Uworld Prioritization
Leadership & Management Concepts
Priority, Projectile Vomit
Test Id: 54335228
Question Id: 32076 (751847)
4 of 20
A A A
The nu... [Show More] rse is managing assigned clients on the evening shift. Which client presentation
is a priority?
Unordered Options Ordered Response
1. Blunt head trauma with projectile vomiting
2. History of Alzheimer disease with agitation
3. History of carpal tunnel syndrome with hand numbness
4. History of third cranial nerve pathology with double vision
You answered this question correctly.
Time Spent: 66 Seconds
95% of people answered this question correctly.
Last Updated: 12/30/2015
Explanation
A client with a traumatic head injury from blunt force can have delayed symptoms if
there is bruising in the brain and subdural hematoma/cerebral edema develops. A
subdural hematoma is typically a slower venous bleed, and symptoms appear 24-48
hours later. Signs and symptoms are similar to those of increased intracranial
pressure and include change in level of consciousness, projectile vomiting, ataxia,
ipsilateral (unilateral) pupil dilation, and seizures. Brain herniation can occur if the
condition is not recognized and treated.
(Option 2) Neuropsychiatric symptoms such as agitation, aggression, delusions,
hallucinations, wandering, and depression are very common in clients with dementia.
Some may have an underlying etiology (eg, pain, infection) that requires identification
and treatment. This client is the second priority as the condition is not immediately lifethreatening.
(Option 3) Carpal tunnel syndrome is a compression of the median nerve within the
carpal tunnel at the wrist. Clinical manifestations are weakness, pain, numbness, and
impaired sensation in the median nerve distribution. Numbness is an expected
symptom; a splint is worn to relieve the pressure.
(Option 4) The third cranial nerve controls the majority (4/6) of the extraocular
muscles. As a result, the lesion can cause weakness in eye movements with resultant
diplopia, which is an expected finding.
Educational objective:
A client with a head injury and signs of increased intracranial pressure (eg, change in
level of consciousness, projectile vomiting, pupil dilation, ataxia) is a priority.
Leadership & Management Concepts
DIC Priority
Test Id: 54335228
Question Id: 34070 (751847)
6 of 20
A A A
The nurse is caring for clients on a busy medical-surgical unit. Which client would be
priority to assess first?
Unordered Options Ordered Response
1. A client with an ileostomy bag that has leaked stool all over
2. A client with chronic obstructive pulmonary disease, diminished
breath sounds, and SpO2 of 91%
3. A client with deep venous thrombosis who missed the last warfarin
dose
4. A client with sepsis who is developing petechiae
You answered this question correctly.
Time Spent: 189 Seconds
69% of people answered this question correctly.
Last Updated: 2/25/2016
Explanation
Clients with sepsis are at risk for developing disseminated intravascular coagulation
(DIC), a condition that initially causes clotting within the microvessels. Platelets and
clotting factors are consumed in clotting and become unavailable for body use, leading
to bleeding complications. The initial clotting also disrupts blood flow to extremities
and organs.
Signs of DIC include frank external bleeding (eg, venipuncture site bleeding), signs of
internal bleeding (petechiae, ecchymosis, hematuria, hematemesis, and bloody stools),
and respiratory distress (eg, bleeding/clotting into lungs). Signs of DIC need immediate
assessment and emergency intervention. Rapid replacement of clotting factors (fresh
frozen plasma), platelets, and blood is needed to save the client from death.
(Option 1) Stool leaking from an ileostomy bag is not a priority.
(Option 2) It is common for clients with chronic obstructive pulmonary disease to have
diminished breath sounds; the goal SpO2 level in this population is generally ≥90%.
(Option 3) Although missing warfarin can increase the risk of clotting, most clients will
usually have a therapeutic INR for 1-2 days. This is not a priority over the DIC client.
Educational objective:
Disseminated intravascular coagulation (DIC) results from abnormal activation of
clotting cascade followed by consumption of clotting factors and platelets; this quickly
leads to life-threatening external and internal bleeding. Any signs of DIC should be
assessed immediately as emergent replacement of clotting factors, blood, and platelets
is needed to save the client.
Postoperative Assessment - Prioritization
Test Id: 54335228
Question Id: 31099 (751847)
8 of 20
A A A
A nurse receives the following change-of-shift morning report for the assigned clients.
Which client should the nurse assess first?
Unordered Options Ordered Response
1. Client 1 day postoperative with fine inspiratory crackles in the lung
bases on auscultation who is to ambulate for the first time this morning
2. Client 1 day postoperative with serosanguineous drainage on the
abdominal surgical dressing and temperature of 100.4 F (38 C)
3. Client 2 days postoperative receiving intermittent epidural bolus
analgesia who now reports incisional pain as a 4 on a 0-10 scale
4. Client 2 days postoperative receiving fluids infusing at 125 mL/hr, with
a Foley catheter and urine output of 100 mL during the last 8 hours
You answered this question correctly.
Time Spent: 408 Seconds
76% of people answered this question correctly.
Last Updated: 12/13/2015
Leadership & Management Concepts
Postoperative DVT Priority Assessment
Test Id: 54335228
Question Id: 33974 (751847)
12 of 20
A A A
The nurse receives report on 4 assigned clients. Which client should the nurse assess
first?
Unordered Options Ordered Response
1. Client 1 hour post laparoscopic cholecystectomy for gallstones who
reports right shoulder pain
2. Client 4 hours post tracheostomy who has a small amount of pink
drainage on the tracheotomy dressing
3. Client 48 hours post abdominal hysterectomy who is ambulatory and
reports aching in the right leg
4. Client 3 days post open gastric bypass who reports fever and foulsmelling
discharge at the surgical site
You answered this question correctly.
Time Spent: 387 Seconds
37% of people answered this question correctly.
Last Updated: 3/8/2016
Explanation
The nurse should first assess the client showing symptoms of a deep venous
thrombosis (DVT) (eg, unilateral edema, warmth, redness, tenderness on palpation).
DVT is a postoperative complication related to venous stasis and subsequent
thrombosis. If a DVT is suspected, early diagnostic testing (eg, venous ultrasound) and
treatment with anticoagulant therapy (eg, heparin, enoxaparin) are critical to prevent
clots from traveling to the pulmonary circulation and causing pulmonary embolism.
(Option 1) The client is experiencing a common post laparoscopic cholecystectomy
problem of referred pain to the right shoulder. Carbon dioxide, used to inflate the
abdominal cavity during surgery, causes irritation to the phrenic nerve and diaphragm,
which may cause difficulty breathing. Interventions for alleviation include the Sims
position, deep breathing, ambulation, and analgesics.
(Option 2) A small amount of pink serosanguineous drainage at the new tracheostomy
site is expected postoperatively. The nurse should notify the health care provider if
bleeding becomes excessive.
(Option 4) Conditions that increase the likelihood of surgical site infection include
obesity, immunosuppression, malnutrition, diabetes, and advanced age. The nurse
should notify the health care provider of signs and symptoms of infection (eg, fever,
purulent drainage), but the client with a DVT is priority due to the risk of pulmonary
embolism.
Educational objective:
Assessing the client with a possible deep venous thrombosis is the priority due to lifethreatening
risk of pulmonary embolism. Characteristic manifestations of deep venous
thrombosis include calf pain, unilateral edema, warmth, redness, and tenderness on
palpation. [Show Less]
