An emergency department nurse triages a group of clients who were injured in a school bus crash. Which of the following clients should the nurse have the provider evaluate first?
A client who has a forehead wound that is bleeding copiously
A client who has a compound fracture of the femur and is crying in pain
A client who was unconscious at the scene and now reports diplopia and nausea
A client who has several missing teeth and a swollen, ecchymotic upper lip
The Correct Answer is C
A. A client who has a forehead wound that is bleeding copiously. Although bleeding may appear dramatic, most scalp wounds bleed heavily and can be controlled with pressure. This is not immediately life-threatening if the client is stable.
B. A client who has a compound fracture of the femur and is crying in pain. This is a serious injury with risk for blood loss and infection, but the client is alert and stable enough to express pain, suggesting less immediate neurologic risk than other clients.
C. A client who was unconscious at the scene and now reports diplopia and nausea. This client likely has a head injury with signs of increased intracranial pressure or concussion (diplopia = double vision, nausea, and prior loss of consciousness). These are neurological red flags and require immediate evaluation to prevent deterioration.
D. A client who has several missing teeth and a swollen, ecchymotic upper lip. While painful and concerning, oral trauma without airway compromise is less urgent than potential brain injury.
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Related Questions
Correct Answer is D
Explanation
A. Able to unzip a zipper. This fine motor skill typically develops closer to age 2 to 3 years. At 15 months, most toddlers do not yet have the dexterity required to manipulate clothing fasteners.
B. Builds a tower of 4 cubes. A 15-month-old can usually build a tower of 2 to 3 cubes, while building a tower of 4 or more cubes is more typical around 18 to 24 months.
C. Throws a ball without falling. While some toddlers may attempt to throw a ball, doing so without falling is more characteristic of children around 18 months or older as balance improves.
D. Walks without help. This is an expected milestone by 12 to 15 months. Most toddlers at 15 months are able to walk independently, though gait may still be wide-based and unsteady.
Correct Answer is A
Explanation
A. Occupational therapist. An occupational therapist is the appropriate specialist to assess and assist with fine motor skills and daily living activities, such as eating. They can provide adaptive equipment and training to help the client maintain independence and improve quality of life.
B. Physical therapist. A physical therapist focuses primarily on gross motor skills, mobility, and physical strength, not fine motor control necessary for holding utensils. They are more involved in rehabilitation related to ambulation and transfers.
C. Dietitian. A dietitian helps develop nutritionally appropriate meal plans based on medical conditions and dietary needs. However, they do not address the client’s ability to physically manage eating tools or self-feed.
D. Social worker. A social worker provides support with emotional, financial, and community resources, but does not assist with the physical or mechanical aspects of daily tasks like feeding. They may coordinate care but not deliver direct therapy for motor challenges.
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