A nurse is prioritizing client care after receiving a change-of-shift report. Which of the following clients should the nurse plan to see first?
A client who told an assistive personnel he is short of breath
A client who has a prescription for discharge
A client who received oral pain medication 30 minutes ago
A client who is scheduled for an abdominal x-ray and is awaiting transport
The Correct Answer is A
Choice A reason (client care): A client reporting shortness of breath may be experiencing a life-threatening situation that aligns with the ABCs (Airway, Breathing, Circulation) of patient prioritization. This client requires immediate assessment and intervention.
Choice B reason (client care): While discharge is important, it does not take precedence over a client with potential respiratory distress.
Choice C reason (client care): A client who received pain medication 30 minutes ago is likely stable and can be seen after more urgent cases are addressed.
Choice D reason (client care): A client waiting for an abdominal x-ray is not a priority over a client with respiratory issues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: While it is useful to know the patient's current pain management strategies, new onset severe back pain could indicate a serious complication such as a spinal fracture or compression, which requires immediate attention.
Choice B reason: Reassuring the patient is not appropriate without further assessment, as new onset severe pain could signify a serious issue that needs to be addressed.
Choice C reason: Suggesting a back brace may be part of the management plan, but it should not precede notifying the healthcare provider of new severe pain.
Choice D reason: Notifying the healthcare provider is the correct action because new onset severe back pain in a patient with multiple myeloma could indicate a serious condition such as a spinal fracture or compression, which requires prompt evaluation and treatment.
Correct Answer is C
Explanation
Choice A reason: Fluid volume status affects preload, not afterload.
Choice B reason: Atrial contraction contributes to filling of the ventricles, not to afterload.
Choice C reason: Afterload is the resistance left ventricular must overcome to circulate blood, which is accurately described as resistance to blood flow.
Choice D reason: Myocardial compliance refers to the elasticity of the heart muscle, which affects how the heart fills, not the resistance it must overcome to eject blood.
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