{"id":133535,"date":"2024-08-23T18:57:24","date_gmt":"2024-08-23T18:57:24","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=133535"},"modified":"2024-08-23T18:59:28","modified_gmt":"2024-08-23T18:59:28","slug":"which-of-the-following-clients-should-the-nurse-plan-to-assess-first","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2024\/08\/23\/which-of-the-following-clients-should-the-nurse-plan-to-assess-first\/","title":{"rendered":"Which of the following clients should the nurse plan to assess first"},"content":{"rendered":"\n<p>A nurse is receiving change-of-shift report for a group of clients.<\/p>\n\n\n\n<p>Which of the following clients should the nurse plan to assess first?<\/p>\n\n\n\n<p>A.<br>client who has a hip fracture and a new onset of tachypnea<\/p>\n\n\n\n<p>B.<br>client who has diabetes mellitus and an HbA1c of 6.8%.<\/p>\n\n\n\n<p>C.<br>A client who has epidural analgesia and weakness in the lower extremities<\/p>\n\n\n\n<p>D.<br>A client who has sinus arrhythmia and is receiving cardiac monitoring<\/p>\n\n\n\n<p>The correct answer is:<\/p>\n\n\n\n<p><strong>A. Client who has a hip fracture and a new onset of tachypnea<\/strong><\/p>\n\n\n\n<p><strong>Explanation:<\/strong><\/p>\n\n\n\n<p>Tachypnea (rapid breathing) in a client with a hip fracture could indicate a serious complication such as a pulmonary embolism, which is a medical emergency. This condition requires immediate assessment to determine if the tachypnea is related to a life-threatening issue that needs urgent intervention.<\/p>\n\n\n\n<p>Here\u2019s why the other options are less urgent:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>B. Client who has diabetes mellitus and an HbA1c of 6.8%<\/strong>: An HbA1c of 6.8% is slightly above the normal range but not an immediate concern. Regular monitoring and management adjustments are needed, but it does not require urgent assessment.<\/li>\n\n\n\n<li><strong>C. A client who has epidural analgesia and weakness in the lower extremities<\/strong>: Weakness in the lower extremities might be a side effect of epidural analgesia, but it is not as immediately life-threatening as potential complications like pulmonary embolism.<\/li>\n\n\n\n<li><strong>D. A client who has sinus arrhythmia and is receiving cardiac monitoring<\/strong>: Sinus arrhythmia is usually a benign condition and not an urgent concern. Cardiac monitoring is appropriate, but it does not require immediate assessment compared to potential complications associated with tachypnea.<\/li>\n<\/ul>\n\n\n\n<p><strong>Correct answer:<\/strong> A<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A nurse is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse plan to assess first? A.client who has a hip fracture and a new onset of tachypnea B.client who has diabetes mellitus and an HbA1c of 6.8%. C.A client who has epidural analgesia and weakness in the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-133535","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/133535","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=133535"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/133535\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=133535"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=133535"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=133535"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}