A nurse is prioritizing care for four clients.
Which of the following clients should the nurse assess first?
An adolescent who has sickle cell anemia and slurred speech.
An adolescent who is in skin traction and reports a pain level of 7 on a scale from 0 to 10.
A toddler who has a new diagnosis of osteomyelitis and is to receive an IV bolus of nafcillin.
A toddler who has a partial-thickness burn on his right hand and requires a dressing change.
The Correct Answer is A
An adolescent who has sickle cell anemia and slurred speech should be assessed first.
Slurred speech can be a sign of a stroke, which is a known complication of sickle cell anemia.
This requires immediate medical attention.
Choice B is wrong because while pain management is important, it is not as urgent as a potential stroke.
Choice C is wrong because while administering medication is important, it is not as urgent as a potential stroke.
Choice D is wrong because while wound care is important, it is not as urgent as a potential stroke.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
An increased respiratory rate is a sign of severe dehydration in infants.
Dehydration occurs when an infant loses so much body fluid that they are not able to maintain ordinary function.
Choice A is wrong because hypertension is not a sign of severe dehydration in infants.
Choice B is wrong because increased urine output is not a sign of severe dehydration in infants.
In fact, decreased urine output is a sign of dehydration 2.
Choice C is wrong because a capillary refill of 2 seconds is normal and not a sign of severe dehydration in infants.
Correct Answer is C
Explanation
People with lactose intolerance can replace milk and dairy products with nondairy sources of calcium such as calcium-fortified products, fish with soft bones, broccoli and leafy green vegetables, oranges, almonds, Brazil nuts, and dried beans.
Choice A is wrong because “You can drink milk on an empty stomach” is not an answer because it may worsen symptoms of lactose intolerance.
Choice B is wrong because “You might tolerate plain milk better than chocolate milk” is not an answer because both plain and chocolate milk contain lactose.
Choice D is wrong because “You should consume flavored yogurt instead of plain yogurt” is not an answer because both flavored and plain yogurt contain lactose.
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