When evaluating clients in the urgent care center, which client should be seen first? The client:.
with a large laceration on the left scapula.
with a compound fracture of the right tibia.
who is unable to breastfeed her 4 week old.
with a labored respiratory rate of 28.
The Correct Answer is D
The client with a labored respiratory rate of 28 should be seen first because this indicates respiratory distress, which is a life-threatening condition that requires immediate intervention. Respiratory rate is one of the vital signs that are used to assess the severity of a patient’s condition and to triage them accordingly. A normal respiratory rate for an adult is 12 to 20 breaths per minute.
Choice A is wrong because a large laceration on the left scapula is not as urgent as respiratory distress.
A laceration is a wound that involves a cut or tear in the skin, which may cause bleeding, pain, and infection. However, it can be managed with wound care and suturing in the urgent care center.
Choice B is wrong because a compound fracture of the right tibia is not as urgent as respiratory distress.
A compound fracture is a fracture that breaks through the skin, which may cause bleeding, pain, infection, and nerve or blood vessel damage. However, it can be stabilized with splinting and dressing in the urgent care center before transferring to a hospital for further treatment.
Choice C is wrong because being unable to breastfeed a 4 week old is not as urgent as respiratory distress.
Breastfeeding difficulties may be caused by various factors, such as poor latch, low milk supply, sore nipples, or mastitis. However, they can be managed with education, support, and medication in the urgent care center.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Heat application increases blood flow and reduces muscle spasms, which can help relieve pain and promote healing. However, heat should not be applied for longer than 30 minutes at a time, as it can cause tissue damage and inflammation.
Choice A is wrong because maximum benefits do not occur within the first five minutes.
It takes time for heat to penetrate the tissues and cause vasodilation.
Choice C is wrong because the heat should not be left in place for at least one hour to be effective.
This can lead to burns, increased edema, and decreased blood flow.
Choice D is wrong because heat can not be left in place for as long as 12 hours without harmful effects.
This can cause severe tissue damage, infection, and necrosis.
Normal ranges for heat application are between 104°F and 113°F (40°C and 45°C).
The temperature should be checked frequently and adjusted according to the patient’s comfort and tolerance.
The skin should also be inspected for signs of erythema, blisters, or burns.
Correct Answer is A
Explanation
The nurse should obtain a sputum culture specimen before administering any antibiotics to the client with bacterial pneumonia.
This is because the sputum culture can help identify the causative organism and the appropriate antibiotic therapy.
Administering antibiotics before obtaining the sputum culture can alter the results and lead to ineffective treatment.
Choice B is wrong because azithromycin is an antibiotic that should be given after obtaining the sputum culture.
Choice C is wrong because coughing and deep breathing are important interventions to promote airway clearance and gas exchange, but they are not the priority actions for this client.
Choice D is wrong because offering clear liquids can help prevent dehydration and thin secretions, but they are not the most urgent action for this client.
Normal ranges for blood urea nitrogen (BUN) are 7 to 20 mg/dL and for creatinine are 0.6 to
1.2 mg/dL.
Elevated levels of these substances can indicate renal impairment, which can be a complication of bacterial pneumonia.
The nurse should monitor these levels and report any abnormalities to the health care provider.
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