The nurse has received a shift report. Which patient should the nurse assess first?
A) The patient diagnosed with type 2 diabetes mellitus who is complaining of dizziness with a glucose level of 120.
B) The patient diagnosed with sleep apnea who is complaining of a morning headache.
C) The patient diagnosed with diverticulitis who has a hard, rigid, abdomen and a temperature of 101.3°F.
D) The patient diagnosed with a stomach virus who vomited three times during the previous shift.

Question

Quizplus · Accepted Answer

Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. A hard, rigid abdomen and elevated temperature are abnormal in any circumstance, and the nurse should assess this patient first. These are clinical manifestations of peritonitis, a potentially life-threatening condition. A glucose level of 120 is normal for a patient with type 2 diabetes. The patient complaining of a headache is the least urgent compared with the other patients. The patient who vomited three times is an urgent patient requiring monitoring of hydration, but less urgent than a patient with a potentially life-threatening condition.

The Nurse Has Received a Shift Report