A child has just arrived by ambulance at the emergency room following a motor vehicle accident and a nurse is assessing him. Which three body systems should the nurse evaluate first?

Choice A rationale The immediate assessment of a trauma client follows a systematic approach known as the primary survey, prioritizing life-threatening injuries based on the ABCs (Airway, Breathing, Circulation). While the skeletal system is assessed in the secondary survey, initial focus must be on the respiratory and cardiovascular systems to ensure adequate oxygenation and perfusion, followed by a rapid neurologic assessment (Disability). Choice B rationale Following any motor vehicle accident, the nurse's priority in the emergency setting is the primary survey, which mandates immediate evaluation of the Respiratory (Airway and Breathing), Cardiovascular (Circulation), and Neurologic (Disability) systems. These three systems are fundamental to maintaining life, and compromise in any of them, such as inadequate ventilation or brain injury, requires immediate, life-saving intervention before proceeding to a more detailed, secondary assessment. Choice C rationale Gastrointestinal assessment is part of the secondary survey, focusing on potential abdominal injuries, and is not one of the immediate life-saving priorities. The neurologic system, crucial for determining brain function and spinal cord injury, must be assessed immediately after circulation, while the respiratory and cardiovascular systems must be addressed first to prevent irreversible damage. Choice D rationale The endocrine system, which regulates hormones and metabolism, is assessed later during the secondary survey or ongoing monitoring. It is not an immediate life-saving priority following acute trauma. The primary focus must remain on the ABCs (Airway, Breathing, Circulation) and Disability (Neurologic assessment) to identify and treat injuries that pose the most immediate threat to the child's survival.