Pathophysiology · practice question

A 59-year-old client in the intensive care unit is being evaluated for nursing care related to hypoxia and impaired gas exchange. Assessment data include urine output 15 mL/hr for 2 hours with rising creatinine. Which assessment approach should the nurse use first?

Multiple choiceMediumnclex-rn-bsnnclex-validatednclex-2026pathophysiology

Begin invasive procedures before any focused assessment.Use only the chart from admission without current data.Screen for instability, then perform a focused assessment related to the presenting concern.Defer assessment until all medications are administered.

Answer and explanation

Correct answer

C. Screen for instability, then perform a focused assessment related to the presenting concern.

Why

Assessment begins with stability screening and focused data collection before invasive or delayed actions.

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A 59-year-old client in the intensive care unit is being evaluated for nursing care related to hypoxia and impaired gas exchange. Assessment data include urine output 15 mL/hr for 2 hours with rising creatinine. Which assessment approach should the nurse use first?

Correct answer

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