The charge nurse is managing clients in the intensive care unit.
Which of the following clients is most appropriate to transfer to the medical-surgical unit?
The charge nurse is managing clients in the intensive care unit.
Which of the following clients is most appropriate to transfer to the medical-surgical unit?
A. a client 48 hours post-stroke with stable vital signs and new-onset atrial fibrillation on telemetry
[10%]
B. a client admitted for upper GI bleed, hemoglobin 9.0 g/dL, tolerating fluids, no bleeding in 24 hours
[48%]
C. a client with alcohol withdrawal, last lorazepam dose 6 hours ago, currently mildly confused
[5%]
D. a client recently transitioned from insulin infusion to subcutaneous insulin after DKA resolution
[37%]
Statistics
Subject/Lesson
Subject
Critical Care
Lesson
Critical Care Concepts
Client Need
Test Plan
Management of Care
Related Topic
Establishing Priorities
Item Type
Item Type
Analysis
Explanation
Choice B is correct. The most appropriate client to transfer from the ICU to the medical-surgical unit is the one with a resolved upper GI bleed. This client has been hemodynamically stable for 24 hours, is tolerating oral fluids, and has a hemoglobin of 9.0 g/dL, which—though low—is acceptable and expected after a bleed. This clinical picture suggests the client is no longer in acute danger and can be safely monitored at a lower level of care.
Choice A is incorrect. A client who is 48 hours post-stroke may appear stable, but new-onset atrial fibrillation introduces an acute cardiac complication that increases the risk of thromboembolism or rapid decompensation.
Choice C is incorrect. Although the client with alcohol withdrawal may seem stable, the mild confusion noted 6 hours after the last dose of lorazepam is concerning for potential progression to delirium tremens, seizures, or severe autonomic instability. Clients in withdrawal require frequent neuro checks and rapid access to IV benzodiazepines.
Choice D is incorrect. The client recently transitioned off an insulin infusion following resolution of diabetic ketoacidosis (DKA) and is still in a critical transition period. These clients are at risk for recurrent ketosis, hypoglycemia, or electrolyte shifts and require hourly monitoring that is not feasible on a medical-surgical unit.
Learning Objective
The learner will be able to analyze client acuity and clinical stability to determine appropriate transfer from the intensive care unit to a lower level of care.
Related Videos
2 Key Topics
ABCs: Airway
15.5 Prioritization Part 1
Additional Info
✓ ICU transfer decisions must be based on stability, not just time elapsed since admission.
