Exam Guide

First Action for a Client With Mild Hypothermia

Foundations of Practice & Clinical Judgment · Question from the ATI PN Fundamentals 2023 Proctored Exam study set

Question: A nurse is caring for a client who has a temperature of 35°C (95°F) following a fall into a cold lake. Which action should the nurse take first?
Provide the client with dry clothing

Correct answer: Provide the client with dry clothing

Why this is the answer

Removing wet clothing and providing dry clothing/warm blankets is a priority passive rewarming measure that prevents ongoing heat loss from evaporation and conduction.

The bigger concept

'First action' items with hypothermia follow a simple rule: stop the heat loss before adding heat. Wet clothing conducts heat away many times faster than dry, so removing it and covering the client with dry blankets is the priority passive rewarming step. Active measures — warm blankets, warmed IV fluids, heated humidified oxygen — follow and are directed by the RN and provider. Handle a hypothermic client gently, because a cold myocardium is irritable.

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