NR-446 Collaborative Healthcare - Set 2 - Part 2

Correct Answer: Assess a client reporting new chest pressure and dyspnea

New chest pressure with shortness of breath may be a myocardial infarction or a pulmonary embolism, both immediate threats to circulation and breathing. Every other task on the list has time to spare. Option a is incorrect because a bag with fluid still running has a margin of several minutes before it empties. Replacing it is routine maintenance work, and no harm follows from a short delay. Option b is incorrect because teaching sits at the third level of priority and this client is not leaving for hours. Education is essential to a safe discharge, yet it competes poorly against a possible cardiac event. Option c is incorrect because scheduled medications carry an administration window rather than an exact minute, and both clients are described as stable. Time bound is not the same as time critical.

Correct Answer: Give the personnel their tasks with reporting parameters

Delegation happens on the first pass, not the fifth. Giving assistive personnel their work early, with specific reporting parameters and a check-back time, frees the nurse for the assessment and judgment that only the nurse can provide. Option a is incorrect because idle staff waiting on the nurse is exactly the bottleneck good planning prevents. Hygiene, vital signs, and intake records would then all crowd into the same hour later in the morning. Option c is incorrect because holding delegation until the medications are finished delays work that could already be under way. The medication pass is one of the periods when the nurse most needs someone else covering routine requests. Option d is incorrect because equal division ignores what each worker may legally and competently do. Sound assignment matches the task to scope, validated skill, and current capacity, none of which an even split takes into account.

Correct Answer: Dependent ankle edema with fine crackles at the bases

Dependent edema and mild crackles at the lung bases fit long standing heart failure and reflect the chronic fluid retention the regimen is managing. The nurse records them and compares them with the client's baseline. Option a is incorrect because pink frothy sputum means fluid has flooded the alveoli in acute pulmonary edema. That is a breathing emergency needing oxygen, an upright position and rapid escalation to the medical team. Option b is incorrect because orthopnea that appears suddenly marks worsening congestion rather than the settled picture of a managed condition. The word sudden moves this finding into the unexpected column. Option d is incorrect because gaining four pounds overnight represents retained fluid, not tissue, and signals decompensation. Daily weights exist precisely to catch this change, and the finding calls for assessment and a call to the provider.

Correct Answer: Go to the client whose bed alarm is sounding

A sounding bed exit alarm is a safety event happening right now, and a fall can occur in seconds. The nurse goes to that client and delegates or defers the remaining three demands. Option b is incorrect because a telephone conversation can be picked up by the charge nurse or returned in a few minutes. Talking to the provider does nothing for a client who is climbing out of bed. Option c is incorrect because an arriving admission can be settled by another team member while the nurse handles the alarm. Greeting a new client is important work, but nobody is in danger at the desk. Option d is incorrect because antibiotics have an administration window measured in tens of minutes, not seconds. The dose still matters and must not be forgotten, yet it ranks below an injury that is about to happen.

Correct Answer: Right person, because competence was never validated

Right person requires the correct role, demonstrated competence on this specific task and device, and available capacity. A job title is not competence, and this worker has never been checked off on the meter. Option a is incorrect because point of care glucose testing appears in many assistive personnel job descriptions where policy permits it. The activity itself is delegable once the individual has been trained. Option c is incorrect because staffing pressure is not what circumstance means. Circumstance asks whether the client is stable and the setting is suitable, and no client condition appears in this scenario. Option d is incorrect because the failure occurred before anyone touched a meter. Skipping competence verification is an error made at the moment of choosing the worker, not at the point of later review.

Correct Answer: Deep leg pain unrelieved by the prescribed opioid

Pain out of proportion to the injury and unrelieved by opioids is the earliest sign of compartment syndrome, which destroys muscle and nerve within hours. The nurse loosens constricting layers and notifies the provider at once. Option a is incorrect because a small amount of swelling distal to a new cast reflects the trauma and the surgery themselves. It is watched for progression along with color, warmth and movement, not treated as an emergency. Option b is incorrect because slight temperature elevation on the first day after surgery usually comes from atelectasis and the inflammatory response to tissue injury. Deep breathing and mobility address it during the shift. Option c is incorrect because visible bruising is the expected result of bleeding into soft tissue at an operative site. Documenting the extent gives a baseline for comparison, which is a very different concern from ischemia.

Correct Answer: Tell the nurse right away that turns remain undone

The delegatee must inform the licensed nurse immediately when a delegated task cannot be completed. Prompt notice lets the nurse redistribute the work before pressure injuries or other harm develop. Option a is incorrect because a delegatee may never pass a delegated task to anyone else. Only the licensed nurse who made the original decision may choose a different person for the work. Option c is incorrect because recording care that has not happened is falsification of the record. It also hides a gap in repositioning from the nurse who is responsible for the skin. Option d is incorrect because waiting hours to disclose missed care removes every chance to correct it during the shift. Timeliness is what makes the report useful, not merely the fact of reporting.

