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NCLEX-RN&CGFNS真题解析-priority&first action 3

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A clinical nurse received four phone calls from discharged clients as following. Which one is at highest priority for the nurse to follow up?

    1. An above-knee amputation client discharge with crutches yesterday called for arms edema and numbness.

    2. A gastric cancer client discharged with intravenous tube insertion 2 days ago complained infiltration around insertion side.

    3. A fractured client with traction about home called that the rope of the traction is broken.

    4. A mother of a 4-month infant with infant apnea syndrome told the nurse that the alarm of Respiratory monitor did not work well.

这个题目中的病人都带有不同的医疗器械。第一个病人上肢的水肿麻木,很有可能是拐杖使用不当或者不合适,需要纠正调整。这是一个有关 peripheral circulation的状况。第二个病人保留针头外渗,也是一个peripheral circulation的状况。第三个病人的牵引的绳子断了,需要帮助修复,否则影响骨折的恢复,但是这个情况并不致命。第四个病人因为有呼吸停止综合 征,所以需要使用monitor all the time,并且一定要有报警装置,报警时一定要立即检查婴儿的呼吸情况。现在报警装置出问题了,虽然婴儿本身可能还没有出现呼吸停止,但是仍然非常危险, 所以要先解决。因此这个题的选项应该是4。

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