Question

The nurse comes upon a vehicle accident. Which client does the nurse see first?

1. An infant who is strapped in a car seat and crying uncontrollably.
2. A child who is crying that the leg is broken.
3. A restless client with pale, cool, clammy skin, and a rigid abdomen with absent bowel sounds.
4. An alert, but mildly disoriented client with a scalp laceration with well-controlled bleeding.

Answer 1

The nurse would prioritize the client with the most life-threatening condition, which is the restless client with pale, cool, clammy skin, and a rigid abdomen.

Step-by-step explanation:

The nurse would prioritize the client with the most life-threatening condition, which in this case is option 3. A restless client with pale, cool, clammy skin, and a rigid abdomen with absent bowel sounds is showing symptoms of internal bleeding and possible organ damage from the vehicle accident. This client is likely experiencing hypovolemic shock, characterized by restricted blood flow, rapid heart rate, weak pulse, and hypothermia. Immediate medical attention is necessary to stabilize the client and prevent further deterioration.