During a routine school visit to a physical education class, a nurse receives multiple reports of shortness of breath, coughing, and nausea. Which of the following actions should the nurse take first?
Contact the local health department.
Establish a triage area.
Administer oxygen therapy.
Notify the parents of the students.
The Correct Answer is B
Choice A reason: This statement is not the first action, as it does not address the immediate needs of the students. Contacting the local health department may be necessary to report a potential outbreak or environmental hazard, but it is not a priority.
Choice B reason: This statement is the first action, as it addresses the immediate needs of the students. Establishing a triage area can help the nurse assess the severity of the symptoms, identify the possible cause, and provide appropriate interventions.
Choice C reason: This statement is not the first action, as it may not be appropriate for all students. Administering oxygen therapy may be necessary for some students who have severe respiratory distress, but it is not a universal intervention.
Choice D reason: This statement is not the first action, as it does not address the immediate needs of the students. Notifying the parents of the students may be necessary to inform them of the situation and obtain consent for treatment, but it is not a priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Teaching the client about appropriate food choices is an important intervention for diabetes mellitus, but it is not the first action the nurse should take. The nurse needs to assess the client's current dietary habits and preferences before providing education.
Choice B reason: Referring the client to a diabetes mellitus support group is a helpful strategy to promote coping and self-management, but it is not the first action the nurse should take. The nurse needs to address the client's immediate needs and priorities before making referrals.
Choice C reason: Identifying the client's dietary preferences is the first action the nurse should take. This is an assessment step that will help the nurse tailor the nutritional program to the client's individual needs and preferences. It will also help the nurse establish rapport and trust with the client.
Choice D reason: Developing a nutritional program is a planning step that requires assessment data. The nurse should not develop a nutritional program without first identifying the client's dietary preferences and needs.
Correct Answer is C
Explanation
Choice A reason: Assembling an emergency disaster response team is not the first action to take when developing a disaster-preparedness plan. The nurse should first assess the community's needs and resources before forming a team.
Choice B reason: Evaluating the effectiveness of local disaster-preparedness drills is not the first action to take when developing a disaster-preparedness plan. The nurse should first identify the potential hazards and vulnerabilities of the community before conducting or reviewing any drills.
Choice C reason: Identifying the community's risks and capabilities is the first action to take when developing a disaster-preparedness plan. The nurse should perform a comprehensive assessment of the community's strengths, weaknesses, opportunities, and threats (SWOT) related to disaster management.
Choice D reason: Providing education about first aid and triage is not the first action to take when developing a disaster-preparedness plan. The nurse should first determine the learning needs and preferences of the community before designing and implementing any educational programs.
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