A nurse is caring for four patients. Select the patient that the nurse should assess first:

Question

1. A 63-year-old male complaining of mild discomfort in the chest after walking to the bathroom.
2. A 45-year-old female with a history of type 2 diabetes whose blood glucose reading two hours post-prandial is 180 mg/dL.
3. A 35-year-old male who is post-operative day 1 following a cholecystectomy, reporting pain at a level of 5 on a 0-10 scale.
4. A 50-year-old female with asthma who reports shortness of breath after using a nebulizer.

Answer 1

Patient No 4: A 50-year-old female with asthma who reports shortness of breath after using a nebulizer.

That patient has the most pressing need for care. The patient might be experiencing a bronchospasm or a tightening of the airways, a side effect of the medication used in the nebulizer. In addition, too frequent use of the nebulizer or using it for too long can sometimes worsen symptoms instead of improving them.

Patient No. 1 can be managed by imposing rest and relaxation for 45 min to one hour. An electrocardiogram should be performed to try to find any abnormality, and a re-evaluation of the patient's medication should be performed to determine if there is a need for adjustments.

For patient no 2, a blood glucose reading of 180 mg/dl two hours post-prandial is not life-threatening. A proper review of the patient's recent records and an adjustment of her diabetic medication are necessary.

Patient No 3 needs better pain management. It is critical to investigate his recent medication and allow him more time to recover from the surgery.

Answer 2

Correct Answer: 4. A 50-year-old female with asthma who reports shortness of breath after using a nebulizer.

Rationale: The patient who requires immediate assessment is the 50-year-old female with asthma experiencing shortness of breath after using a nebulizer. This symptom could indicate an adverse reaction to medication or inadequate relief from the current asthma treatment regimen, posing a risk of acute respiratory distress. Prompt evaluation is critical to assess her airway and breathing and to intervene as necessary.

1. Option 1: While chest discomfort in any patient is concerning, the description of it as "mild" and occurring only after exertion suggests it may be less urgent than acute respiratory symptoms. However, this patient should be monitored closely as it could escalate.
2. Option 2: A blood glucose level of 180 mg/dL post-prandial in a diabetic patient, although higher than normal, is not immediately life-threatening and can typically be addressed with routine adjustments in medication or diet.
3. Option 3: Post-operative pain at a level of 5, while important to manage for comfort and recovery, is not as urgent as respiratory distress and can be addressed with appropriate pain management strategies.