Nursing Care of the Adult Client
What this domain tests
The Adult Client domain of the ACE PN-RN samples medical-surgical nursing: assessment, prioritization, postoperative care, chronic disease management, and client teaching. Items often ask what the nurse should do first, not what is merely interesting.
Core rules
- Prioritize using ABCs (airway, breathing, circulation), then safety, then Maslow needs; acute changes outrank routine tasks.
- Compare findings with the client's baseline and normal ranges; a PaO2 of 60 mm Hg or SpO2 below 90% on room air is abnormal.
- In heart failure, recall fluid overload: crackles, JVD, weight gain, edema; daily weight is more reliable than intake/output alone.
- In COPD, baseline SpO2 may be 88-92%; a sudden drop with new confusion suggests worsening oxygenation, not just the usual baseline.
- Postoperative priorities: airway, bleeding, vital signs, pain, early ambulation, and preventing atelectasis.
Worked example
A 68-year-old admitted with pneumonia has RR 28, SpO2 88% on room air, new confusion, and temperature 38.9 C. Which action first? New confusion plus hypoxemia points to impaired oxygenation; apply oxygen and reassess, then notify the provider. Do not start with the antibiotic or discharge teaching. Reasoning: ABCs and an acute mental-status change trump scheduled tasks.
Traps
- Choosing a routine intervention such as ambulation when the client is unstable.
- Accepting a low SpO2 as normal for COPD without checking the client's baseline.
- Delegating assessment or teaching to unlicensed assistive personnel; UAP may collect vital signs but not interpret them.