Level: Clinical
Difficulty: Medium
Subtopic: Clinical practice guidelines
NCLEX: The nurse reviewing a unit quality dashboard is being evaluated for evidence-based practice and clinical practice…
Statistics or evidence-based practice Management of Care
Case Study
The nurse reviewing a unit quality dashboard is being evaluated for evidence-based practice and clinical practice guidelines. Assessment data include a guideline recommends chlorhexidine bathing for central-line infection prevention. Which finding requires the nurse to intervene immediately?
Question
A. A stable, long-standing finding that matches the expected care plan.
B. A comfort request with unchanged vital signs and no new symptoms.
C. The new finding that a guideline recommends chlorhexidine bathing for central-line infection prevention.
D. Routine data unchanged from the prior assessment.
B. A comfort request with unchanged vital signs and no new symptoms.
C. The new finding that a guideline recommends chlorhexidine bathing for central-line infection prevention.
D. Routine data unchanged from the prior assessment.
Rationale
Correct answer: C. The new finding that a guideline recommends chlorhexidine bathing for central-line infection prevention.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.