for 4 to 6 hours.” o 4. “Family visitors will be restricted until the next day.” ● 4. The health care provider’s orders for Ms. J, who is currently experiencing chest pain, are as follows. List the orders in the sequence in which they should be completed. (Answers may be used more than once.) o 1. Obtain a 12-lead electrocardiogram (ECG) when the client experiences chest pain. o 2. Administer nitroglycerin (Nitrostat) 0.6 mg sublingually every 5 minutes as needed for chest pain. o 3. Administer morphine 2 mg IV push as needed for chest pain. o 4. Monitor blood pressure and heart rate. o 5. Place on a telemetry monitor. _5__, 4_, __1__, __2___, ___4__, ____2___, __4_____, __2_____, _4______, ___3____ ● 5. Which task should you delegate to the newly-hired UAP? o 1. Asking Ms. S memory-testing questions o 2. Teaching Ms. J about treadmill exercise testing o 3. Performing pulse oximetry for Mr. L o 4. Monitoring urine output for Ms. B ● 6. The UAP is delegated the task of measuring morning vital signs for all six clients. What would you instruct the UAP to report immediately? o 1. Oral temperature higher than 102° F (38.9° C) o 2. Blood pressure higher than 140/80 mm Hg o 3. Heart rate lower than 65 beats/min o 4. Respiratory rate lower than 18 breaths/min ● 7. The UAP asks you why it is important to notify someone whenever a client with heart disease reports chest pain. What is your best response? o 1. “It’s important to keep track of the chest pain episodes so we can notify the health care provider.” o 2. “The client may need morphine to treat the chest pain.” o 3. “Chest pain may indicate coronary artery blockage and heart muscle damage that will need treatment.” o 4. “Our unit policy includes specific steps to take in the treatment of clients with chest pain.” ● 8. The health care provider’s orders for Mr. R, who had a stroke 4 days ago, include assisting the client with meals. Which person should be assigned to this task? o 1. Physical therapist o 2. UAP o 3. LPN/LVN o 4. Occupational therapist ● 9. The UAP tells you that Mr. L, the client with chronic emphysema, says he is feeling short of breath after walking to the bathroom. What action should you take first? o 1. Notify the health care provider. o 2. Increase oxygen flow to 4 L/min via nasal cannula. o 3. Assess oxygen saturation by pulse oximetry. o 4. Remind the client to cough and deep breathe. ● 10. The oral temperature of Ms. B, the client newly admitted from a long-term care facility with decreased urine output and altered level of consciousness, is now 102.6° F (39.2° C). What is your best action? o 1. Notify the health care provider. o 2. Administer acetaminophen (Tylenol) 2 tablets orally. o 3. Ask the LPN/LVN to give an acetaminophen suppository. o 4. Remove extra blankets from the client’s bed. ● 11. Which factor most likely precipitated Ms. B’s elevated temperature? o 1. Bladder infection o 2. Increased metabolic rat [Show More]

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