#1
Which patient should the nurse prioritize for assessment?
A patient with chest pain and shortness of breath
ExplanationPrioritizing assessment for a patient exhibiting symptoms of chest pain and shortness of breath.
#2
Which patient should the nurse prioritize for immediate intervention?
A patient with a blood pressure of 220/120 mmHg
ExplanationPrioritizing immediate intervention for a patient with severely elevated blood pressure.
#3
Which nursing action is a priority for a patient at risk for aspiration?
Elevate the head of the bed
ExplanationRaising the head of the bed as a preventive measure for a patient at risk of aspiration.
#4
Which intervention is a priority for a patient experiencing anaphylaxis?
Ensuring a patent airway and administering epinephrine
ExplanationAddressing airway obstruction and providing immediate epinephrine for anaphylaxis.
#5
What is the priority nursing action for a patient experiencing a myocardial infarction (MI)?
Administering thrombolytics promptly
ExplanationSwift administration of thrombolytics to dissolve clots and restore blood flow during a myocardial infarction.
#6
Which intervention is a priority for a patient experiencing a hypertensive crisis?
Lowering blood pressure gradually with intravenous antihypertensives
ExplanationGradual reduction of blood pressure using IV antihypertensives for a patient in hypertensive crisis.
#7
What is the priority nursing action for a patient with acute respiratory distress syndrome (ARDS)?
Administering high-flow oxygen therapy
ExplanationProviding high-flow oxygen therapy as the primary intervention for a patient with acute respiratory distress syndrome.
#8
What is the priority nursing intervention for a patient experiencing a seizure?
Protect the patient from injury by removing nearby objects and easing them to the ground
ExplanationEnsuring patient safety by removing nearby objects and easing the patient to the ground during a seizure.
#9
What is the priority nursing intervention for a patient with severe sepsis?
Starting intravenous fluids and broad-spectrum antibiotics
ExplanationInitiating prompt IV fluids and broad-spectrum antibiotics to combat severe sepsis.
#10
Which nursing action is a priority for a patient with a traumatic brain injury (TBI)?
Monitoring intracranial pressure (ICP) and maintaining cerebral perfusion
ExplanationEnsuring close monitoring of intracranial pressure and maintaining cerebral perfusion for a patient with traumatic brain injury.
#11
What is the priority nursing intervention for a patient with diabetic ketoacidosis (DKA)?
Administering insulin bolus
ExplanationAdministering an insulin bolus as the primary intervention for a patient with diabetic ketoacidosis.
#12
Which nursing action is a priority for a patient with acute renal failure?
Monitoring fluid intake and output, and assessing electrolyte levels
ExplanationMonitoring fluid balance and electrolyte levels as a priority for a patient with acute renal failure.
#13
What is the priority nursing intervention for a patient experiencing a hypertensive emergency?
Lowering blood pressure gradually with intravenous antihypertensives
ExplanationGradual reduction of blood pressure using IV antihypertensives for a patient in a hypertensive emergency.