A nurse is prioritizing care for four clients.
Which of the following clients should the nurse assess first?

adolescent who is in skin traction and reports pain level of 7 on a scale of 0 to 10

adolescent who has sickle cell anemia and slurred speech

toddler who has a new diagnosis of osteomyelitis and is to receive an IV bolus

toddler who has partial burn thickness burns on the right hand and requires a dressing change .

Answer and Explanation

The Correct Answer is B

When prioritizing care for multiple clients, the nurse should first assess the client who is most unstable and has the most urgent needs. In this case, the adolescent with sickle cell anemia and slurred speech should be assessed first. Slurred speech could indicate a stroke, which is a life-threatening condition that requires immediate medical attention. The other clients, while they also require care, are not in immediate danger and can be assessed after the adolescent with sickle cell anemia.

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Correct Answer is B

Explanation

Choice A rationale

Consuming flavored yogurt instead of plain yogurt may not be beneficial for a lactose intolerant individual. Flavored yogurts often contain added sugars and may still contain lactose, which can trigger symptoms in individuals with lactose intolerance.

Choice B rationale

Replacing milk with non-dairy sources of calcium is a common strategy for managing lactose intolerance. Non-dairy sources of calcium include foods like broccoli, oranges, almonds, tofu, and certain fortified products. This can help ensure the individual meets their calcium needs without triggering symptoms of lactose intolerance.

Choice C rationale

Drinking milk on an empty stomach is not typically recommended for individuals with lactose intolerance. Consuming lactose-containing foods or drinks on an empty stomach may increase the likelihood of experiencing symptoms.

Choice D rationale

The tolerance for plain milk versus chocolate milk can vary among individuals with lactose intolerance. However, chocolate milk often contains added sugars and may still contain lactose, which can trigger symptoms.

A. Prolonged headache B. decrease temperature C. lack of sleep D. exposure to second-hand smoke

Correct Answer is C

Explanation

Choice A rationale

Prolonged headache is not typically identified as a common trigger for seizures. While headaches can be associated with certain types of seizures, they are not generally considered a trigger for seizure activity.

Choice B rationale

Decreased temperature, or hypothermia, is not typically identified as a common trigger for seizures. In fact, fever or increased body temperature is more commonly associated with triggering seizures, particularly in children.

Choice C rationale

Lack of sleep is a well-recognized trigger for seizures. Sleep deprivation can lead to increased seizure frequency in individuals with epilepsy. Ensuring adequate sleep is an important part of managing seizure disorders.

Choice D rationale

Exposure to second-hand smoke is not typically identified as a common trigger for seizures. While it is generally harmful to health, it is not specifically associated with an increased risk of seizures.

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A nurse is prioritizing care for four clients.Which of the following clients should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning to teach an adolescent who is lactose intolerant about dietary guidelines.Which of the following instructions should the nurse include in the teaching?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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A nurse is prioritizing care for four clients.
Which of the following clients should the nurse assess first?