The nurse is caring for several clients on an orthopedic unit. If the following requests were made simultaneously, which should the nurse do first? A. A family member calls and requests to speak to the nurse about a patient. B. A client with a fractured femur complains of pleuritic pain and reports a rash on the chest and under the arms. C. A client with a fractured leg requests pain medications. D. A client with a cast reports itching within the cast.

In each scenario, we should consider the risks associated with that scenario and determine how urgent it is to address the request. Let us consider each option: A. Family member requests to speak to the nurse about a patient: This is important but doesn't require immediate attention as no medical issue is mentioned. B. Fractured femur client complains of pleuritic pain and rash: This could indicate a serious medical issue, and the risk is higher compared to the other scenarios. C. Fractured leg client requests pain medications: Pain management is important, but it's not an immediate medical emergency. D. Client with a cast reports itching: This is uncomfortable but doesn't pose an immediate risk to the client's health.

Based on the risks and urgency, we can prioritize the tasks in the following order: 1. B. Attend to the client with a fractured femur who is experiencing pleuritic pain and has developed a rash. This may indicate a more serious issue such as infection or an allergic reaction. 2. C. Address the client with a fractured leg requesting pain medications. Pain management is important, but the client is currently stable. 3. D. Check on the client with itching within the cast. It is uncomfortable but not a medical emergency. 4. A. Lastly, return the family member's call to discuss the patient. This can be done after attending to the more urgent tasks. So, the answer is B, as the nurse should first attend to the client with a fractured femur experiencing pleuritic pain and rash.