The practical nurse (PN) is caring for an adolescent with scoliosis who reports bilateral lower leg numbness and tingling 2 days after surgery for a spinal fusion. Which action should the PN take first?
Assess for bilateral pedal pulses.
Contact the healthcare provider.
Complete a neurovascular assessment.
Evaluate the surgical site.
The Correct Answer is C
A. Assess for bilateral pedal pulses: Only checks circulation; neuro symptoms need more complete exam.
B. Contact HCP: Should be done after gathering full assessment data.
C. Complete a neurovascular assessment: Checks motor, sensory, and circulation to determine urgency.
D. Evaluate surgical site: Important, but neurological changes require full neurovascular check first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Talkativeness: Seen during intoxication, not withdrawal.
B. Exhilaration: Associated with the stimulant effects of cocaine, not withdrawal.
C. Extreme drug craving: Withdrawal is characterized by intense cravings, fatigue, depression, and irritability.
D. Increased energy: Seen during intoxication, not during withdrawal.
Correct Answer is C,A,D,B
Explanation
C. Move clients in immediate danger: The fundamental principle of fire safety in a clinical setting is the RACE acronym, which prioritizes Rescue (R) above all other actions. Ensuring the physical safety of the client in the room with the active flame is the immediate life-saving intervention. This action must occur before any administrative or mechanical responses.
A. Activate the fire alarm: Once life-safety is addressed through rescue, the nurse must Alarm (A) to notify the facility and emergency responders. This step ensures that specialized firefighting personnel are dispatched and that the rest of the hospital is alerted to the potential hazard. It provides the necessary infrastructure for a coordinated emergency response.
B. Get the fire extinguisher: Following the alarm, the nurse proceeds to Confine (C) the fire by closing doors to prevent the spread of smoke and heat. This containment strategy protects other patients and limits the oxygen supply to the fire within the affected zone. It is a critical step in preserving the environment of care.
D. Shut the doors to all client rooms: The final step in the sequence is to Extinguish (E) the fire if it is small and manageable using the appropriate device. This should only be attempted after all previous life-safety and notification protocols are complete. If the fire is too large, the priority remains evacuation rather than suppression.
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