The following clients are waiting to be seen in the emergency department. Which client should the nurse assess first?

Cocaine abuser with chest pain

An intoxicated client with a long history of alcoholism

A client who recently experienced a “bad trip” from LSD

A young man who thinks they have been given flunitrazepam (Rohypnol)

Answer and Explanation

The Correct Answer is A

A: A cocaine abuser with chest pain should be assessed first because chest pain can indicate a life-threatening condition such as a myocardial infarction (heart attack). Cocaine use increases the risk of cardiovascular events, making this client a priority.

B: An intoxicated client with a long history of alcoholism needs medical attention, but their condition is likely less immediately life-threatening compared to chest pain from cocaine use.

C: A client who recently experienced a “bad trip” from LSD may be experiencing psychological distress, but this is generally not as immediately life-threatening as chest pain.

D: A young man who thinks they have been given flunitrazepam (Rohypnol) needs to be assessed for potential drug-facilitated assault, but this situation is less immediately critical than chest pain from cocaine use.

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Correct Answer is B

Explanation

A: Encouraging clients to participate in various activities is a positive approach that helps engage them in the program and develop new skills.

B: Allowing the client to skip mandatory programming as a reward for good behavior is inappropriate because it undermines the structure and consistency of the program. Mandatory programming is essential for therapeutic progress and should not be used as a reward or punishment.

C: Ignoring attention-seeking behavior, such as screaming, can be an appropriate strategy to avoid reinforcing negative behaviors, provided it is done within the context of a behavior management plan.

D: Removing a client from group after they become disruptive, per unit policy, is an appropriate action to maintain the therapeutic environment and ensure the safety and well-being of all clients.

A. She rarely eats meals with the family; instead, she sneaks food up to her room. B. She is too tired to do chores around the house, which is unusual for her. C. I know she has been very anxious lately; her schoolwork has been challenging her. D. She will feel a lot better when she finds out if she was accepted to her first-choice college.

Correct Answer is A

Explanation

A: This statement suggests secretive eating behaviors, which are characteristic of bulimia. Individuals with bulimia often eat large amounts of food in secret and then engage in compensatory behaviors such as purging. The mother’s observation that her daughter sneaks food to her room aligns with this pattern.

B: While fatigue and a lack of energy can be associated with various conditions, including eating disorders, this statement is not specific enough to indicate bulimia. It could be related to many other factors such as stress, depression, or physical illness.

C: Anxiety and academic challenges are common among adolescents but do not specifically point to bulimia. While stress can contribute to eating disorders, this statement alone does not provide enough evidence to suggest bulimia.

D: This statement reflects a situational stressor related to college acceptance but does not indicate any eating disorder behaviors. It is more about the adolescent’s emotional state and future plans rather than current eating habits.

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