Arrangements should be made for which nurse to provide care for this patient given the potential for rapid deterioration?

• A. An experienced critical care RN who is scheduled off for the day
• B. An experienced orthopedic unit RN who is scheduled off for the day
• C. A graduate nurse serving a critical care internship who is at work but does not have a client care assignment
• D. An experienced orthopedic LPN who is already at work and has requested to work overtime

Answer: (A)

The situation tests the need for a nurse with high-acuity, critical-care expertise who can recognize early signs of deterioration and intervene immediately. A patient at risk for rapid decline requires someone who can interpret complex monitor data, manage invasive devices or vasoactive infusions if needed, and escalate promptly.

An experienced critical care RN, even if off duty, is the best choice because their specialized training and experience enable rapid assessment and decisive action in unstable situations. Arranging for them to be available (call-in or standby) ensures the patient receives appropriate, timely care as conditions change.

The other options lack either the necessary critical-care expertise or the appropriate scope of practice for high-acuity, rapidly changing conditions. An orthopedic-hospital RN, even with experience in that unit, may not be prepared to manage ICU-level needs. A graduate nurse with a critical care internship but no current patient assignment lacks recent hands-on practice. An experienced orthopedic LPN may have valuable insights but typically does not have the scope to handle rapid deterioration or complex hemodynamic management.

So, arranging for the experienced critical care RN to be available is the safest, most capable approach for a patient with potential rapid deterioration.