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A nurse is admitting a client for an elective surgical procedure. During the client interview, one of the client's family members faints. Which of the following actions should the nurse take first?

A.

Notify the nurse manager.

B.

Complete an incident report.

C.

Obtain the family member's health history.

D.

Check the family member's vital signs.

Answer and Explanation

The Correct Answer is D

A. Notifying the nurse manager is important, but it is not the immediate priority when a family member has fainted.  

 

B. Completing an incident report is necessary for documentation but should occur after addressing the immediate medical concern.  

 

C. Obtaining the family member's health history is not pertinent at this moment as the priority is to assess their current condition.  

 

D. Checking the family member's vital signs is the first action to determine their immediate health status and any necessary interventions to provide appropriate care.


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View Related questions

Correct Answer is D

Explanation

A. Consulting the ethics committee is unnecessary at this stage, as there is no ethical dilemma in arranging social support services.

B. Suggesting a discharge delay is premature and may not be feasible; alternative support should be considered first.

C. Long-term care facility placement is a more permanent solution and may not align with the client’s needs or preferences.

D. Recommending a referral to social services is appropriate as social services can help arrange post-discharge support, including home health services or community resources, ensuring a safe transition home.

Correct Answer is B

Explanation

A. Removing gloves before leaving an isolation room is appropriate practice and helps prevent the spread of infection.

B. Filling a basin with water at 40° C (104° F) is too hot for foot care and could lead to burns or injury; water temperature for foot care should be comfortably warm, typically around 37°C (98.6°F).

C. Instructing a client to look down at their feet when being assisted to ambulate is a safety measure that can help the client maintain balance and avoid tripping.

D. Applying water-soluble lubricant to the nares of a client receiving oxygen is a standard practice to prevent dryness and does not require intervention.

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