Pathophysiology · practice question

A 68-year-old client on a medical-surgical unit is being evaluated for nursing care related to neurologic injury. Assessment data include surgical incision with purulent drainage and fever 101.5°F (38.6°C). Which action should the nurse take first?

Multiple choiceHardnclex-rn-bsnnclex-validatednclex-2026pathophysiology

Offer a warm blanket and reschedule assessment until after lunch.Wait for the provider's routine visit before acting on abnormal findings.Complete all remaining scheduled tasks before reassessing the client.Assess airway, breathing, and circulation; address immediate safety risk; then notify the provider per protocol.

Answer and explanation

Correct answer

D. Assess airway, breathing, and circulation; address immediate safety risk; then notify the provider per protocol.

Why

NCLEX priority questions require stabilizing the client first using ABCs and focused assessment before comfort measures, documentation only, or delayed escalation.

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A 68-year-old client on a medical-surgical unit is being evaluated for nursing care related to neurologic injury. Assessment data include surgical incision with purulent drainage and fever 101.5°F (38.6°C). Which action should the nurse take first?

Correct answer

Why

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