Priority

Definitely #1 needs apresoline. DVT is serious, yes, but there is no embolism yet so this is an actual vs potential problem question. Besides, autonomic dysreflexia is life threatening. PE is bad too but isn't necessarily fatal. Does the question state that Pt 1 had a SCI? Esp SCI at level of C5?

No, answer choice 1 does not state any spinal cord injury, only the sudden severe headache. This is how I am thrown off. I don't have any more information than what is given. I am thinking of what kinds of complications the options can cause and which one is more severe. Or do I answer based on what is stated and not make assumptions??

Who would you see first between these two pts?

1) Pt who is complaining of a sudden severe headache.

2) Pt who has DVT and is complaining of calf pain.

I may be reading too far into these kind of questions. I am able to eliminate 2 answer choices and am left with the other 2 more serious conditions/complications. When I think sudden severe headache I'm thinking increased ICP. It could also a mean life-threatening situation such as autonomic dysreflexia. If it sudden, it is acute. However, it does not state in the answer choice what it actually is. DVT is a serious condition as well and it could lead to pulmonary embolism and clots in other areas if not treated.

So my question is, which one would you select?

In NCLEX questions, you take only the info you are given. I know we try to teach you a lot of stuff, but sometimes, as Freud said, a cigar is just a cigar. Do try very, very hard to get out of the habit of "reading into" as you learn to ask yourself, "What's important here?" because that is what they are asking-- do you know what's important?

OK, then, moving on.

1) You don't know how old this person is, or anything about his past or current medical history. All you know is that he has just told you that he has just had a sudden onset of severe headache. So.

Anyone who complains of a sudden severe headache could have any of a lot of things going on, but almost all of them could be life-threatening. You don't know whether it's rapid-onset migraine, a spike in BP (as you might see with AD), a sudden bleed with pressure/meningeal irritation from an aneurysm or AV malformation, or anything else. Not your job to make a medical diagnosis or prescribe meds. (hint: if any answer says "Give (drug)" without any indication that you have a prn prescription in hand at the time, you say to yourself, "Not in my scope of practice.") Your job is to recognize how damn dangerous this sudden severe headache is (not could be, but is), right now.

2) Most people who have been diagnosed with DVT have it in their legs and have calf pain. Certainly worth following up, especially if this is a new pain or on the other leg than the one they got admitted with. But we don't know that now. All we know is that most people who have been diagnosed with DVT have it in their legs and have calf pain.

So. Now that you can see which one is bad right now and which one might be later but isn't showing you anything unexpected or dangerous now... which one do you think is your priority?

Thank you for your help!! I was leaning towards option 1 since I was thinking 'life-threatening' and acute vs. something that was more expected on assessment. I will definitely keep the 'right now' and 'might be later' in mind!!

If they have a DVT, calf pain is expected. Even without the extra info about possible autonomic dysreflexia, the wording "sudden, severe" still makes me think that it's a higher priority.

Priority questions are hard!

hello,

I would choose option # 1

Expected V. Unexpected.

Calf pain is expected with dvt

SUDDEN sever headache in anyone is unexpected.

For that reason I pick 1.

i choose #1 also... calf pain in DVT is expected..and sudden headache - needs more assessment.

I don't know what your practice question's rationale is but i would think this way...

what is the answer anyway?

No answer or rationale to this, just an example. Thank you for your input!

As an aside, if you are doing practice questions for prep, don't you get the answers? Or is this one you remembered from taking the test?