Nursing Priority vs First nursing action

Nurses General Nursing

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We had an exam today and I struggled with one of the answers. The nurse is caring for pt. with HF who is experiencing dyspnea , and bilateral crackles, and pulmonary edema. What is the nurses priority intervention:

Give PRN oxygen or give lasix as ordered.

The answer is apply oxygen but I chose to give lasix. I know all about ABC's and Maslow. However, the reason why I chose to give Lasix as ordered is because the sx are caused by pulmonary edema and the underlying cause needs to be addressed.

If the question would of asked what would should the nurse do FIRST... I would have picked to apply Oxygen.

There is a difference between priority and what to do first. I'm a nurse in LTC ( LPN) and I have taken care many of residents with HF exacerbation. My first nursing action for any resident with SOB secondary to pulmonary edema is to apply oxygen. However, my priority is to make sure that the underlying cause is addressed in order to prevent and treat symptoms. Most of the time that priority interventions includes getting an order for IM lasix if not already ordered.

Oxygen alone will provide temporary relief however it will not get rid of the pulmonary edema.

Please help me to understand how oxygen is a priority instead of a first nursing action. Thanks.

Specializes in LTC.
"there is a difference between priority and what to do first..." (your understanding)

"there is no difference between priority and what to do first..." (what everyone else assumes)

so the question becomes:

"what is the nurses first intervention: give prn oxygen or give lasix as ordered?"

in other words, priority means first is how most nurses would understand the meaning. and at leslie, you're absolutely right in that many people over think a question and wind up choosing the wrong answers. i recall our nursing class president, who was a nursing aide for years and 4.0 honors student, who unbelievably failed the boards. who wudda thunk it? sometimes, if you think too much, you wind up burying yourself. :idea:

thanks so much for the clarification. one of our instructors actually told us about this priority verses first thing. she stated that students need to know the difference between what to do first and what is a priority. maybe i just misinterpreted what she was trying to convey. thanks though. in real life i seem to react very well in situations but these questions throw me for a loop at times.

Specializes in Spinal Cord injuries, Emergency+EMS.

management priorities of the unwell patient

Airway- Breathing- Circulation

Oxygen is a 'breathing' intervention it's also quicker than going and drawing up the furosemide and administering it correctly, even assuming that the patient has patent IV access

Specializes in Critical Care.
By the time the doc gets to write the Lasix up, I would hope that the patient would be receiving oxygen. Administering Lasix is a task delegated to the nurse by the doctor; that is his/her intervention and the nurse carries it out. The nurse's first intervention is that which is within his/her scope of practice. No nurse needs a dr's script to administer O2, therefore O2 is the first nursing intervention.

Always read your question carefully; you are asked what is the nurse's priority intervention. O2 first, correct positioning immediately afterwards.

O2 is also a medical intervention carried out by the nurse that does require an order, although under ACLS you don't need an order for O2, lasix, or NTG and morphine for that matter in the case of flash pulmonary edema.

Specializes in Critical Care.

We all agree the answer is O2, but because it's quicker to initiate is really the only reason. ABC's would indicate lasix as the first intervention (the purpose of lasix is to clear the alveoli of fluid, alveoli are part of your airway).

Specializes in Emergency, Telemetry, Transplant.
but it won't due squat for the respiratory acidosis that develops when the output side of gas exchange is impaired.

You are muddying the waters by bringing this up. Yes, resp acidosis (or metabolic for that matter) is life threatening. Lasix is not going to do much the short term (i.e. the first couple minutes after you give it) to help in this situation. Correcting any acidosis is not going to matter if the pt. is not getting O2 to his/her tissues. Yes, lasix (or some type of diuretic) is going to help with that but in the short term, it is going to be supplemetal O2. In a clinical sense (yes, I know the OP was about a nsg exam...heaven forbid we deal with the real world) supplemental O2 is going to have the biggest impact on correcting the problem.

Specializes in ICU.

I agree that giving oxygen is both priority and first intervention in the situation presented (however you interpret those terms).

