A nurse receives change-of-shift report. Which of the following clients should the nurse attend to first?
A client who has a productive cough and an oral temperature of 36° C (96.8°F).
A client who reports tingling in the fingers following a thyroidectomy.
A client who is in a long leg cast and has +2 pedal pulses bilaterally.
A client who has dark, foul-smelling urine and a urine output of 320 mL in the last 8 hr
The Correct Answer is B
A. A client who has a productive cough and an oral temperature of 36° C (96.8°F): A normal temperature and stable vital signs indicate that this client’s condition is not immediately life-threatening. Assessment is important but not the priority.
B. A client who reports tingling in the fingers following a thyroidectomy: Tingling in the fingers may indicate hypocalcemia from potential injury or removal of the parathyroid glands during thyroidectomy. This is an acute complication that can lead to tetany or cardiac dysrhythmias, making it the highest priority.
C. A client who is in a long leg cast and has +2 pedal pulses bilaterally: Adequate pedal pulses indicate good circulation. While monitoring for neurovascular compromise is necessary, this client is currently stable.
D. A client who has dark, foul-smelling urine and a urine output of 320 mL in the last 8 hr: Oliguria and infection risk are concerning and require follow-up, but these findings do not pose an immediate threat compared with potential hypocalcemia after thyroid surgery.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Varenicline: Varenicline is used to aid smoking cessation by reducing cravings and withdrawal symptoms. It does not have efficacy in treating gambling disorder and is not indicated for behavioral addictions.
B. Disulfiram: Disulfiram is prescribed for alcohol use disorder to discourage alcohol consumption by causing unpleasant reactions when alcohol is ingested. It does not address the underlying behavioral or psychological aspects of gambling disorder.
C. Sertraline: Sertraline, a selective serotonin reuptake inhibitor (SSRI), can help reduce compulsive behaviors, impulsivity, and anxiety associated with gambling disorder. It may be used as part of a comprehensive treatment plan alongside therapy and behavioral interventions.
D. Clonidine: Clonidine is primarily used to treat hypertension, ADHD, and certain withdrawal symptoms. It does not target the compulsive behaviors or psychological aspects of gambling disorder and is not indicated for this purpose.
Correct Answer is B
Explanation
A. Constipation: Constipation is uncomfortable but usually not life-threatening. It can be addressed after more urgent or potentially serious issues are assessed.
B. Indigestion: Indigestion, especially in a client on a cardiac unit, may indicate angina or myocardial ischemia. Chest discomfort requires immediate assessment to prevent progression to a myocardial infarction, making it the highest priority.
C. Swollen ankles: Peripheral edema can indicate fluid retention or heart failure but is typically a chronic or slowly developing issue. While important to monitor, it is not immediately life-threatening.
D. Urinary frequency: Urinary frequency is generally a non-urgent concern unless associated with other symptoms like pain or signs of infection. It is a lower priority compared to potential cardiac issues.
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