Correct Answer: Stable clients awaiting discharge, with a resource nurse

A floated nurse should receive clients whose care matches demonstrated competence, typically the more stable and less specialized ones, along with orientation to the unit and a named resource person for questions. Option b is incorrect because titrating an antiarrhythmic drip demands continuous interpretation of rhythm and pressure that a postpartum nurse has not practiced. Licensure alone does not establish competence on this unit. Option c is incorrect because new admissions need comprehensive assessment and rapid recognition of cardiac deterioration. Handing the least familiar nurse the least predictable clients inverts the rule for matching acuity to skill. Option d is incorrect because an assignment built from what the regular staff declined is chosen for staff preference rather than client need. Assignments follow acuity, competence, and workload, never leftovers.

Correct Answer: Redistribute the clients to balance acuity, not head count

A safe assignment balances total workload and acuity rather than the number of clients each nurse holds. Three total care clients represent far more work than the client count alone suggests. Option a is incorrect because staying inside a numeric ratio does not make a load manageable. Ratios set a ceiling on counts and say nothing about how heavy each of those clients actually is. Option b is incorrect because telling someone to speed up treats a structural imbalance as a personal failing. Rushing through total care raises the odds of falls, skin injury, and missed findings. Option c is incorrect because clients are never assigned to unlicensed staff as their own responsibility. An aide receives specific tasks for clients whose care still belongs to a licensed nurse.

Correct Answer: Clinical reasoning about the client's data

Clinical reasoning is the mental process of analyzing the elements of a clinical situation and using that analysis to move toward a decision. Connecting several patient findings into one line of thought is exactly that process. Option a is incorrect because clinical judgment is the conclusion reached and the action taken, not the thinking that leads there. The nurse is still assembling meaning and has not yet settled on a course. Option b is incorrect because reflection on action happens after an episode of care is over and reviews how the reasoning held up. Nothing here has been completed for the nurse to look back on. Option d is incorrect because critical thinking is the broader, general purpose capacity marked by questioning one's own assumptions and weighing evidence. This nurse is applying nursing knowledge to one client's specific data set.

Correct Answer: The systematic review of randomized trials

A systematic review or meta analysis of randomized trials sits at the top of the evidence hierarchy because it synthesizes multiple trials rather than resting on one sample. Expert opinion sits at the bottom. Option a is incorrect because one randomized trial is strong evidence but ranks a level below a review that pools many such trials. A small sample makes its result easier to overturn. Option c is incorrect because expert opinion occupies the weakest level of the hierarchy. Reputation does not control for bias the way a study design does, so an editorial cannot outrank pooled trial data. Option d is incorrect because established habit is not evidence at all and never enters the hierarchy. The way a unit has always changed dressings is exactly the tradition an evidence based review exists to test.

Correct Answer: Place the client with a roommate infected with that organism

Cohorting is permitted when two clients carry the same active infection with the same organism and nothing else. That pairing adds no new exposure for either one while the private room remains unavailable. Option a is incorrect because a client with severe neutropenia has almost no defense against a resistant organism. Infection control guidance names the immunocompromised client as the roommate to avoid above all others. Option b is incorrect because an open wound is a direct portal of entry, so sharing a room with a resistant wound infection gives the organism the easiest route it could take. Option d is incorrect because the uninfected roommate stands to gain nothing and to lose a great deal. Contact precautions exist precisely to keep this organism away from someone who does not yet have it.

Correct Answer: Asking the aide to feed a dysphagic client breakfast

Feeding a client whose swallowing is impaired requires ongoing judgment about aspiration risk during the meal. That judgment cannot be handed to unlicensed staff, so this is the delegation the charge nurse stops. Option a is incorrect because placing compression stockings is a simple noninvasive measure with a predictable result. Assistive personnel apply them routinely, and the nurse checks the skin underneath during rounds. Option b is incorrect because ostomy care on an established stoma is a routine procedure inside the licensed practical nurse's scope. Nothing about the request crosses a boundary or needs charge nurse correction. Option c is incorrect because measuring and writing down urine volumes involves no interpretation. The registered nurse later reads the trend and decides whether output is adequate, which keeps the thinking where it belongs.

Correct Answer: A client newly started on a heparin infusion

A newly started heparin infusion is a high alert drug requiring ongoing interpretation of laboratory results and bleeding assessment, with rate changes based on those results. That continuous judgment belongs to the registered nurse. Option b is incorrect because a long standing colostomy with an established routine is exactly the predictable work the licensed practical nurse handles. Nothing in that care depends on a changing clinical picture. Option c is incorrect because a client several days into antibiotics and improving has a stable trajectory. The practical nurse can give the doses and report findings, leaving the registered nurse free for the unstable client. Option d is incorrect because bathing and ambulation are hands on tasks the assistive personnel performs every shift. Reserving them for the registered nurse would waste the only license that can manage the infusion.

