Difficulty: Medium
Average Score: 81%
Simulated
The nurse has been made aware of the following client situations. The nurse should first assess the client
Correct answer
D
Rationale
Dyspnea with a chest tube (D) suggests complications like tube occlusion or pneumothorax, requiring immediate assessment to ensure airway and breathing stability. COPD saturation (A), hypertension with headache (B), and catheter-related fever (C) are less urgent.