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A client at 24 weeks’ gestation has been scheduled for an amniocentesis. Which actions should the nurse plan to take in the care of this client? Select all that apply.
The nurse caring for a high-risk client in labor observes the presence of variability of the fetal heart rate (FHR) of 10–12 beats per minute as recorded by the internal fetal monitor. What interpretation should the nurse make about the fetal condition or state?
A 10-month-old infant is admitted to the emergency department with a 1.2 ° F 1.2°F ( 38.9 ° C 38.9°C) rectal temperature and a history of vomiting and diarrhea for 48 hours. For which signs should the nurse assess?
Which finding should the nurse expect a client to exhibit who is newly diagnosed with fibromyalgia?
Which finding in an elderly female client who was started on digoxin (Lanoxin) 0.25 mg indicates that the medication is producing a therapeutic effect?
Which dietary change should the nurse recommend to a client who has recently been diagnosed with a goiter?
Which client situation requires the most immediate intervention by the nurse?
Which client should the nurse assess first immediately after receiving
Which assessment finding would indicate to the nurse the need for intramuscular
administration of vitamin K to a client with cirrhosis?
Which action should the nurse take first when performing tracheostomy care?
When planning home care for a child with juvenile rheumatoid arthritis (JRA), which recommendation should the nurse provide to the child’s parents?
When infusing a large number of banked packed red blood cells (PRBCs) over a short period of time, why should the nurse plan to administer a calcium replacement?
When giving a presentation on nursing at a college career day, which content should the speaker include as the best description of nursing as a profession?
When entering the room of a 78-year-old female client, the nurse finds the client slumped in her chair with no visible signs of life. What is the first action the nurse should take?
When developing an initial plan of care for a hospitalized client with bipolar disorder who is in the manic phase, what nursing intervention has the highest priority?
When developing a teaching plan on tuberculosis, which information would be accurate for the nurse to include?
When conducting a postpartum assessment, the nurse notes that the client has a positive Homan’s sign. Based on this finding, what action should the nurse take?
When conducting a nursing assessment of a client with a nasal fracture, which finding is most significant?
When bathing an elderly client, the nurse notes that the client’s skin is very dry, flaky, and rough. Which nursing intervention should be added to this client’s plan of care?
What recommendation is best for the nurse to provide to an elderly client who is concerned about constipation?
What nursing intervention is of greatest benefit in preventing postpartum thrombophlebitis?
What nursing diagnosis has the highest priority for a client with severe ascites as a result of liver disease?
What is a priority nursing diagnosis for a client with restless legs syndrome?
What intervention is most important for the nurse to implement when dealing with family members of a critically ill client?
What assessment finding indicates to the nurse that a client has a healthy, functioning sigmoid colostomy two weeks after surgery?
Upon making a 0900 hour arrival to the home of a client with a glomerular filtration rate of 19%, the nurse finds the client sitting on the side of the bed. Both lower legs are weeping copious amounts of clear malodorous fluid. The client asks the nurse why a visit is being made in the middle of the night. What action should the nurse take first?
Does the nurse conclude which sign reliably indicates that ascites fluid is being effectively mobilized in response to therapy?
Select all that apply.
A client is admitted to the hospital after vomiting for 3 days. What arterial blood gas (ABG) results should the nurse expect?
The registered nurse (RN) has finished reviewing the 0700 shift report on a telemetry unit. Which client would be best for the RN to assign to the licensed practical/vocational nurse (LPN/LVN)?
Which assessment finding in a 35-year-old client with an intracranial hematoma should concern the nurse?
The nurse should prevent corneal abrasion in a client with myasthenia gravis by performing which nursing intervention? Select all that apply
The client is post-transsphenoidal hypophysectomy. The client demonstrates an understanding of methods for preventing increases in intracranial pressure by stating to perform which activity?
After conducting client teaching with the mother of a 4-year-old child exposed to chickenpox, the nurse determines additional instruction is needed when the mother makes which statement?
A client diagnosed with a terminal illness states, “What’s left for me? I feel hopeless.” Does the nurse determine which of the following would be the best response?
What is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this medication with a full water glass?
The nurse is preparing a client for a barium study of the stomach and esophagus. Which nursing interventions should the nurse perform? Select all that apply.