A client with dysphagia is eating breakfast and suddenly slumps over. What should the nurse do first?
Call the rapid response team.
Move the client to the bed.
Call the primary care provider.
Assess client for unresponsiveness.
The Correct Answer is D
This is because the nurse should always follow the ABC (airway, breathing, circulation) priority when dealing with a client who suddenly slumps over. The nurse should check if the client is conscious and breathing before calling for help or moving the client.
Choice A is wrong because calling the rapid response team should not be done before assessing the client’s condition and ensuring a patent airway.
Choice B is wrong because moving the client to the bed may cause further harm or aspiration if the client has food in the mouth or airway.
Choice C is wrong because calling the primary care provider is not a priority action in this situation. The nurse should first assess and stabilize the client before notifying the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A client with expiratory wheezing after an albuterol treatment.
This indicates that the client has a severe bronchospasm that is not responding to the medication and may lead to respiratory failure.
The client needs immediate intervention to improve airway patency and oxygenation.
Choice A is wrong because a fasting blood sugar of 187 mg/dL is high but not life- threatening. The normal range for fasting blood sugar is less than 99 mg/dL.
The client may have diabetes or prediabetes and needs further evaluation and treatment, but this is not a priority over choice B.
Choice C is wrong because a client who has been called to surgery 2 hours early may need some preparation and education, but this is not an urgent situation.
The client can wait until the nurse has assessed the other clients.
Choice D is wrong because a blood pressure of 178/90 mmHg is elevated but not critical. The normal range for blood pressure is less than 120/80 mmHg.
The client needs a dose of atenolol, which is a beta
Correct Answer is A
Explanation
This is the proper way to obtain a throat culture, which is a test to look for infections in the back of the throat.
Some possible explanations for the other choices are:
Choice B is wrong because there is no need to avoid eating or drinking after a throat culture.
The swab does not interfere with the normal function of the mouth or throat.
Choice C is wrong because coughing while swabbing the throat could contaminate the sample or cause discomfort to the client. The swab should be gently passed along the back area of the throat and tonsils.
Choice D is wrong because swabbing only the anterior tongue would not collect enough cells from the infected area. The swab should reach the back of the throat where bacteria or fungi may grow.
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