A nurse is teaching a client about prevention of injury when lifting. Which of the following instructions should the nurse include in the teaching?

The first client the nurse should assess is Client 3 (Pulmonary Edema) followed by Client 1 (Hip Fracture).

Rationale:

Client 3 (Pulmonary Edema) – Highest Priority:

1. 1. Pulmonary edema is a life-threatening condition that can impair oxygenation.
   2. The client has a history of congestive heart failure (CHF) and a chest x-ray confirming pulmonary edema.
   3. Immediate assessment is required to evaluate for respiratory distress, oxygenation status, and potential need for diuretics or oxygen therapy.

Client 1 (Hip Fracture) – Second Priority:

1. 1. The x-ray confirms a fractured femoral neck, which can cause severe pain, bleeding, and immobility.
   2. The nurse must assess for circulation, sensation, and movement (CSM) of the affected limb and manage pain.
   3. While this is urgent, it is not as immediately life-threatening as pulmonary edema.

Priority Order (Using ABCs & Maslow’s Hierarchy):

1. Client 3 – Pulmonary Edema (Airway/Breathing concern)
   2. Client 1 – Hip Fracture (Risk for bleeding, pain, mobility issues)
   3. Client 4 – Low Potassium (Risk for cardiac arrhythmias, needs electrolyte management)
   4. Client 6 – Poor Diabetes Control (HbA1c 9%, requires education & glucose monitoring)
   5. Client 5 – Malnutrition (Prealbumin 12 mg/dL, needs nutrition support for wound healing)
   6. Client 2 – Hyperlipidemia (Not an immediate concern, requires long-term management)

A. "Although this is your first incident, we will have to terminate your employment." This response is punitive and does not align with a just culture, which seeks to identify the cause of errors rather than immediately disciplining staff.
B. "We will review the incident report to determine the cause of the missed medication." This aligns with just culture principles by focusing on finding the root cause (e.g., workload issues, system inefficiencies) rather than blaming the nurse.
C. "I will need to report this incident to the state board of nursing." A missed medication dose that caused no harm typically does not require reporting to the state board. Just culture focuses on improving processes rather than unnecessary punishment.
D. "The facility's legal team will be contacting you to discuss the incident." Involving legal action for a minor, non-harmful event is excessive and contradicts just culture, which emphasizes education, accountability, and system improvements over legal consequences.