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A nurse is the triage officer in the emergency department during a disaster when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first?

An unconscious adult client who has no respirations, capillary refill is > 2 seconds, and paramedics have already tried to reposition airway without results

A conscious adult client who has a broken tibia, blood pressure of 160/90 mm Hg, and heart rate of 118 beats per minute

An unconscious adult client who has a sucking chest wound, SpO2 of 85%, and capillary refill of < 2 seconds

A conscious adult client who reports shortness of breath, has a respiratory rate of 24/min, and capillary refill of <2 seconds

Answer and Explanation

The Correct Answer is C

C. The unconscious adult client with a sucking chest wound and low SpO2 (85%) is in immediate need of intervention. A sucking chest wound is a life-threatening injury that can lead to respiratory distress and compromised oxygenation. This client requires immediate attention to address the chest wound and improve oxygenation.
A. The unconscious client with no respirations and an ineffective airway attempt is likely beyond rescue, making them lower priority compared to those with potentially reversible conditions.
B. The conscious client with a broken tibia and elevated vital signs is stable enough to be seen after more critical cases are addressed.
D. The conscious client with shortness of breath and a high respiratory rate is concerning but not as immediately life-threatening as a client with a sucking chest wound.

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Correct Answer is B

Explanation

A. Chicken noodle soup is high in sodium, which can exacerbate fluid retention and worsen symptoms of Meniere disease. Clients with Meniere disease are typically advised to follow a low-sodium diet to help manage their symptoms.
B. Scrambled eggs are low in sodium and are an appropriate food choice for a client with Meniere disease. This option supports the dietary modifications needed to manage the condition effectively.
C. Baked ham is high in sodium, which is not suitable for a client with Meniere disease. High-sodium foods can lead to fluid retention, worsening vertigo and other symptoms associated with the disease.
D. Cheese pizza contains significant amounts of sodium, which can aggravate Meniere disease symptoms. Clients are advised to avoid high-sodium foods to manage their condition better.

A. Malnutrition and acute pancreatitis B. Heavy alcohol consumption and smoking C. Caffeine consumption and cigarette smoking D. Acute hepatitis and sporadic alcohol consumption

Correct Answer is B

Explanation

A. Malnutrition and acute pancreatitis are not primary causes of chronic pancreatitis. While acute pancreatitis can lead to chronic conditions, malnutrition is not a common direct cause.
B. Heavy alcohol consumption and smoking are well-established risk factors for chronic pancreatitis. These lifestyle factors can cause inflammation and damage to the pancreas over time.
C. Caffeine consumption does not have a direct correlation with chronic pancreatitis. Cigarette smoking is a risk factor, but caffeine is not.
D. Acute hepatitis is not a common cause of chronic pancreatitis. While alcohol consumption is a risk factor, the presence of acute hepatitis is not typically a direct cause.

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A nurse is the triage officer in the emergency department during a disaster when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with Meniere disease is instructed to modify his diet. The nurse would explain that which item would be acceptable for the client to include?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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