An NCLEX question for you.

[Lev, MSN, RN, NP]

After receiving report, which patient should the nurse see first?

1) Mr. Jones, a 57 year old man with a history of pancreatitis, going through alcohol withdrawal and has a heart rate of 107.

2) Ms. Smith, a 87 year old with COPD who is recovering from hip surgery and needs to ambulate in the hall.

3) Ms. Brown, a 24 year old admitted for sickle cell crisis who is complaining of body aches and wants pain medication.

4) Mr. Thomas, a 82 year old admitted for pneumonia whose oxygen saturation reads at 95% on oxygen at 3 liters per minute via nasal cannula.

*I thought it would be a good idea to start a thread where members could post NCLEX style questions for us to learn from and discuss.*

[loving2024, BSN, RN]

Attend to the Alcohol withdraw patient first due to safety. My unit has alot of ETOH patient (it's summer time😂) and preventing fall is our priority and also withdrawal patients are most of the time confused, agitated and spewed everywhere and requires a sitter. Therefore, I will attend to this patient first followed by 3

[autolink]

I would also choose 1 considering the person is experiencing acute etoh withdrawal. Safety is a concern and without further Tx, the client is likely to experience delirium tremens. Client 3 is obviously exhibiting early signs of Sickle Cell Crisis and should be triaged accordingly (Urgent not emergent).

[RNNPICU, BSN, RN]

I say number 3.. Sickle cell having body aches needing pain meds - could be potentially acute chest.

[MendedHeart]

I agree with the 2 PP. Go with number 1.

[autolink]

Body aches are vague. There are no other indications of ACS. Also even if if it is ACS mortality rates are 4%. Mortality rate of DT IS 5-15% depends on ICU setting.

[RNNPICU, BSN, RN]

Please enlighten us with the answer.

just as an aside people who are siting reasons for #1. There is no evidence that he is in the ICU, nor acute s/s of alcohol withdrawal, all it states is going through withdrawal.

For my own learning sake - what are signs of acute alcohol withdrawal

[203bravo, MSN, APRN]

weather patient 1 is in the ICU or not is irrelevant -- Because alcohol withdrawal symptoms can rapidly worsen, it's important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs. --

also from another point of view -- patient 1 and 3 both have acute changes, so either could potentially be correct, the next step would be to figure out which is more of a priority -- someone with a heart rate of 107? or someone with mild body aches?

[loving2024, BSN, RN]

Please enlighten us with the answer.

just as an aside people who are siting reasons for #1. There is no evidence that he is in the ICU, nor acute s/s of alcohol withdrawal, all it states is going through withdrawal.

For my own learning sake - what are signs of acute alcohol withdrawal

s/s of alcohol withdrawal is the opposite of alcohol. We all know alcohol is a depressant but when patient is going through alcohol withdrawal they manifest these classic symptoms such as tremors, insomnia, diaphoresis, agitation, severe anxiety and altered level of consciousness. However, when patients starts to shows signs of rapid heart beat then know that the patient is in a severe stage of alcohol withdrawal.

[loving2024, BSN, RN]

weather patient 1 is in the ICU or not is irrelevant -- Because alcohol withdrawal symptoms can rapidly worsen, it's important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs. --

also from another point of view -- patient 1 and 3 both have acute changes, so either could potentially be correct, the next step would be to figure out which is more of a priority -- someone with a heart rate of 107? or someone with mild body aches?

The question didn't states "mild body aches," it says the patient was having body aches due to the sickle cell. However, since pain is subjective, more assessment needs to be done in order to manage the pain, which means assessing the patient by using the PQRST method. You will never know what type of pain meds to give based on her quality of pain. I work in the ICU and the nurses uses PQRST method to assess patient's pain

[direw0lf, BSN]

Love this idea! I thought 3 because of the word crisis. But the HR in no1 is not normal and he had a history of infection so maybe he has one again.

[203bravo, MSN, APRN]

The question didn't states "mild body aches," it says the patient was having body aches due to the sickle cell. However, since pain is subjective, more assessment needs to be done in order to manage the pain, which means assessing the patient by using the PQRST method. You will never know what type of pain meds to give based on her quality of pain. I work in the ICU and the nurses uses PQRST method to assess patient's pain

True enough :) I'm guilty of reading something that isn't there... lol the downfall of most test takers.. but the theory still holds.