Which patient should be assigned to the most experienced intensive care nurse?

Which patient should be assigned to the most experienced intensive care nurse?

• A. The client diagnosed with respiratory failure who is on a ventilator and requires frequent sedation.
• B. The client diagnosed with lung cancer and iatrogenic Cushing's disease with ABGsof pH 7.35, PaO2 88, PaCO2 44, and HCO3 22.
• C. The client diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and R 28.
• D. The client diagnosed with hyperthyroidism who has undergone a thyroidectomy two days ago and has a negative Trousseau's sign.

Answer: (C)

The major idea here is prioritizing acuity and instability. The patient with Addison’s disease who is lethargic and has a very low blood pressure (80/45), tachycardia (124), and tachypnea (28) is showing signs of adrenal crisis with circulatory shock. This is a life-threatening emergency requiring the most experienced ICU nurse. In adrenal crisis, the body cannot maintain perfusion, so the nurse must be ready to perform rapid reassessment, secure reliable IV access, monitor vital signs continuously, and coordinate urgent interventions such as fluid resuscitation and steroid therapy, while watching for evolving electrolyte imbalances. That degree of instability and the need for swift, complex management is why this patient should be matched with the most experienced nurse. The other scenarios describe serious situations but not in the same acutely unstable state. A ventilated patient on frequent sedation requires skilled airway, ventilator, and sedation management, but the critical threat—circulatory collapse—is not explicitly present. A thyroidectomy patient two days post-op has airway and calcium-risk concerns, but current signs don’t indicate hemodynamic collapse. The lung cancer patient with relatively stable ABGs isn’t acutely unstable either.

The major idea here is prioritizing acuity and instability. The patient with Addison’s disease who is lethargic and has a very low blood pressure (80/45), tachycardia (124), and tachypnea (28) is showing signs of adrenal crisis with circulatory shock. This is a life-threatening emergency requiring the most experienced ICU nurse. In adrenal crisis, the body cannot maintain perfusion, so the nurse must be ready to perform rapid reassessment, secure reliable IV access, monitor vital signs continuously, and coordinate urgent interventions such as fluid resuscitation and steroid therapy, while watching for evolving electrolyte imbalances. That degree of instability and the need for swift, complex management is why this patient should be matched with the most experienced nurse.

The other scenarios describe serious situations but not in the same acutely unstable state. A ventilated patient on frequent sedation requires skilled airway, ventilator, and sedation management, but the critical threat—circulatory collapse—is not explicitly present. A thyroidectomy patient two days post-op has airway and calcium-risk concerns, but current signs don’t indicate hemodynamic collapse. The lung cancer patient with relatively stable ABGs isn’t acutely unstable either.