A nurse enters a client's room and sees smoke coming from the trash can next to the client's bed. Which of the following actions should the nurse take first?
Pull the fire alarm panel.
Obtain a fire extinguisher.
Remove the client from the room.
Close the door to the client's room.
The Correct Answer is C
Choice A reason: This is not an appropriate action to take first because pulling the fire alarm panel can alert other staff and personnel about the fire and activate the emergency response system, but it does not address the immediate safety and well-being of the client who is exposed to smoke and flames. The nurse should pull the fire alarm panel after removing the client from the room.
Choice B reason: This is not an appropriate action to take first because obtaining a fire extinguisher can help extinguish or contain the fire and prevent it from spreading to other areas, but it does not address the immediate safety and well-being of the client who is exposed to smoke and flames. The nurse should obtain a fire extinguisher after removing the client from the room.
Choice C reason: This is an appropriate action to take first because removing the client from the room can protect them from smoke inhalation, burns, or injuries and ensure their safety and well-being. The nurse should remove the client from the room as quickly and safely as possible and follow the RACE protocol (Rescue, Alarm, Contain, Extinguish).
Choice D reason: This is not an appropriate action to take first because closing the door to the client's room can help contain the fire and prevent it from spreading to other areas, but it does not address the immediate safety and well-being of the client who is exposed to smoke and flames. The nurse should close the door to the client's room after removing them from the room.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should assess the client's anxiety level and provide coping strategies and emotional support as needed.
Choice B reason: This data is the priority for the nurse to address because it indicates a potential infection that can be contagious and harmful to the client and others in the room. The nurse should isolate the client in a private room with negative pressure ventilation and wear personal protective equipment when entering the room. The nurse should also notify the infection control team and obtain sputum samples for testing.
Choice C reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should ask about the frequency, severity, duration, triggers, and treatment of the migraine headaches and provide pain relief and comfort measures as needed.
Choice D reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should inquire about the possible causes, such as urinary tract infection, diabetes mellitus, prostate enlargement, or medication side effects, and monitor the client's fluid intake and output and urine characteristics.
Correct Answer is D
Explanation
Choice A reason: This medication does not need to be avoided within 24 hours of using nitroglycerin because it does not interact with nitroglycerin. Metformin is an oral antidiabetic drug that lowers blood glucose levels by decreasing hepatic glucose production and increasing insulin sensitivity.
Choice B reason: This medication does not need to be avoided within 24 hours of using nitroglycerin because it does not interact with nitroglycerin. Atorvastatin is a statin drug that lowers blood cholesterol levels by inhibiting an enzyme involved in cholesterol synthesis.
Choice C reason: This medication does not need to be avoided within 24 hours of using nitroglycerin because it does not interact with nitroglycerin. Omeprazole is a proton pump inhibitor drug that lowers stomach acid levels by blocking an enzyme involved in acid secretion.
Choice D reason: This medication needs to be avoided within 24 hours of using nitroglycerin because it can interact with nitroglycerin and cause severe hypotension and syncope. Sildenafil is a phosphodiesterase inhibitor drug that treats erectile dysfunction by increasing blood flow to the penis by relaxing smooth muscle cells.
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