Clinical Nurse Specialist CNS Adult Practice Test

Answer: C - A complete set of vitals is the priority nursing action for clients in any sort of distress. The first step in the nursing process is the assessment. A complete set of vitals will provide information on the client’s status, give a baseline for further assessment, and help to form the plan for further care and treatment. Auscultation of heart and breath sounds and gathering history information are both important parts of the assessment process, but only after vital signs are measured. Starting an IV and administering analgesics are not part of the assessment process.