A nurse finds a client who is not breathing. The nurse does not suspect any cervical vertebrae fractures. Which of the following actions should the nurse take first?

Evaluate the client for other injuries.

Open the client's airway using the head tilt-chin lift.

Open the client's airway using the jaw-thrust maneuver.

Place the client in a rigid cervical collar.

Answer and Explanation

The Correct Answer is B

A. Evaluating for other injuries is important but not the immediate priority.
B. If no cervical spine injury is suspected, the head tilt-chin lift is the recommended method to open the airway first in an apneic client.
C. The jaw-thrust maneuver is used when cervical spine injury is suspected to avoid neck movement.
D. Applying a rigid cervical collar is not necessary if no cervical injury is suspected.

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Free Nursing Study Resources

Correct Answer is ["325"]

Explanation

Total fluid volume for 24 hours = 5,200 mL

First 8-hour period = receive half of total volume
5,200 ÷ 2 = 2,600 mL

Time = 8 hours

Calculation:

2,600 mL ÷ 8 hr = 325 mL/hr

Answer: 325 mL/hr

A. Urinary output 25 mL/hr B. Difficulty swallowing C. Heart rate 122/min D. Pain of 6 on a scale of 0 to 10

Correct Answer is B

Explanation

A. Urinary output of 25 mL/hr is low and concerning but not immediately life-threatening compared to airway compromise.
B. Burns to the face, ears, and eyelids can cause airway edema and swelling that may rapidly progress to airway obstruction. Difficulty swallowing may indicate swelling of the airway or impending airway compromise, which requires immediate intervention.
C. Heart rate of 122/min indicates tachycardia, which is common in burn patients due to pain, stress, or hypovolemia but is not as urgent as airway concerns.
D. Pain level of 6 requires management but is not a priority over airway or circulatory issues.

View Question and Answer

A nurse is caring for a client who is admitted to the emergency department for fatigue.

Exhibits

Which 4 findings indicate that the client may be experiencing transplant rejection? (Select all that apply).

View Question and Answer

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A nurse finds a client who is not breathing. The nurse does not suspect any cervical vertebrae fractures. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["325"]

Explanation

A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider?

Correct Answer is B

Explanation

A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?

A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?

A nurse is caring for a client who is admitted to the emergency department for fatigue. Exhibits Which 4 findings indicate that the client may be experiencing transplant rejection? (Select all that apply).

A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take?

A nurse in an emergency department is planning care for a client who is having an acute myocardial infarction (MI). The nurse should plan to administer which of the following medications after the initial acute phase to manage the client's pain and anxiety?

A nurse is caring for a client who is at risk for shock. Which of the following findings is the earliest indicator that shock is developing and compensation is beginning?

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?

A nurse is helping to triage a group of clients at a mass casualty incident who were involved in an explosion at a local factory. Which of the following clients should the nurse tag to be the priority for care?