"Prioritizing" Question

  1. Would you all just debate this question for a while and I'll sit back and take it all in...this is from ERI and it goes something like this: (I could hardly remember the question, so it's not pretty)

    RN team leader has 15 clients and is responsible for all IV meds. At 9:00 am, three clients require: antibiotics IVPB, IV needs to be started in client going to surg within the hour, and the third needs a unit of whole blood to be started. RN schededuled for in service (mandatory). Order to perform:
    a. Ask another RN to start IV while you hang IVPB and blood, then go to in service
    b. Hang blood and let IVPB med and IV start wait while going to inservice; notify supervisor
    c. Ask someone else to attend in-service and bring back the info, hang IVPB, start IV, then start blood
    d. Hang IVPB, start blood, call surgery to see if iv can be started there, assign RN to watch the team leader's clients and go to in-service

    Thanks a bunch! I have many, many more if you guys enjoy answering, I'll keep writing!
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  2. 14 Comments

  3. by   Jolie
    c. Skip the inservice!
  4. by   BEANURSE
    I agree with Jolie.....C is the best answer IMO......The other three lead me to believe that the RN will be starting the blood and then leaving the patient.....you must stay with patient to make sure that the patient does not have a reaction to the blood.....that would be my rationale for choosing C......
  5. by   SFCardiacRN
    Three of the answers say to go to the inservice. I choose send someone else. Besides, you can't hang blood and leave. What if there is a reaction?
    (I passed my NCLEX by looking for the oddball answer.)
  6. by   MIA-RN1
    I pick d. The RN can assign someone to watch her patient while the blood goes in. It does say the inservice is mandatory so I would discount the answer that says to send someone else.
  7. by   Daytonite
    C - once you hang the blood, you shouldn't be leaving the unit in case there are problems with the transfusion. Patient comes first. If the inservice is mandatory there would be other sessions of it to make it accessible to everyone and account for patient priorities.

    Also, you want to give the blood ASAP. Once the blood bank has called you and said a unit is ready, you need to get it and get it hung quickly. If they have had to do special prep on the unit (like make it into packed cells or compound several units of platelets), there is a time factor involved and you cannot delay giving it for very long.
    Last edit by Daytonite on Dec 22, '05
  8. by   Imafloat
    I chose C. Taking care of patients is more important than an inservice.
  9. by   GooeyRN
    I also choose C. If the inservice is so important they can have it at varying times. :rollI would want to monitor the pt getting blood, give the IVPB's on time so you don't have to fill out an incident report for late meds (med error) and start the IV before the pt goes to surgery so the surgeon doesn't have a fit if the patient wasn't ready.
  10. by   AtlantaRN
    i hate questions like that...because whatever is the right answer isn't what you would do in the real world...even if an inservice is 'mandatory", client care always comes first...

    linda
  11. by   SCmomof3
    So what was the answer?
  12. by   SFCardiacRN
    Do you have any more like this? It's fun!
  13. by   UM Review RN
    Well, in the Real World, all these patients' rooms are close by and the inservice is held in our break room. So I would probably hang the ABT first, then hang the blood, wait 5-10 minutes, and then go start the IV, and return to check on the blood patient and the IVPB patient.

    So we've only lost about 1/2 hour. In the real world, it'd still be possible to catch the inservice. (I've never seen one start on time yet, have you?)

    I guess that means my answer would be (c).
  14. by   SFCardiacRN
    I think the critical thinking behind the question is to do everything else first so you can watch for reactions while the blood goes in. The inservice, though mandatory, is not a priority over patient care.

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