A nurse in an emergency department is performing triage on a group of clients.
Which of the following clients should the nurse see first?
A client who has heart failure and peripheral edema.
A client who has cirrhosis of the liver and bruising on their arms.
A client who reports urinary burning and a temperature of 39.2° C (102.5° F).
A client who has a new onset of atrial fibrillation and a heart rate of 152/min.
The Correct Answer is D
Atrial fibrillation with a rapid heart rate can lead to decreased cardiac output and compromised blood flow, which can have serious consequences, including stroke and heart failure. Therefore, this client requires immediate attention to assess and manage the cardiac rhythm.
While the other clients also have significant health concerns, they are not as acutely life-threatening as a new onset of atrial fibrillation with a high heart rate. Prioritizing care based on the urgency and severity of the condition is crucial in the emergency department setting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Abstract thinking develops during the formal operational stage of Piaget's cognitive development theory. This stage typically occurs in adolescence and beyond. During this stage, individuals can think abstractly, solve complex problems, and reason about hypothetical situations. They can also engage in deductive reasoning, which allows them to think logically and systematically.
Choice B rationale:
The concrete operational stage in Piaget's theory, not the formal operational stage, is characterized by the development of logical thinking and operational thought. It typically occurs in children aged 7 to 11 and is marked by the ability to think logically about concrete events and objects.
Choice C rationale:
The sensorimotor stage is the earliest stage in Piaget's theory, occurring in infants from birth to about 2 years old. This stage is characterized by sensory and motor exploration of the environment, and abstract thinking has not yet developed at this stage.
Choice D rationale:
The preoperational stage in Piaget's theory, which typically occurs in children aged 2 to 7, is marked by the development of symbolic thought and language. However, abstract thinking is not a characteristic of this stage.
Correct Answer is C
Explanation
Choice C rationale:
Respite care provides support for a client's caregiver. Respite care offers temporary relief or rest for caregivers who are taking care of individuals with chronic illness, disabilities, or those approaching the end of life. It allows caregivers to have a break from their responsibilities, reducing caregiver burnout and stress. This type of support helps maintain the caregiver's physical and emotional well-being, which, in turn, benefits the client's overall care.
Choice A rationale:
Postmortem care is the care provided to a deceased client, and it does not directly support the caregiver of a living client. It is essential for ensuring respectful and appropriate handling of the deceased individual but does not provide support to caregivers.
Choice B rationale:
Home care involves healthcare services delivered in the client's home, which can be beneficial for the client's care but does not specifically address the needs of the caregiver. While it may indirectly ease the caregiver's responsibilities, it is not a service designed to support caregivers directly.
Choice D rationale:
Restorative care focuses on rehabilitation and restoring the client's health and independence, which primarily benefits the client rather than the caregiver. It is not a service aimed at supporting caregivers in the same way that respite care does.
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