Which client should the nurse assess first?

A. A client with a femur fracture who has a cool, pale foot with a weak pedal pulse
B. A client 2 days after knee replacement who rates pain 5/10
C. A client with osteoarthritis asking for a heating pad
D. A client with a wrist cast who reports itching

Show answer and rationale

Correct answer: A

A cool, pale extremity with a weak pulse below a fracture suggests vascular compromise or compartment syndrome, which threatens the limb. The others are stable.

Source: Lewis's Medical-Surgical Nursing, 13th ed. (fracture complications)

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This question is one of 193 Management of Care items in NCLEXSim. On the NCLEX-RN, this category makes up 15–21% of the exam.

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Study tip

Work every 'who first' item through the same ladder: airway, breathing, circulation; then unstable before stable, acute before chronic, actual before potential.
Delegation: the RN keeps initial assessment, care planning, teaching, evaluation, and any unstable client. LPNs take stable, predictable clients. Assistive personnel take routine tasks such as vital signs on stable clients, hygiene, feeding without swallowing risk, and ambulation.

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Which client should the nurse assess first?

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