Editing Medical-Surgical Nursing – RN Practice Questions (section)

==Question 1==
A registered nurse receives report on four patients at the start of the shift. Which patient should the nurse assess first?
# A patient two days after a total knee arthroplasty who reports incisional pain rated 7 out of 10.
# A patient with chronic obstructive pulmonary disease whose oxygen saturation is 90 percent on 2 liters per minute by nasal cannula.
# A patient admitted with a right femur fracture 36 hours ago who is now restless and reports feeling short of breath.
# A patient with type 2 diabetes whose morning blood glucose is 210 mg/dL.

'''Answer:''' Option 3, the patient with a femur fracture who is restless and dyspneic.

''Rationale:'' New restlessness with dyspnea 24 to 72 hours after a long bone fracture is the classic presentation of fat embolism syndrome, and restlessness is an early sign of hypoxia. This patient has an actual, unstable airway and breathing problem requiring immediate assessment and escalation. Option 1 is expected postoperative pain and is treatable but not life threatening. Option 2 is an acceptable saturation for a patient with chronic obstructive pulmonary disease, whose target is often 88 to 92 percent. Option 4 is an abnormal but non-emergent glucose in a patient with known diabetes.