Two days after surgical fixation of a fractured femur, a client suddenly reports chest pain and difficulty in breathing. The nurse suspects the client had a pulmonary embolus. Which action should the nurse take first?

The correct order is:

- Note date and time of the behavior.

- Discuss the issue privately with the UAP.

- Plan for scheduled break times.

- Evaluate the UAP for signs of improvement.

Here are the reasons for this order:

- Note date and time of the behavior. This should be done first, as it can provide objective evidence of the UAP's behavior and its impact on patient care and staff workload. The unit manager should document any incidents or complaints related to the UAP's behavior in a factual manner.

- Discuss the issue privately with the UAP. This should be done second, as it can provide an opportunity for feedback and clarification. The unit manager should use a respectful and professional tone, and explain how the UAP's behavior affects patient safety and staff morale. The unit manager should also listen to any concerns or challenges that the UAP may have, and offer support or guidance as needed.

- Plan for scheduled break times. This should be done third, as it can provide a solution or prevention strategy for future occurrences. The unit manager should work with the UAP and other staff members to ensure that there are adequate breaks and coverage for patient care. The unit manager should also review any policies or procedures related to break times and staff attendance.

- Evaluate the UAP for signs of improvement. This should be done last, as it can provide a measure of effectiveness and accountability. The unit manager should monitor and document any changes in the UAP's behavior, performance, or attitude. The unit manager should also provide positive reinforcement or corrective action as appropriate.

Choice A is correct because the nurse's priority is to provide comfort and dignity to the dying patient. Pain management is an essential aspect of end-of-life care.

Choice B is incorrect because updating the nurse manager is not a priority action. The nurse manager can be informed later, after the patient's needs are met.

Choice C is incorrect because conveying the patient's status to the chaplain is not a priority action. The chaplain can be contacted later, after the patient's needs are met. The chaplain may also need the consent of the patient or the family before providing spiritual support.

Choice D is incorrect because documenting the impending signs of death is not a priority action. Documentation can be done later, after the patient's needs are met. Documentation is important, but not as important as providing comfort and dignity to the dying patient.