A nurse at a shelter is assisting with client triage after a tornado destroyed a community. Which of the following clients should receive priority care?
An adult client who is short of breath.
An infant client who is crying.
An older adult client who has a fractured arm.
A school-age client who has a head abrasion.
The Correct Answer is A
The correct answer is Choice A because, "An adult client who is short of breath." Shortness of breath may indicate a life-threatening condition that requires immediate medical attention. The other clients should also receive care as soon as possible, but the client who is short of breath should be the priority.
Choice B is wrong because, "An infant client who is crying," is not the correct answer because crying is a normal behavior for infants and does not necessarily indicate a lifethreatening condition.
Choice C is wrong because, "An older adult client who has a fractured arm," is not the correct answer because a fractured arm is not a life-threatening condition and can be treated after the more urgent needs of other clients are addressed.
Choice D is wrong because, "A school-age client who has a head abrasion," is not the correct answer because a head abrasion is not a life-threatening condition and can be treated after the more urgent needs of other clients are addressed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D"]
Explanation
The correct answers are A and D. The extension cord presents a trip hazard and should be replaced with a longer power strip or have a qualified electrician install additional outlets. The water heater temperature is above the recommended range of 49° C (120° F) and should be adjusted to prevent scalding. The red light in the bedroom (Choice B is wrong because) is not a safety hazard, the rubber-backed bath mat (Choice C is wrong because) is a safety measure to prevent falls, and carpeted floors (choice E) are also not a safety hazard.
Choice A is An extension cord extends across the floor of the living room presents a trip hazard.
Choice B is wrong because: A red light is kept on in the bedroom at night is not a safety hazard.
Choice C is wrong because: A rubber-backed bath mat is on the floor outside the shower is a safety measure to prevent falls.
Choice D is The water heater is set at 54.4° C (130° F) is above the recommended range and can cause scalding.
Option E: Carpeted floors are not a safety hazard.
Correct Answer is A
Explanation
The correct answer is Choice A because, "I am obese because it's in my genes." The client is using rationalization as a coping mechanism by justifying their obesity as being predetermined by their genes, rather than acknowledging their personal responsibility in managing their weight. Rationalization is a defense mechanism in which a person gives a false or socially acceptable explanation for an unacceptable behavior or situation.
Choice B is wrong because, "I have difficulty resisting the items in vending machines," is not the correct answer because it is an excuse rather than a rationalization.
Choice C is wrong because, "I know you don't like me because I am obese," is not the correct answer because it is an example of projection, in which the client attributes their own feelings of dislike to others.
Choice D is wrong because, "I have lots of health problems from being obese," is not the correct answer because it is a justification, not a rationalization
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