The charge nurse has just received report from another nurse, who is ill and going home. The nurse gave medications to his patients about 40 minutes ago
The charge nurse is prioritizing which patient should be seen first based on the nurse's report. Which patient should the charge nurse assess first?
a. A patient with multiple allergies, just started on a new medication with complaints of pruritus
b. A patient with a history of migraines and complaints of a mild headache
c. A postoperative patient who had a total knee replacement (TKR) with complaints of leg pain rated as a 4 on a scale of 1 to 10, with 10 being the greatest amount of pain
d. A patient on anticonvulsant therapy who is complaining of lethargy
ANS: A
A patient with multiple allergies who complains of pruritus after beginning a new medication has the greatest chance of an allergic reaction, including anaphylaxis.
A mild headache would not be a priority in someone who has a history of migraines.
A rating of leg pain of 4 out of 10 would not be a priority for a postoperative patient.
Lethargy is an expected side effect in a patient taking anticonvulsants, which depress central nervous system activity; this, therefore, is not a priority.
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