A first-response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?
A client who has a rigid abdomen with manifestations of shock
A client who has a femur fracture with a 2+ pedal pulse
A client who has superficial partial-thickness burn injuries over 5% of his body
A client who is ambulatory and exhibits manic behavior
The Correct Answer is A
The correct answer is choice A. A client who has a rigid abdomen with manifestations of shock should receive treatment priority in this situation. In a bombing incident, clients with life-threatening injuries, such as those with uncontrolled bleeding, airway compromise, or shock, should receive immediate attention. A rigid abdomen may indicate internal bleeding, which is a medical emergency requiring prompt intervention. Manifestations of shock, such as tachycardia, hypotension, and altered level of consciousness, indicate poor tissue perfusion and require immediate intervention. The other clients described in the question have less severe injuries and can wait for treatment while more critical injuries are addressed first. A femur fracture with a 2+ pedal pulse indicates adequate circulation to the extremity, superficial partial-thickness burn injuries over 5% of the body are not life-threatening, and an ambulatory client with manic behavior does not have immediate medical needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C, "Describe the place where you are currently living." When discussing discharge plans with a client, the first step is to assess the client's living situation to ensure that they will be able to safely manage their health condition at home. In this case, the client requires a special bed at home due to their pressure injury. By asking the client to describe their living situation, the case manager can determine if the client's home is suitable for their needs or if they require additional assistance or resources. Once the client's living situation has been assessed, the case manager can then discuss options for obtaining necessary supplies and provide education on how to manage the pressure injury.
Correct Answer is A
Explanation
The first step the nurse should take is to perform a needs assessment. This involves determining the specific needs of the older adults who will be served by the mobile meal program. The nurse should identify the target population and assess their nutritional needs, dietary restrictions, and food preferences. The nurse should also determine the availability of transportation for the delivery of meals and the potential need for volunteers. Once the needs assessment is complete, the nurse can begin to develop a plan for the program.
Inquiring about the availability of volunteers (choice B) and determining potential funding sources for the program (choice D) are important steps, but they should come after performing a needs assessment. Identifying alternative solutions (choice C) may be necessary at some point, but it is not the first step.
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