However, what I have found since being a nursing student is that there are many times when there is no consistency in how to interpret a test question. There have been times when I've had one question give the rationale basically stating that priority and first action are the same, while another question gives the rationale that priority and first intervention are not the same. Nursing logic is easy enough to grasp, but what is unfortunate is that it isn't always consistent.

You just have to do your best within the context of the question to figure out what the H-E-DOUBLE HOCKEY STICKS they're actually trying to ask and therefore what answer they're looking for and get the heck outta there and deal with the real world where they do things in a more logical sense with the resources that are ACTUALLY available not this perfect world NCLEX we have everything at our disposal thing. (not really referring to this particular question just more nursing exams in general) NCLEX world does not =real world. Sometimes you have to make yourself be less logical during exams like an above poster said: you actually have to force yourself to think LESS! :)

We had an exam today and I struggled with one of the answers. The nurse is caring for pt. with HF who is experiencing dyspnea , and bilateral crackles, and pulmonary edema. What is the nurses priority intervention:

Give PRN oxygen or give lasix as ordered.

The answer is apply oxygen but I chose to give lasix. I know all about ABC's and Maslow. However, the reason why I chose to give Lasix as ordered is because the sx are caused by pulmonary edema and the underlying cause needs to be addressed.

If the question would of asked what would should the nurse do FIRST... I would have picked to apply Oxygen.

There is a difference between priority and what to do first. I'm a nurse in LTC ( LPN) and I have taken care many of residents with HF exacerbation. My first nursing action for any resident with SOB secondary to pulmonary edema is to apply oxygen. However, my priority is to make sure that the underlying cause is addressed in order to prevent and treat symptoms. Most of the time that priority interventions includes getting an order for IM lasix if not already ordered.

Oxygen alone will provide temporary relief however it will not get rid of the pulmonary edema.

Please help me to understand how oxygen is a priority instead of a first nursing action. Thanks.

No there is not. Your thinking is a bit skewed in a way that I do not understand from your post. Priority IS what to do first.

1. Priority: The pt. has to breathe. Applied oxygen is the fastest, easiest route to solve the problem. As to what to do first: the pt. will likely code while you are thinking about priority vs what to do first. He could die of hypoxemia while you are waiting for the lasix to be sent from the pharmacy.

2. While you apply oxygen,and gather other data such as VS and history, think about the likely

causes of the problem. It may NOt be CHF. This pt. may have developed a PE. "Shame" on you for not doing a a more thorough scan. (trick questions DO occur)

3. This stuff happens in real life, and these questions are designed to make you "think out of the box".

Specializes in SICU.
O2 is also a medical intervention carried out by the nurse that does require an order, although under ACLS you don't need an order for O2, lasix, or NTG and morphine for that matter in the case of flash pulmonary edema.

I disagree that a nurse cannot give O2 without an order.... Infact.... as a Nurse with a License, it is within your scope of practice to make a critical judgment that your pt needs o2. This may be done without having to call a doctor for an order.....

Specializes in Oncology; medical specialty website.

Lasix IM?

Specializes in Critical Care.
I disagree that a nurse cannot give O2 without an order.... Infact.... as a Nurse with a License it is within your scope of practice to make a critical judgment that your pt needs o2. This may be done without having to call a doctor for an order.....[/quote']

You won't find many nurses that disagree with your rationale, yet you still need order for O2 pretty much everywhere. That doesn't mean you wouldn't administer O2 to a hypoxic patient and worry about the order later, but it still technically requires an order.

Thanks so much for the clarification. One of our instructors actually told us about this Priority verses First thing. She stated that students need to know the difference between what to do first and what is a priority. Maybe I just misinterpreted what she was trying to convey. Thanks though. In real life I seem to react very well in situations but these questions throw me for a loop at times.

I am STILL completely flummoxed that there seems to be a difference between "what to do first" vs a "priority".

Apparently, the English language has undergone a sea change while I was not looking.

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