A nurse in an emergency department is assessing four clients. Which of the following clients should the nurse see first?

A client who reports a sudden onset of dizziness when sitting up

A client who has new onset urticaria and angioedema

A client who has numerous rectal polyps and blood-tinged stools

A client who has a subluxation of the fifth digit on the left foot

Answer and Explanation

The Correct Answer is B

Rationale:

A. A client who reports a sudden onset of dizziness when sitting up: Although concerning, dizziness on position change may indicate orthostatic hypotension and is not immediately life-threatening. This client requires monitoring but is not the top priority based on airway or circulatory compromise.

B. A client who has new onset urticaria and angioedema: New urticaria and angioedema suggest a potential anaphylactic reaction, which can quickly progress to airway obstruction. This is a life-threatening emergency requiring immediate intervention to secure the airway and administer epinephrine.

C. A client who has numerous rectal polyps and blood-tinged stools: This condition could indicate a colorectal condition such as polyposis or malignancy, but it is not acutely life-threatening. The client needs evaluation, but not before those with airway or circulatory risks.

D. A client who has a subluxation of the fifth digit on the left foot: A subluxation is a partial dislocation, which can be painful but does not involve vital organ systems. This musculoskeletal issue is stable and can be addressed after more urgent needs are met.

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Correct Answer is A

Explanation

Rationale:

A. Oxytocin: Oxytocin is the first-line uterotonic used to manage postpartum hemorrhage by stimulating uterine contractions to reduce bleeding. It is safe for use in clients with preeclampsia and does not elevate blood pressure.

B. Methylergonovine: Methylergonovine is contraindicated in clients with preeclampsia or hypertension because it causes vasoconstriction, which can dangerously elevate blood pressure and increase the risk of stroke or seizure.

C. Carboprost: Although carboprost is effective for postpartum hemorrhage, it should be used cautiously in clients with hypertension. It can cause bronchospasm and elevate blood pressure, which may worsen preeclampsia symptoms.

D. Nifedipine: Nifedipine is a calcium channel blocker used for managing hypertension and preterm labor. It is not indicated for treating postpartum hemorrhage as it lacks uterotonic effects.

A. Initiate fundal massage. B. Apply a fetal heart rate monitor. C. Insert an indwelling urinary catheter. D. Initiate an oxytocin IV infusion.

Correct Answer is B

Explanation

Rationale:

A. Initiate fundal massage: Fundal massage is performed after delivery to prevent or manage uterine atony and postpartum hemorrhage. It is not appropriate during active labor, especially before the birth of the fetus.

B. Apply a fetal heart rate monitor: After rupture of membranes, there is an increased risk of umbilical cord prolapse or fetal distress. Continuous fetal monitoring is essential to assess fetal well-being and detect complications promptly.

C. Insert an indwelling urinary catheter: While catheterization may be done later, especially before epidural placement or cesarean delivery, it is not the most urgent action. It does not address immediate risks associated with ruptured membranes.

D. Initiate an oxytocin IV infusion: Oxytocin is used to augment or induce labor, but should not be started without first assessing fetal status. Fetal monitoring is necessary to establish a baseline before initiating uterotonic agents.

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A nurse in an emergency department is assessing four clients. Which of the following clients should the nurse see first?

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