The nurse is triaging victims of a tornado at an emergency shelter. An adult who has been wandering and crying comes to the nurse. Which action should the nurse take?
Check the client’s temperature, blood sugar, and urine output.
Arrange for the client to be transported for laboratory tests and an electrocardiogram (ECG).
Delegate care of the crying client to an unlicensed assistant.
Direct the client to the shelter’s nutrition center to obtain water and food.
The Correct Answer is D
Answer and explanation
The correct answer is Choice D.
Choice A rationale
Checking the client’s temperature, blood sugar, and urine output could be important in certain situations, but in this case, it may not be the most immediate need. The client is wandering and crying, which suggests emotional distress rather than a physical health issue.
Choice B rationale
Arranging for the client to be transported for laboratory tests and an electrocardiogram (ECG) would be an overreaction in this situation. There’s no indication from the client’s behavior that they are experiencing a medical emergency.
Choice C rationale
Delegating care of the crying client to an unlicensed assistant is not the best choice. The client is likely experiencing emotional distress due to the traumatic event, and they would benefit from the care and attention of a trained professional.
Choice D rationale
Directing the client to the shelter’s nutrition center to obtain water and food is the best action in this situation. The client may be dehydrated or hungry, which could be contributing to their distress. Providing for these basic needs can help to calm the client and provide a sense of safety and stability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Answer and explanation
The correct answer is Choice C.
Choice A rationale
While understanding the type of bicycle injuries sustained can provide useful information for tailoring educational sessions, it does not directly measure the effectiveness of the program. The goal of the program is to eliminate bicycle injuries, so the key measure of success is a decrease in the incidence of these injuries.
Choice B rationale
Surveying parents about their understanding of the educational pamphlet can provide useful feedback on one component of the program. However, it does not directly measure whether the program has achieved its goal of reducing bicycle injuries.
Choice C rationale
Comparing the incidence of bicycle injuries at the beginning and end of the program directly measures the impact of the program on the issue it was designed to address. If the program is effective, there should be a noticeable decrease in the incidence of bicycle injuries.
Choice D rationale
Conducting a survey to assess children’s knowledge of bicycle safety can provide useful information on the educational component of the program. However, increased knowledge does not necessarily translate into behavior change or a decrease in injuries.
Correct Answer is A
Explanation
Answer and explanation
The correct answer is Choice A.
Choice A rationale
If an older adult client reports pain, redness, and swelling in the eye, asking about discharge from the eye is crucial. These symptoms could indicate a number of conditions, including conjunctivitis or uveitis. Discharge, especially if it is pus-like or sticky, could suggest an infection.
Choice B rationale
While keeping immunizations up-to-date is generally important for health, it is not the most relevant question in this context. Not all eye conditions are preventable through immunization.
Choice C rationale
Asking about new medications is relevant as certain medications can cause side effects or allergic reactions that affect the eyes. However, the symptoms described are more commonly associated with conditions like conjunctivitis or uveitis, which are not typically caused by medications.
Choice D rationale
Regular hand washing is important for general health and can prevent the spread of many diseases. However, it is not the most relevant question when a client presents with pain, redness, and swelling in the eye.
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.