A nurse on a medical unit is planning care for a group of clients.
Which of the following clients should the nurse attend to first?
A client who has chronic obstructive pulmonary disease and an oxygen saturation of 89%.
A client who has thrombocytopenia and reports a nosebleed.
A client who has left-sided paralysis and slurred speech from a prior stroke.
A client who has multiple sclerosis and reports ataxia and vertigo.
The Correct Answer is B
The nurse should attend to the client who has thrombocytopenia and reports a nosebleed first.
Thrombocytopenia is a condition characterized by low platelet count, which increases the risk of bleeding.
A nosebleed can be a sign of significant bleeding, and it is important for the nurse to assess the severity and take appropriate action to stop the bleeding and prevent further complications.
Although the other clients also require nursing care, their conditions are not as urgent as the client with thrombocytopenia and a nosebleed.
The client with chronic obstructive pulmonary disease and an oxygen saturation of 89% may require oxygen therapy or other interventions to improve respiratory function, but the situation is not immediately life-threatening.
The client with left-sided paralysis and slurred speech from a prior stroke may require ongoing care and rehabilitation, but there is no indication of an acute change in their condition.
The client with multiple sclerosis and ataxia and vertigo may require assistance with mobility and balance, but their symptoms do not pose an immediate threat to their health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Lithium. Lithium is a medication that has been associated with an increased risk of developing diabetes insipidus. This is because lithium can interfere with the function of the kidneys and their ability to respond to antidiuretic hormone (ADH), which regulates the balance of fluids in the body.
Atorvastatin (choice B) is a medication used to lower cholesterol levels and has not been associated with an increased risk of diabetes insipidus.
Propranolol (choice A) is a beta-blocker used to treat high blood pressure and heart conditions and has not been associated with an increased risk of diabetes insipidus.
Ranitidine (choice C) is a medication used to reduce stomach acid production and has not been associated with an increased risk of diabetes insipidus.
Correct Answer is A
Explanation
This can help prevent dizziness and loss of balance, which are common symptoms of Ménière’s disease.
Choice B is not correct because range-of-motion exercises to the client’s neck every 4 hours are not a standard intervention for Ménière’s disease.
Choice C is not correct because aspirin is not always the recommended medication for headaches associated with Ménière’s disease.
Choice D is not correct because limiting fluid intake is not a standard intervention for Ménière’s disease.
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