A nurse is caring for a client who experienced a femur fracture 8 hr ago and now reports sudden onset dyspnea and severe chest pain. Which of the following actions should the nurse take first?
Provide high-flow oxygen.
Administer an IV vasopressor medication.
Monitor the client for headache.
Check the client for a positive Chvostek's sign.
The Correct Answer is A
A. Provide high-flow oxygen
The client may have a fat embolism. Oxygenation is the priority to prevent hypoxia and support vital organs.
B. Administer IV vasopressor
Vasopressors may help hypotension, but oxygenation comes first.
C. Monitor for headache
Headache is not the primary concern here.
D. Check for Chvostek’s sign
Chvostek’s sign is for hypocalcemia, unrelated to this emergency.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
A. Gently place a hand on the client's arm during conversation
Avoid touching an anxious or potentially aggressive client-may escalate agitation.
B. Employ active listening skills
Validates feelings and promotes therapeutic communication.
C. Administer an anxiolytic medication
Client is showing signs of withdrawal and agitation-medication may be indicated.
D. Explain behavioral limits
Setting limits provides structure and promotes safety.
E. Assist in identifying source of anger
Supports emotional processing and de-escalation.
Correct Answer is A
Explanation
A. "It sounds like it has been very challenging to find a job."
This response uses therapeutic communication. It reflects the client’s feelings and encourages further sharing. It shows empathy and supports emotional validation.
B. "I'm sure someone will call you next week."
This offers false reassurance, which is non-therapeutic. It doesn't address the client’s emotional needs and may hinder open communication.
C. "Don't worry. There are plenty of jobs out there."
This minimizes the client’s concern and dismisses their current struggle. It’s a non-therapeutic response.
D. "You need to apply for more jobs."
This response is directive and judgmental. It doesn't acknowledge the client’s current emotional state.
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