# Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, and thyroid disorders. It uses team nursing: each team has a registered nurse team leader, one or two staff nurses, and a nursing attendant. The head nurse is working to improve how the teams work with the laboratory, pharmacy, and dietary services. A client arrives from the emergency room whose condition is unstable and who needs reassessment every 30 minutes. The team leader already cares for 4 clients and must supervise the team. The other members are a new graduate nurse in the second week of orientation, a staff nurse with 6 years on the ward, and a nursing attendant. To whom should the team leader assign the new client?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630453  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, and thyroid disorders. It uses team nursing: each team has a registered nurse team leader, one or two staff nurses, and a nursing attendant. The head nurse is working to improve how the teams work with the laboratory, pharmacy, and dietary services.

A client arrives from the emergency room whose condition is unstable and who needs reassessment every 30 minutes. The team leader already cares for 4 clients and must supervise the team. The other members are a new graduate nurse in the second week of orientation, a staff nurse with 6 years on the ward, and a nursing attendant. To whom should the team leader assign the new client?

## 보기

1. The new graduate nurse, with the team leader checking at the end of the shift
2. The nursing attendant, who will report the reassessment findings every 30 minutes
3. The staff nurse with 6 years on the ward **✔ 정답**
4. The new graduate nurse and the nursing attendant working together

**정답: 3**

## 해설

Assignments match the client's acuity and complexity to the nurse's demonstrated competence, so the most unstable client goes to the most experienced registered nurse. A nurse in orientation needs a lighter, stable assignment, and unlicensed workers do not assess unstable clients.

## 심화 해설

Matching acuity to competence
A new client arrives from the emergency room who is unstable and needs reassessment every 30 minutes. In team nursing, the team leader makes assignments by matching the client's acuity and complexity to each member's demonstrated competence and scope of practice. The most unstable client goes to the most experienced registered nurse available, here the staff nurse with 6 years on the ward. The team leader is already caring for four clients and must also supervise, so taking the client personally would compromise both roles.

Why the experienced staff nurse
Frequent reassessment of an unstable client requires professional nursing assessment: interpreting trends, recognizing early deterioration, and deciding when to escalate. A nurse with 6 years on the ward knows the unit's routines, resources, and typical complications and can manage rapid changes. The team leader can then supervise and support the newer members.

| Team member | Appropriate assignment | Unstable new client? |
| --- | --- | --- |
| Staff nurse, 6 years | Complex and unstable clients | Yes |
| New graduate in orientation | Lighter, stable assignment with close support | No |
| Nursing attendant | Routine care of stable clients, under supervision | No; cannot assess |
| Team leader | Supervision, coordination, a limited load | Already at capacity |

Why the other options are wrong
A new graduate in the second week of orientation should not carry an unstable client, and checking only at the end of the shift is inadequate supervision for a client who can deteriorate within minutes. Reassessing an unstable client is professional assessment, which cannot be given to an unlicensed nursing attendant; the attendant may collect vital signs but not interpret them. Pairing the new graduate with the attendant combines two less-prepared workers and still does not supply experienced judgment.

Watch out! Options that add supervision or pair workers can look safe. Ask whether the person actually responsible for assessment has the competence the client needs.

Exam takeaway
The new graduate could take a stable client from the experienced nurse's group, which balances workload while protecting safety and supporting orientation. Key point! Assign the most unstable, complex client to the most competent registered nurse; nurses in orientation take stable clients, and unlicensed workers never assess unstable clients.

## 임상 시나리오

Assigning an Unstable ClientTeam nursing assignment
An unstable client needs reassessment every 30 minutes; the team leader already has four clients and must supervise.

Assign the client to the staff nurse with 6 years on the ward, matching acuity to demonstrated competence.

A new graduate in orientation takes stable clients; the nursing attendant cannot perform professional assessment.

CautionEnd-of-shift checks or pairing two less-prepared workers do not provide safe care for a client who can deteriorate quickly.

## 핵심 개념

- **Team nursing** — A care delivery model in which a registered nurse team leader directs a small team caring for a group of clients.
- **Acuity** — The severity of a client's condition and the intensity of nursing care required.
- **Assignment** — Allocation of clients and tasks to staff according to client needs and staff competence.
- **Orientation** — A planned introduction period that prepares a new nurse for the role and unit.

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