A nurse is caring for a client when the safety on the bed plug's electrical outlet pops and begins to smoke.
Which of the following actions is the nurse's priority?

Use a fire extinguisher on the outlet.

Activate the fire alarm.

Move any clients to safety.

Answer and Explanation

The Correct Answer is C

The correct answer is choice C: Move any clients to safety.

Choice C rationale: The nurse's priority is always client safety. In the event of an electrical issue that poses a potential risk, such as smoke or fire, the nurse should first ensure that any clients in the area are moved to a safe location. This aligns with the widely-used RACE acronym for fire response (Rescue, Alarm, Confine, Extinguish), which highlights the importance of removing individuals from danger before attending to other aspects of fire safety.

Choice A rationale: Using a fire extinguisher is an appropriate action to take when dealing with a small, manageable fire. However, in this scenario, ensuring client safety takes precedence over attempting to extinguish the source of the smoke. This is also in line with the RACE mnemonic, which emphasizes the importance of prioritizing evacuation.

Choice B rationale: Activating the fire alarm is an important step to alert others in the building about a potential fire and the need for evacuation. However, the priority remains client safety, so moving clients to a safe location should be the nurse's initial response, following the RACE acronym.

In summary, the nurse's priority action when encountering an electrical hazard is to move clients to safety. After ensuring client safety, the nurse can then activate the fire alarm and, if trained to do so, use a fire extinguisher on the outlet if necessary. This approach aligns with the RACE mnemonic, which serves as a guideline for fire response.

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Correct Answer is C

Explanation

Choice A rationale:

This option is incorrect. Tachypnea refers to abnormally fast breathing, typically defined as a respiratory rate higher than 20 breaths per minute in adults. It is the opposite of the condition described in the question, where the respiratory rate has fallen below 10 respirations per minute.

Choice B rationale:

This option is incorrect. Apnea refers to the absence of breathing, often resulting from a temporary cessation of airflow to the lungs. It is characterized by the complete absence of respiratory movements and sounds, which is different from the situation described in the question where the client is breathing at a very slow rate.

Choice C rationale:

Bradypnea, or abnormally slow breathing, is the correct answer in this case. It is defined as a respiratory rate lower than the normal range, which is typically between 12 to 20 breaths per minute in adults. Bradypnea can be caused by various factors, including drug overdose, neurological disorders, or metabolic imbalances. In this scenario, the client's slow respiratory rate (below 10 respirations per minute) indicates bradypnea.

Choice D rationale:

This option is incorrect. Eupnea refers to normal breathing, where the rate and depth of respirations are within the normal range. It does not describe the condition of the sedated client in the question, who is experiencing abnormally slow breathing (bradypnea)

Correct Answer is B

Explanation

Choice A rationale:

Obtaining the blood pressure first thing in the morning is not the most critical factor in accurately measuring blood pressure. Blood pressure can vary throughout the day due to various factors, and it is essential to use the appropriate technique and equipment at any time of the day.

Choice B rationale:

Using the appropriate size cuff for the client is crucial in obtaining an accurate blood pressure reading. If the cuff is too small, it can lead to falsely elevated blood pressure readings, while a cuff that is too large can result in falsely lowered readings. This is because cuff size affects the pressure applied to the artery during measurement.

Choice C rationale:

Ensuring that the client is relaxed and comfortable prior to obtaining the blood pressure is important but not the most critical factor. Anxiety or discomfort can temporarily elevate blood pressure, so it's essential to create a calm and comfortable environment for the client. However, using the correct cuff size is still more critical for accurate measurements.

Choice D rationale:

Removing clothing from the arms before obtaining blood pressure is not the most important action. While it is generally recommended to expose the client's arm for proper cuff placement, it is secondary to using the appropriate cuff size. The cuff should be placed directly on the skin or over a thin layer of clothing, but this step should not take precedence over cuff size selection.

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A nurse is caring for a client when the safety on the bed plug's electrical outlet pops and begins to smoke. Which of the following actions is the nurse's priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

To accurately take a client's blood pressure, which action by the nurse is most important?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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A nurse is caring for a client when the safety on the bed plug's electrical outlet pops and begins to smoke.
Which of the following actions is the nurse's priority?