A nurse working in the emergency department is assessing several clients. Which of the following clients is the highest priority?
A client who has active bleeding from a puncture wound to the groin area
A client who has a raised red skin rash on his arms, neck, and face
A client who reports shortness of breath and left shoulder and neck pain
A client who reports right-sided flank pain
The Correct Answer is C
A. A client who has active bleeding from a puncture wound to the groin area is urgent but not immediately life-threatening compared to a potential heart attack. Active bleeding requires immediate intervention, but this is often manageable with pressure and quick action.
B. A client who has a raised red skin rash on his arms, neck, and face could indicate an allergic reaction or infection, but it's generally not as life-threatening as signs of a myocardial infarction.
C. A client who reports shortness of breath and left shoulder and neck pain is the highest priority. These are classic signs of a myocardial infarction (heart attack), which is a life-threatening emergency. Shortness of breath and pain in the left shoulder and neck indicate a need for immediate assessment and intervention to prevent cardiac arrest or other complications.
D. A client who reports right-sided flank pain is likely experiencing kidney stones, which can cause significant pain, but it is generally not life-threatening and can be managed after a more urgent situation like a heart attack is addressed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. In emergency situations where the client is unconscious and no legal representative is available, life-saving treatment or surgery can proceed without consent under the doctrine of implied consent.
b. Delaying the surgery until informed consent can be obtained may jeopardize the client's health if immediate surgery is necessary.
c. Consent from a facility administrator is not required; the healthcare team can act under implied consent in emergencies.
d. Asking the anesthesiologist to sign the consent is not appropriate; consent should ideally be obtained from the client or a legally authorized representative.
Correct Answer is D
Explanation
a. L/S ratio of 2:1 at 37 weeks gestation indicates fetal lung maturity, requiring monitoring but not necessarily immediate interdisciplinary care.
b. Negative Coombs's titer at 28 weeks gestation suggests Rh incompatibility, which may require monitoring but is not an immediate indication for interdisciplinary care.
c. Negative contraction stress test at 39 weeks gestation indicates a lower likelihood of uteroplacental insufficiency but does not necessarily warrant interdisciplinary care.
d. A biophysical profile score of 6 at 35 weeks gestation suggests potential fetal compromise and may require interdisciplinary care to assess and manage the situation.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.