When making assignments, the nursing staff’s scope of practice, skills, and experience must be considered. For a client with a new diagnosis, substantial client education on disease management will be needed. Therefore, the most appropriate nurse to assign to this client is the RN with 1 year of telemetry experience. This nurse has experience working with cardiac conditions and has specialized knowledge of congestive heart failure (CHF).

Advance directives are documents that outline a client’s medical treatment decisions. These directives typically include a client’s code status decision. If a client wants to modify advance directives, the nurse should immediately notify the health care provider. The health care provider is responsible for writing a do-not-resuscitate (DNR) order. A DNR order is a health care provider’s directive stating a client’s choice to decline CPR during cardiac or respiratory arrest. It does not exclude other treatments such as medications or nutrition.

The nurse should prioritize clients experiencing complications or those that are unstable. However, if all clients are stable, the nurse should prioritize tasks that can place the client at risk for immediate complications. Delaying administration of medications that help maintain hemodynamic stability and adequate circulation can have immediate health implications. The nurse should first administer an overdue antihypertensive medication (e.g., labetalol, lisinopril). Delaying administration could worsen hypertension and potentially cause life-threatening complications (e.g., stroke, myocardial infarction).

Respiratory distress syndrome (RDS) in newborns can occur from insufficient surfactant, excess lung fluid not adequately cleared after birth, or aspiration (e.g., meconium-stained amniotic fluid). Grunting, retractions, nasal flaring, central cyanosis, tachypnea, and apnea >20 seconds indicate increased work of breathing, necessitating prompt intervention to prevent respiratory failure. Initiating continuous positive airway pressure (CPAP) is necessary for a newborn experiencing RDS to maintain lung function and improve oxygenation. CPAP provides constant positive pressure to the airways, keeping alveoli open and reducing the work of breathing.