The charge nurse is planning client care assignments for the medical-surgical unit. A nurse floated from the labor and delivery unit to the adult medical-surgical unit.
The nurse should assign the client
The charge nurse is planning client care assignments for the medical-surgical unit. A nurse floated from the labor and delivery unit to the adult medical-surgical unit.
The nurse should assign the client
A. receiving a continuous infusion of heparin for pulmonary embolism.
[30%]
B. eight hours post-operative following an open appendectomy.
[52%]
C. with a water-seal chest tube for a pneumothorax.
[8%]
D. admitted with an exacerbation of congestive heart failure (CHF).
[10%]
Statistics
Subject/Lesson
Subject
Leadership & Management
Lesson
Assignment/Delegation
Client Need
Test Plan
Management of Care
Related Topic
Assignment, Delegation and Supervision
Item Type
Item Type
Application
Explanation
Choice B is correct. This client is the most stable and appropriate for assignment to a float nurse. A nurse from labor and delivery is skilled in surgical recovery, vital signs monitoring, incision care, pain management, and fluid assessments, all of which are relevant to a post-op appendectomy client. No specialty-specific skills outside the float nurse’s scope are required.
Choice A is incorrect. This client is high acuity and requires close monitoring for bleeding, changes in respiratory status, and lab values (e.g., aPTT). The use of a continuous heparin infusion and the management of a PE often involve protocols unfamiliar to a nurse without adult critical care or med-surg experience. This client should be assigned to a regularly scheduled medical-surgical nurse.
Choice C is incorrect. Chest tube management is not typically within the scope of labor and delivery nurses, especially with unfamiliar equipment like water-seal drainage systems. This client may require urgent intervention if there is a system disconnection, air leak, or tension pneumothorax, and must be assigned to a nurse experienced in respiratory and thoracic care.
Choice D is incorrect. CHF exacerbations require monitoring of fluid balance, breath sounds, weight, diuretics, and oxygen therapy, and may involve titrating medications or evaluating hemodynamic instability. This places it outside the safe zone for a float nurse from L&D, who may not have recent experience managing chronic adult cardiac conditions.
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