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A nurse on a surgical unit is caring for a group of clients. Which of the following is the priority action of the nurse?

A.

Reassuring the partner of a client who sustained a closed head injury

B.

Reinforcing a client's dressing for the surgical site of an above-the-knee amputation

C.

Taking a telephone prescription about a client who is to be transferred from PACU

D.

Assessing a client who experiences unilateral calf pain when ambulating

Answer and Explanation

The Correct Answer is D

Rationale:

 

A. Reassuring the partner is important for emotional support but does not directly impact the immediate safety of clients.

 

B. Reinforcing a dressing is important for wound care but does not address urgent concerns.

 

C. Taking a telephone prescription is necessary but not as immediate as addressing a potential complication.

 

D. Assessing a client with unilateral calf pain is the priority as it may indicate a serious condition such as deep vein thrombosis (DVT), which requires immediate evaluation and intervention.


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View Related questions

Correct Answer is C

Explanation

Rationale:

A. Providing appropriate resources is an outcome of effective delegation but not its primary purpose.

B. Promoting discharge teaching is not the primary purpose of delegation; it’s more about ensuring tasks are appropriately assigned.

C. Delegation permits a designated individual to meet a goal on your behalf, accurately reflecting the purpose of delegating tasks to others to achieve client care goals efficiently.

D. Decreasing health care costs may be an indirect benefit, but it is not the primary purpose of delegation.

Correct Answer is A

Explanation

Rationale:

A. Clients will have a decreased incidence of foot amputations is a measurable outcome goal for a diabetes management program and aligns with long-term objectives of improving patient outcomes.

B. A facility will be reserved for the program is a logistical consideration but not a goal of the program itself.

C. Handouts and teaching materials will be distributed at the program is a part of the program's implementation, not a goal.

D. Proper foot care will be demonstrated to clients during the program is a teaching activity, not a program outcome goal.

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