A patient with a pulmonary embolism (PE) is admitted. What is the priority nursing intervention?

Correct Answer: B

Rationale: The correct answer is B: Provide oxygen therapy as needed. In a patient with a pulmonary embolism, ensuring adequate oxygenation is the priority to prevent hypoxia and tissue damage. Oxygen therapy helps improve oxygen saturation levels, reducing the workload on the heart and lungs. Administering anticoagulants (Choice A) is important but not the immediate priority. Positioning in high Fowler's (Choice C) may help with breathing but doesn't address immediate oxygen needs. Notifying the healthcare provider (Choice D) is essential but not the immediate action needed to stabilize the patient.

Correct Answer: B

Rationale: The correct answer is B: Monitor the patient for changes in neurological status. This is the priority intervention because patients with a history of stroke are at risk for complications such as recurrent strokes or worsening neurological status. Monitoring for changes allows for early detection and timely intervention. A: Assisting with a swallowing assessment is important, but monitoring neurological status takes precedence as it directly assesses the patient's brain function. C: Having a family member for rehabilitation is beneficial but not the priority over monitoring neurological status for immediate complications. D: Providing medication for swallowing improvement may be necessary, but monitoring neurological status is crucial for detecting any emergent issues. In summary, monitoring neurological status is the priority as it directly assesses the patient's brain function and allows for early detection of complications.

Correct Answer: A

Rationale: The correct answer is A. Administering intravenous fluids is the priority nursing action for a patient at risk for fluid volume deficit due to severe burns. This helps restore fluid balance and prevent complications like hypovolemic shock. Monitoring respiratory status (B) is important but not the priority in this case. Administering oral antibiotics (C) may be necessary but does not address the immediate risk of fluid deficit. Providing family support (D) is essential but not the priority when the patient's physiological needs must be addressed first.

Correct Answer: B

Rationale: The correct answer is B because a sudden onset of shortness of breath in a patient on bed rest may indicate a life-threatening condition like a pulmonary embolism or cardiac event. Assessing this patient first is crucial for prompt intervention. Choice A can wait as pulmonary function testing is a scheduled procedure. Choice C, the TB patient, can wait briefly as medications can be administered a bit later without immediate harm. Choice D, the patient with pneumonia and a low-grade fever, is stable and can be assessed after the patient with sudden shortness of breath.

Correct Answer: C

Rationale: The correct answer is C: Monitor the patient's blood glucose levels. This is the priority action because blurred vision can be a sign of uncontrolled blood glucose levels in diabetic patients. By monitoring the patient's blood glucose levels, the nurse can assess if the blurred vision is related to high or low blood sugar levels, and take appropriate actions such as administering insulin or providing glucose if needed. Checking the blood glucose level (choice A) is a single-point assessment and may not provide the full picture. Monitoring blood glucose levels (choice B) is repetitive and not specific to the current complaint. Administering intravenous fluids (choice D) is not necessary unless the patient is severely dehydrated, which is not indicated by the complaint of blurred vision.