Section 2. Clinical question.
Choose one of the following:
2.1 You are caring for a male patient who suffered a fractured shaft of femur 5 days ago. He develops chest
pain and shortness of breath. What would your immediate actions be?
2.2 A patient 2 days post-operative Femoropopliteal bypass is on four hourly vascular observations. You
find the foot cool and slightly mottled. What actions should you take?
2.3 Your patient is 2 days post laparotomy and has started taking fluids. They are now complaining of
abdominal discomfort and nausea. What will your actions be?
Explain your answer in detail including your assessment, hypotheses and rationales for actions.
Section 3. Prioritization
After morning handover of your 4 patients you have reviewed the charts and have entered the room to greet your
patients. It is 0730 and breakfast is usually delivered at 0740. Before you can introduce yourself, the following
demands on your time occur concurrently:
Patient 1 Mrs Peterson is asking for help to the ensuite to use her bowels. You know Mrs Peterson had a stroke
2 weeks ago and has a moderate left hemiplegia and needs assistance to move. She is classified as a high falls
Registered Nurse An Nguyen in the adjacent bed unit enters the room and asks you to check some Endone for
Patient 2 Mrs Walters requires a blood glucose assessment. You noted it was not done at 0600 when you
reviewed the chart. She may require sliding scale insulin prior to eating.
Patient 3 Mr Young is nil by mouth and has IV therapy running at 167mls per hour. The infusion pump alarm is
sounding and the IV flask appears to be close to empty.
Patient 4 Mr Stavropoulous has been admitted for acute asthma. He is due to have Ventolin and Seretide at
0800 but as you look at him you note he appears short of breath and he is sitting upright with increased work of
In what order would you address these requests? Describe your rationale for each decision.
Section 4 Professional
Choose one of the following:
A colleague has removed every second suture from a long wound on the lower leg. She has asked for your
assistance to support the patient’s limb while she reapplies a dressing. A small area at the end of the suture line
is moist. The wound is being dressed with Melolin ™, Combine and crepe bandage for protection and support.
During the dressing your colleague drops a piece of Melolin ™ on the bed and retrieves this placing it back on
the dressing tray. She remarks it will be fine up the clean end of the wound. How will you respond to this
You are working in the Day procedure unit. Your postoperative patient requires Morphine 2.5mg IV. The order
prescribes 2.5 mg every 10 minutes up to a maximum of 3 doses. This is the first dose. Your colleague comes to
the medication room and checks the drug from the schedule 8 storage cupboard with you. You prepare a syringe
of 10mg of Morphine diluted to 10ml with Normal Saline according to the local protocol. You both check the order
and drug and all is correct. Your colleague says she is happy for you to go and administer the drug alone. “Just
remember only give 2.5 ml” she says and she leaves the medication room. How will you manage this situation?
Your patient Mr Stanley is having an ascitic tap on the ward today. You have reviewed the requirements of the
procedure and understand that you need to assist by caring for the patient, managing analgesia and monitoring
vital signs during the procedure. It is lunchtime in your busy ward. Your colleagues including the ANUM in
charge, are off the ward having lunch. The ANUM handed over to you that Mr Stanley is having the ascitic tap
after 1.30 when sufficient staff are available and that she has negotiated this with the resident medical officer
(RMO). You are monitoring another patient with hypoglycaemia when you see the RMO with the procedure
trolley going into Mr Stanley’s room. The procedure requires a nurse be in attendance. You have no available
staff and you need to monitor your hypoglycaemic patient. How will you manage this RMO?
Describe in detail your response to your chosen scenario drawing upon your knowledge and research of
professional regulations and requirements, professional behaviour, conflict resolution techniques, education and
provision of feedback.
Appropriate use of references including in text citations and reference list (5 marks)