A nurse is caring for a client who has acute pulmonary edema. Which of the following is the priority nursing intervention?

A. The first priority is to rescue any individuals in immediate danger. Moving the client ensures their safety before addressing the fire. Delaying this step could expose the client to smoke inhalation or burns.

B. Once the client is safe, the nurse must activate the fire alarm system. This alerts the rest of the facility and triggers the emergency response protocol. Early alarm activation helps prevent the fire from spreading further.

C. Attempting to extinguish the fire comes only after other safety measures. If the fire is small and controllable, using a fire extinguisher may prevent escalation. However, it must only be attempted when it is safe to do so.

D. Closing nearby windows and doors helps contain the fire to one area. This reduces oxygen flow and slows the spread of fire and smoke throughout the unit. Containment is a key step in minimizing damage and injury.

Rationale for Correct Choices:

• Compartment syndrome: Occurs when pressure within a closed muscle compartment compromises circulation and tissue function. The client presents with classic signs: pain out of proportion, pallor (cool foot), pulselessness (non-palpable pulses), paresthesia (numbness), and paralysis (inability to move foot/toes) which are hallmark signs of compromised perfusion.

• Osteomyelitis: The presence of drainage from the splint site, increasing temperature, and markedly elevated WBC count (from 14,000 to 28,000/mm³) strongly suggest developing bone infection. The client’s open fracture and internal fixation increase susceptibility, especially with new signs of systemic infection and localized inflammation at the injury site.

Rationale for Incorrect Choices:

• Deep vein thrombosis (DVT): While trauma and immobility increase DVT risk, there is no evidence of unilateral leg swelling, calf tenderness, or redness. The primary concern here is neurovascular compromise, not venous thromboembolism, and the symptoms point more urgently to compartment syndrome and infection.

• Fat embolism syndrome: Fat embolism is a risk with long bone fractures, typically presenting within 24–72 hours with respiratory distress, hypoxia, confusion, and a petechial rash. This client is alert and not in respiratory distress, with normal oxygen saturations and no mental status changes, making fat embolism less likely at this stage.