A nurse is caring for a patient with a history of stroke. What should the nurse do first?

Correct Answer: C

Rationale: The correct answer is C: Assess for signs of hypoglycemia. This is the first step because hypoglycemia can mimic stroke symptoms and must be ruled out before proceeding with any other assessments or interventions. Treating hypoglycemia promptly is crucial to prevent further complications. Assessing the patient's neurological status (choice A) and performing a neurological exam (choice B) can be done after ruling out hypoglycemia. Administering thrombolytic therapy (choice D) is not appropriate without a proper assessment and diagnosis.

Correct Answer: B

Rationale: The correct answer is B: Notify the healthcare provider. The symptoms described suggest signs of infection at the surgical site, which requires immediate attention by the healthcare provider. In this situation, the nurse should prioritize notifying the healthcare provider to ensure prompt assessment and appropriate intervention. Checking the patient's temperature (choice A) may provide additional information but does not address the immediate need for intervention. Administering pain medication (choice C) may temporarily alleviate symptoms but does not address the underlying issue of infection. Performing a neurological exam (choice D) is not indicated based on the symptoms described.

Correct Answer: A

Rationale: The correct answer is A: Administer oxygen therapy. The priority action is to address the patient's shortness of breath, which could indicate decreased oxygenation. Administering oxygen therapy helps improve oxygen levels and alleviate respiratory distress. IV fluids (B) are not indicated unless the patient is hypovolemic. Pain relief (C) is important but not the priority in this case. Administering thrombolytics (D) may be appropriate for an MI but is not the immediate priority when the patient is experiencing shortness of breath.

Correct Answer: A

Rationale: The correct answer is A: Administer pain relief. The priority action is to address the patient's immediate need, which is pain control to ensure comfort and promote recovery. Administering pain relief is crucial for patient well-being post-surgery. Choice B is incorrect as a bronchodilator is not indicated for pain management. Choice C is also incorrect as monitoring blood glucose levels is not the priority for a patient complaining of pain post-surgery. Choice D is a duplicate answer and does not provide any additional information.

Correct Answer: A

Rationale: The correct answer is A: Administer bronchodilators. Bronchodilators help to open the airways quickly, providing immediate relief for the patient's shortness of breath in an acute asthma attack. This intervention addresses the patient's current distress and helps improve oxygenation. Administering corticosteroids (choice B) is important for long-term management but not the priority in an acute situation. Monitoring vital signs (choice C) is essential but not the immediate priority when the patient is in respiratory distress. Administering insulin (choice D) is not indicated for asthma and would not address the patient's shortness of breath.