A nurse is assessing a client who has a long history of rheumatoid arthritis. The nurse should expect to find which of the following?

Choice A rationale

Client 1 presents with stable vital signs. A temperature of 97.8 F, pulse of 66 bpm, respiratory rate of 14, and blood pressure of 122/72 mmHg are all within normal limits. An oxygen saturation of 97 percent is also excellent. This client is physiologically stable and does not require immediate intervention. The nurse should prioritize clients with abnormal respiratory parameters or signs of hypoxia over those who are maintaining normal homeostatic values and adequate oxygenation.

Choice B rationale

Client 2 has vital signs that are mostly within normal ranges. The temperature of 98.8 F and pulse of 82 are normal. A respiratory rate of 16 is ideal. The blood pressure of 130/62 mmHg shows a slightly widened pulse pressure but is not acutely concerning. The pulse oximetry of 95 percent is within the acceptable range for most adults. This client is stable and does not exhibit the acute respiratory distress seen in other potential candidates.

Choice C rationale

Client 3 is the priority because they are showing signs of respiratory distress and hypoxia. A respiratory rate of 28 breaths per minute is tachypneic (normal is 12 to 20), and an oxygen saturation of 90 percent is below the standard target of 95 to 100 percent. This indicates the client is struggling to maintain oxygenation and requires immediate assessment, potential oxygen therapy, and further diagnostic evaluation to prevent further respiratory failure or cellular hypoxia and related complications.

Choice D rationale

Client 4 demonstrates very stable vital signs. A temperature of 97.2 F, pulse of 70, and respiratory rate of 14 are normal. A blood pressure of 120/80 mmHg is the textbook definition of a normal reading. An oxygen saturation of 100 percent indicates perfect hemoglobin saturation. There is no clinical reason to see this client before Client 3, who is currently experiencing significant respiratory compromise and requires urgent nursing and possibly medical intervention.

Choice A rationale

Asking why questions often sounds accusatory or judgmental to the patient. This can cause the client to become defensive or shut down, which hinders the therapeutic relationship. In a crisis or after an injury, the patient may not know the cause of the fall, and being pressured for an explanation can increase anxiety. Effective communication focuses on open-ended inquiries rather than seeking justifications. The nurse should avoid language that implies the patient is at fault.

Choice B rationale

This statement provides false reassurance and minimizes the patient's concerns. Telling a patient not to stress or that everything will resolve itself is dismissive of their current physical and emotional pain. It shuts down further communication by implying that the patient's feelings are not valid. While involving family is helpful, the nurse cannot guarantee specific outcomes or total resolution. Therapeutic communication requires acknowledging the patient's reality and providing honest, empathetic support throughout the evaluation process.

Choice C rationale

This is an open-ended, therapeutic inquiry that encourages the patient to provide a detailed narrative of the event. By asking for the sequence before, during, and after the fall, the nurse gathers essential clinical data for diagnosis while showing interest in the patient's perspective. It allows the patient to express their experience without feeling rushed or judged. This approach helps identify potential causes like syncope or environmental hazards. It fosters a collaborative environment and validates the patient's experience.

Choice D rationale

Comparing the patient to other clients is unprofessional and violates the principle of individualized care. It minimizes the patient's specific trauma by suggesting their situation is common or routine for the staff. This can make the patient feel like just another number in a busy emergency department. Therapeutic communication should remain focused entirely on the individual patient currently being treated. Discussing other cases is a breach of privacy and distracts from the immediate clinical needs of the falling victim.