A client is brought to the emergency department after sustaining ...

[Yi-Chen]

A client is brought to the emergency department after sustaining injuries in a severe car crash. The client's chest wall does not appear to be moving normally with respirations, oxygen saturation is 82, and the client is cyanotic.
 
  What action by the nurse is the priority?
  a.
  Administer oxygen and reassess.
  b.
  Auscultate the client's lung sounds.
  c.
  Facilitate a portable chest x-ray.
  d.
  Prepare to assist with intubation.

Question 2

A client has been diagnosed with a very large pulmonary embolism (PE) and has a dropping blood pressure. What medication should the nurse anticipate the client will need as the priority?
 
  a. Alteplase (Activase)
  b. Enoxaparin (Lovenox)
  c. Unfractionated heparin
  d. Warfarin sodium (Coumadin)

[bubulittle310@msn.cn]

Answer to Question 1

ANS: D
This client has manifestations of flail chest and, with the other signs, needs to be intubated and mechanically ventilated immediately. The nurse does not have time to administer oxygen and wait to reassess, or to listen to lung sounds. A chest x-ray will be taken after the client is intubated.

Answer to Question 2

ANS: A
Activase is a clot-busting agent indicated in large PEs in the setting of hemodynamic instability. The nurse knows this drug is the priority, although heparin may be started initially. Enoxaparin and warfarin are not indicated in this setting.

[Yi-Chen]

Excellent

[shailee]

Thanks for the timely response, appreciate it