Level: Clinical
Difficulty: Medium
Subtopic: Middle adult development
NCLEX: A 48-year-old client at an annual wellness visit is being evaluated for developmental expectations for middle adu…
Psychology / lifespan development Health Promotion and Maintenance
Case Study
A 48-year-old client at an annual wellness visit is being evaluated for developmental expectations for middle adult development. Assessment data include blood pressure screening is 168/96 mm Hg at two visits. Using ABCs and Maslow, which need should the nurse address first?
Question
A. Airway, breathing, and circulation problems before comfort or psychosocial needs.
B. Pain relief before checking airway and breathing.
C. Visitor concerns before physiologic stability.
D. Long-term teaching before treating acute physiologic risk.
B. Pain relief before checking airway and breathing.
C. Visitor concerns before physiologic stability.
D. Long-term teaching before treating acute physiologic risk.
Rationale
Correct answer: A. Airway, breathing, and circulation problems before comfort or psychosocial needs.
Rationale: Physiologic stability and ABCs take priority over comfort, teaching, or psychosocial needs when the client is unstable.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Physiologic stability and ABCs take priority over comfort, teaching, or psychosocial needs when the client is unstable.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.