Correct Answer: The bed exit alarm sounding nearby

An alarm signals a safety event already in progress and outranks the other three requests. Comfort and scheduling matters can be delegated or deferred, while medication preparation resumes once the client at risk of falling is safe. Option a is incorrect because a scheduling question has no clinical deadline and can wait until the medications are prepared. Answering it mid-preparation splits attention during the task most strongly associated with medication error. Option b is incorrect because comfort requests belong with assistive personnel rather than being deferred by the nurse. The client receives the blanket promptly, and the nurse never leaves an unfinished syringe unattended on the cart. Option c is incorrect because the call is described as routine, which by definition means it carries no urgency. Taking it now fragments a preparation window that should stay protected, and the caller loses nothing by waiting.

Correct Answer: Review the reporting parameters privately with the personnel

Once the client is assessed, the nurse determines why the report never came and closes the gap. A private review of what to report and when re-establishes the parameters, and supervision of that worker increases going forward. Option b is incorrect because stripping a worker of all measurement tasks is a punishment, not a correction. The remedy for a missed report is clearer parameters and closer oversight, so that the same worker reports correctly next time. Option c is incorrect because a chart entry assigning blame is inappropriate and changes nothing about future practice. The medical record holds clinical facts about the client, while personnel performance is handled through coaching and the facility's own process. Option d is incorrect because a group setting turns feedback into public exposure. Correction is delivered privately and specifically; demanding an explanation in front of colleagues teaches the whole team to hide mistakes rather than surface them.

Correct Answer: Tell the charge nurse which items need coverage

A disruption invalidates the plan, so the nurse re-sorts and communicates. Naming the time-bound items to the charge nurse lets them be covered or redistributed, and an undone task that someone knows about is a delay rather than an error. Option a is incorrect because discharge teaching is a third-level task that tolerates delay. Finishing it while a client is deteriorating elsewhere reverses the priority order and holds the nurse away from an event happening now. Option b is incorrect because silent postponement is the step nurses most often skip. The medication window will close whether or not anyone is told, and a task nobody knows was dropped becomes an omission rather than a delay. Option d is incorrect because relatives carry no responsibility for monitoring clients and cannot recognize deterioration. Coverage during an absence is arranged with licensed staff and the charge nurse, never with visitors who happen to be present.

Correct Answer: Impaired gas exchange related to alveolar inflammation and secretions

Impaired gas exchange is an actual breathing problem and sits at the first level of priority, ahead of pain, teaching and any risk statement. Oxygenation is addressed before anything else on this plan. Option a is incorrect because a risk statement describes a problem that has not happened yet. Skin protection is planned and carried out through the shift, but every actual problem on the list outranks it. Option c is incorrect because pain from coughing is genuine and physiological, yet it belongs to the second level rather than the first. Comfort improves the ability to cough effectively, which makes it the next step after oxygenation. Option d is incorrect because education about a new medication is third level work that can be completed before discharge. Teaching a breathless client also fails, since attention and learning require adequate oxygen first.

Correct Answer: Reexamine the cues and revise the hypothesis

When evaluation shows the expected outcome was not met, the model cycles back rather than forward. The nurse returns to recognizing and analyzing cues so a new explanation for the deterioration can be formed. Option a is incorrect because a plan that has failed to produce any of its expected results is not a plan worth continuing. Persisting through another shift lets a worsening circulatory picture go unaddressed. Option b is incorrect because recording that a treatment was given proves only that implementation occurred. Evaluation has already told the nurse the treatment did not work, and that finding demands a response. Option c is incorrect because none of the three target findings moved in the right direction, so calling the outcome partially met misstates the data. Waiting after an unmet outcome is how deterioration is missed.

Correct Answer: Reorder the remaining tasks and notify the charge nurse

A change on the unit invalidates the earlier plan, so the nurse reruns the priority sequence and identifies what is now time critical. Telling the charge nurse allows work to be redistributed rather than silently dropped. Option a is incorrect because a plan built before the rapid response no longer matches the resources available. Holding to it ignores the shift in staffing and leaves the preoperative client at risk of a delayed case. Option b is incorrect because dressing changes are routine care with flexible timing, while a surgical case has a fixed start controlled by another department. Choosing this order puts the least urgent work in front. Option d is incorrect because postponing everything abandons time bound work that still has to happen, and documentation is never the first response to a changing situation. An undone task nobody knows about becomes an error.