A nurse is in the emergency department (ED) and is caring for a client that has arrived by ambulance after a cervical spinal cord injury. Which assessment should be the priority for the nurse to perform at this time?
Assess the client's respiratory status and airway patency.
Assess the client's extremity strength and sensation.
Assess the client's pain level and provide pain management.
Assess the client's level of consciousness and orientation.
The Correct Answer is A
A. Assessing respiratory status and airway patency is the highest priority in this situation due to the risk of respiratory compromise from cervical spinal cord injuries, which can affect the diaphragm and other respiratory muscles.
B. While assessing extremity strength and sensation is important, it comes after ensuring the client’s airway and breathing are stable.
C. Pain management is essential, but addressing immediate life-threatening conditions takes precedence over pain assessment.
D. Assessing the client's level of consciousness is crucial for overall evaluation but does not take priority over ensuring adequate respiratory function in the context of a cervical spinal cord injury.
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Correct Answer is B
Explanation
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C. Driving is not recommended during symptomatic periods of vertigo, as it could be unsafe.
D. The logroll technique is typically used for clients with spinal issues rather than vertigo management in Meniere’s disease.
Correct Answer is C
Explanation
A. A short-term, low-dose steroid use (one week) has minimal risk for adrenal suppression.
B. Three weeks of steroids increases risk, but daily use presents a higher risk.
C. Prolonged daily steroid use, especially in an older adult, poses the greatest risk for adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis.
D. Intermittent steroid use is less likely to cause adrenal insufficiency compared to daily long-term use.