The patient’s father is observed pressing the patient’s patient-controlled analgesia (PCA) pump while the patient is asleep. The nurse attempts to arouse the patient, who only opens the eyes after being pinched. Once aroused, the patient is able to raise the hand upon request. When asked what the year is, the patient responds with the previous year. The nurse reports the patient’s condition to the provider with which number on the Glasgow Coma Scale? Enter your response using a whole number.

The nurse finds a 70-year-old client admitted with heart failure, unresponsive with agonal gasping respirations. Which action does the nurse take first?

Following an explosion at a factory, the patient is brought by ambulance to the emergency department. The patient has soot on the face and around the mouth and is coughing up black sputum. He verbalizes severe pain in his leg and his voice is noted to be a hoarse whisper. Further assessment reveals full thickness burns to the arms and hands and partial thickness burns to the legs. Shrapnel appears to have been embedded in the patient’s thigh. While moving the leg to assess the inner thigh, a piece of shrapnel shifts and the patient begins bleeding profusely from the wound. The patient cries out in pain and requests pain relief. Which action does the nurse take first?