A nurse is assigned to care for four clients. Which client should the nurse assess first?

A postoperative client preparing for discharge with a new medication.

A client requiring daily dressing changes of a recent surgical incision.

A client scheduled for a chest x-ray after insertion of a nasogastric tube.

A client with asthma who requested a nebulizer treatment during the previous shift.

Answer and Explanation

The Correct Answer is D

Choice A reason: While it is important to prepare the postoperative client for discharge and ensure they understand how to take their new medication, this situation is less urgent than addressing a potential respiratory issue.

Choice B reason: Changing the dressing on a recent surgical incision is part of routine care and can be scheduled after more urgent needs are addressed. The client’s wound care is important, but it does not take precedence over potential respiratory distress.

Choice C reason: Although the chest x-ray is necessary to confirm the correct placement of the nasogastric tube, this can be done after the more immediate concern of a respiratory issue is addressed. The nasogastric tube will remain in place for feeding or drainage in the meantime.

Choice D reason: This client should be assessed first because asthma can lead to respiratory distress or an asthma attack, which requires prompt intervention. Since the client requested a nebulizer treatment during the previous shift, it is crucial to assess their current respiratory status and administer the treatment if necessary to prevent any complications.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is ["A","B","C","D","E"]

Explanation

Choice A reason: Including client information on the disaster tag is crucial for identification and tracking purposes. This information ensures that each client can be accurately identified, which is essential for providing appropriate care and for communication with family members and other healthcare providers.

Choice B reason: Triage priority is an essential piece of information that indicates the level of urgency for each client's care. This prioritization helps healthcare providers quickly identify which clients need immediate attention and which can wait, thereby optimizing the use of limited resources during a mass casualty incident.

Choice C reason: Next of kin information is important for contacting family members and loved ones in case of emergency. This information is essential for communicating the client's status, obtaining additional medical history, and providing support to the family during a stressful time.

Choice D reason: Decontamination information, if applicable, indicates whether the client has undergone decontamination procedures. This is critical for ensuring that contaminated clients do not pose a risk to others, including healthcare providers and other patients, and for maintaining a safe environment within the healthcare facility.

Choice E reason: Documenting medications and treatments administered is vital for continuity of care. This information allows healthcare providers to track what treatments have been given, avoid duplication of medications, and monitor the client's response to treatment. It also ensures that any subsequent healthcare providers have a complete record of the client's care.

A. Radiology B. Hospital Security C. Hospital Housekeeping D. Dietary E. Registration

Correct Answer is ["A","B","C","E"]

Explanation

Choice A reason: The radiology department plays a crucial role in mass casualty incidents by providing imaging services to diagnose and assess the extent of injuries. Involving radiology in the drill planning process ensures that they are prepared to handle a sudden influx of patients.

Choice B reason: Hospital security is essential for managing crowd control, maintaining order, and ensuring the safety of patients, staff, and visitors during a mass casualty incident. Their involvement in the drill planning process is necessary to coordinate security measures effectively.

Choice C reason: Hospital housekeeping is responsible for maintaining cleanliness and sanitation, which is especially important during a mass casualty incident to prevent the spread of infections and ensure a safe environment for patient care. Their participation in the drill planning helps prepare them for increased demands.

Choice D reason: The dietary department, while important for overall patient care, is not immediately critical in the context of a mass casualty drill. The focus of such drills is typically on urgent medical care, security, and logistical coordination.

Choice E reason: The registration department is vital for efficiently processing and documenting patient information during a mass casualty incident. Their involvement in the drill planning process ensures that they are prepared to handle a large number of patients quickly and accurately.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is assigned to care for four clients. Which client should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The emergency department nurse is triaging clients arriving from a mass casualty incident. During the triage, the nurse confirms that each client has a disaster tag. What information should be placed on the tag for each client? (Select all that apply)

Correct Answer is ["A","B","C","D","E"]

Explanation

The emergency department nurse manager would like to develop a mass casualty drill to help with the training of the staff. What other hospital departments should be involved in the drill planning process? (Select All that Apply)

Correct Answer is ["A","B","C","E"]

Explanation

A newly hired nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the nurse educator best provides information about this aspect of therapeutic communication?

The nurse is assessing a client with a diagnosis of acute emphysema. The client is receiving oxygen at a flow rate of 5 L/min by nasal cannula. Which assessment findings should be reported to the provider immediately?

A nurse has several tasks to delegate to assistive personnel (AP). Which of the following tasks should the nurse ask the AP to perform first?

The nurse is working on the medical-surgical unit when a visiting family member reports the sudden onset of a headache and numbness on the left side of their body. The visitor asks the nurse to check their blood pressure. What is the most appropriate response by the nurse?

The nurse working on the medical-surgical unit has delegated several patient care tasks to the unlicensed assistive personnel. What is the nurse's primary responsibility after the delegation of tasks?

The nurse manager of the emergency department arranges for critical incident stress debriefing for the staff after a mass casualty incident. Which statement by the debriefing team leader is most appropriate for this situation?

A nurse is caring for several clients. For which of the following situations should the nurse complete an incident report?

The nurse is caring for a client on the medical unit when the waste basket catches fire. What is the priority action for the nurse?