A nurse is triaging clients in the emergency department. Which of the following clients should the nurse ask the healthcare provider to care for first?
A client who has acute tonsillitis, is drooling, and has difficulty swallowing
A client who sustained a deep laceration to their leg and is complaining of dizziness and weakness
A client who has chronic obstructive pulmonary disease (COPD) with a pulse oximetry reading of 88%
A client who has lower left abdominal pain and bloody stools
The Correct Answer is A
A. A client who has acute tonsillitis, is drooling, and has difficulty swallowing: This client is likely experiencing severe swelling or an airway obstruction, which requires immediate attention to ensure the airway is not compromised.
B. A client who sustained a deep laceration to their leg and is complaining of dizziness and weakness: While this client has concerning symptoms, airway compromise is prioritized in triage.
C. A client who has chronic obstructive pulmonary disease (COPD) with a pulse oximetry reading of 88%: This client is hypoxic and requires prompt intervention, but airway issues take precedence.
D. A client who has lower left abdominal pain and bloody stools: This client may have a serious condition but does not require as immediate intervention as a compromised airway.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Pantoprazole: This medication is a proton pump inhibitor used to treat acid-related disorders and does not interact adversely with sildenafil.
B. Isosorbide mononitrate: This is correct. Isosorbide mononitrate is a nitrate used to treat angina. Combining it with sildenafil can lead to severe hypotension due to their additive vasodilatory effects.
C. Acetylsalicylic acid: This is incorrect. Acetylsalicylic acid (aspirin) is used for pain relief and cardiovascular protection and does not contraindicate sildenafil use.
D. Atorvastatin sodium: This is incorrect. Atorvastatin is a statin used to manage cholesterol levels and does not contraindicate sildenafil use.
Correct Answer is C
Explanation
A. Allow a drinking glass on the client's meal tray: This is incorrect. Allowing objects that could potentially be used for self-harm is unsafe. All items on the client's meal tray should be carefully reviewed to ensure they do not pose a risk.
B. Place the client in four-point restraints: This is incorrect. Restraints are used as a last resort and should only be applied following a thorough assessment of the client's needs and risks, considering less restrictive measures first.
C. Inspect the client's personal belongings: This is correct. Inspecting personal belongings is crucial to ensure that the client does not have items that could be used for self-harm. This step helps in identifying and removing potential hazards.
D. Assign the client to a private room: This is incorrect. Assigning a client to a private room might not be appropriate as it could isolate the client and reduce opportunities for observation and intervention. A safer approach is to place the client in a room where they can be closely monitored, typically a shared room with staff supervision.
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