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What 2 orders should the nurse complete first?

Chesty

Start oxygen 3 L via nasal cannula

Acetaminophen 350 mg PO q4h for temperature greater than 101 F (38.3")

Normal saline 150 mi/hour

NPO

Start a IV

Sputum culture

Place the client on a cardiorespiratory monitor

Answer and Explanation

Correct Answer : B,H

A. Not a priority compared to monitoring vital signs and ensuring adequate oxygenation.

B: Increased oxygen flow is necessary to manage the client's respiratory distress and history of smoking. Correct Answer: 3 L, not 1 L as initially listed.
C: Acetaminophen 350 mg PO q4h for temperature greater than 101 F (38.3°C): Important for fever management but not the first priority in acute respiratory distress.
D: Helps maintain hydration but is secondary to respiratory support in this scenario.

E: Not applicable as there is no immediate need for surgery or risk of aspiration currently indicated.
F: Important for medication administration and fluid balance but follows after ensuring respiratory function.
G: Useful for diagnosing the cause of respiratory symptoms but not a first-line action.

H: Essential for continuously assessing the client's respiratory and cardiac status due to difficulty breathing.

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Correct Answer is ["D","E"]

Explanation

A. Bending from the waist to pick up trash can cause imbalance and strain; it is safer to bend at the knees.

B. Leaning forward to pull a pan from a high shelf can lead to loss of balance; using a step stool is safer.
C. Locking the knees can lead to loss of balance and is not a recommended posture.

D. Widening the stance provides a stable base and helps maintain balance while working.
E. Bringing a heavy can close to the body before lifting uses proper body mechanics, reducing the risk of strain and promoting balance.

A. Obtain a focused history to determine recent bleeding and use of anticoagulants. B. Initiate bilateral intermittent sequential pneumatic compression devices. C. Administer aspirin to prevent further clot formation and platelet clumping. D. Place an indwelling urinary catheter and measure strict intake and output.

Correct Answer is A

Explanation

A. Obtaining a focused history to determine recent bleeding and use of anticoagulants is crucial to evaluate the risk of hemorrhage and guide treatment decisions, especially considering the symptoms suggest a possible stroke.
B. Initiating sequential pneumatic compression devices is not relevant to the immediate neurological symptoms.
C. Administering aspirin is contraindicated without confirming whether the stroke is ischemic or hemorrhagic.
D. Placing an indwelling urinary catheter is not an immediate priority compared to assessing the stroke symptoms.

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What 2 orders should the nurse complete first?

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Naxlex Comprehensive Predictor Exams

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Explanation

Correct Answer is A

Explanation

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What 2 orders should the nurse complete first?