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    Ati nurs 250 med surg Proctored exam

    A nurse is caring for four clients who are all requesting assistance. Which of the following clients should the nurse assist first?

    Explanation & Rationale

    A. While nausea can cause discomfort and may require intervention, it is typically not immediately life-threatening. This client requires timely attention but does not take priority over a client who may have experienced trauma or injury. B. A fall can result in serious injury, including fractures, head trauma, or internal bleeding. According to nursing triage principles, clients with potential life-threatening conditions or acute injuries take priority. The nurse should assess this client first to determine the extent of injury and provide immediate care to prevent further harm. C. An alarm may indicate a disrupted infusion, which needs attention, but it is usually less urgent than a potential injury resulting from a fall. The nurse should address the IV alarm after assessing the client who fell. D. Requesting a bedpan addresses comfort and hygiene needs. While important, it is non-urgent compared with the risk of injury from a fall and can safely be delayed.

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