NCLEX-RN

Category - Care Management

Rick Rescue, RN enjoys a fulfilling career in the Emergency Department. He thrives on the fast-pace and unpredictable environment of the ED. Tonight, four clients have arrived at nearly the same time! Which client is Rick Rescue, RN’s priority?
  1. 28-year-old male, third degree burns to face and upper chest.
  2. 70-year-old female, possible left hip fracture.
  3. 45-year-old female, history of alcohol abuse, complaining of epigastric pain and vomiting.
  4. 66-year-old female, complaining of chest pain.
Explanation
Answer: A - To determine priority clients, the potential for life-threatening events is the most important factor to consider. Severe edema to the face and chest is likely with third degree burns, causing airway restriction. Maintaining a patent airway is always priority.
Use ABCs (airway, breathing, circulatory) when prioritizing, airway being first priority, then breathing problems, followed by circulatory issues. The client complaining of chest pain has a patent airway and is not experiencing breathing difficulties.
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