A nurse in an emergency department is planning care for a client who has abdominal trauma from a motor-vehicle crash. Which of the following provider prescriptions should the nurse implement first?

Administer packed RBCS.

Obtain a specimen for ABG analysis.

Place a large-bore IV catheter in an upper extremity.

Insert an indwelling urinary catheter.

Answer and Explanation

The Correct Answer is C

A. Administer packed RBCs. While blood transfusion may be urgently needed for hemorrhagic shock, it cannot be initiated until vascular access is established. It is important, but not the first step.
B. Obtain a specimen for ABG analysis. Arterial blood gases can provide valuable information about respiratory and metabolic status, but they are not the top priority in an unstable trauma patient.
C. Place a large-bore IV catheter in an upper extremity. Establishing IV access is the priority in trauma care, as it allows for rapid fluid resuscitation and medication administration. This intervention supports all subsequent emergency treatments.
D. Insert an indwelling urinary catheter. A catheter may be necessary for monitoring urine output as a sign of perfusion, but this is not the first action in a trauma situation where immediate stabilization is the priority.

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Correct Answer is A

Explanation

A. Turn off oxygen sources. After ensuring the client is safe, the priority is to reduce the risk of fire spreading, and oxygen greatly increases flammability. Turning off oxygen is a critical safety measure to prevent rapid combustion.
B. Put out the fire with an extinguisher. While extinguishing the fire is important, it should only be attempted if safe to do so and after addressing immediate dangers, such as oxygen sources and client safety.
C. Close the fire doors on the unit. This is part of containment under the RACE protocol (Rescue, Alarm, Contain, Extinguish), but it is not the first priority after rescue when oxygen is actively feeding the fire.
D. Notify the facility operator. This step corresponds to the "Alarm" phase of RACE and is essential for initiating the emergency response. However, it follows immediately after ensuring client safety and environmental hazard reduction, like turning off oxygen.

A. Initiate an oxytocin IV infusion B. Apply a fetal heart rate monitor. C. Initiate fundal massage. D. Insert an indwelling urinary catheter

Correct Answer is B

Explanation

A. Initiate an oxytocin IV infusion. Oxytocin may be used to augment labor, but it should not be started immediately without first assessing maternal and fetal well-being. Continuous monitoring is necessary before initiating any uterotonic agent.
B. Apply a fetal heart rate monitor. After rupture of membranes, assessing the fetal heart rate is critical to detect signs of umbilical cord prolapse or fetal distress. Continuous electronic fetal monitoring helps evaluate the baby's response to labor.
C. Initiate fundal massage. Fundal massage is performed after delivery of the placenta to help contract the uterus and reduce postpartum bleeding. It is not appropriate during active labor.
D. Insert an indwelling urinary catheter. A catheter may be placed if necessary during labor, especially before epidural anesthesia, but it is not the immediate priority following membrane rupture. Fetal monitoring takes precedence.

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A nurse in an emergency department is planning care for a client who has abdominal trauma from a motor-vehicle crash. Which of the following provider prescriptions should the nurse implement first?

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