hard · NCLEX-RN Physiological Adaptation

A client with severe ARDS is receiving a continuous neuromuscular blocking agent (NMBA).

Which nursing assessment is the priority for the safety of this client?

  1. Perform a 'Train of Four' (TOF) assessment every hour, at this point in care.
  2. Ensure the ventilator alarms are enabled and the apnea backup is functional.
  3. Assess for bowel sounds and gastric residual volumes.
  4. Monitor for the development of deep vein thrombosis (DVT), for this client.

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