A nurse is teaching a client about advance directives. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is assessing a client who is prescribed spironolactone. Which of the following laboratory values should the nurse monitor for this client?

A nurse is caring for a client who has a history of depression and is experiencing a situational crisis. Which of the following actions should the nurse take first?

A nurse is assessing a client who is at 24 weeks of gestation during a routine prenatal exam. Which of the following findings should the nurse report to the provider?

A nurse is caring for a 1-month-old infant who has manifestations of severe dehydration and a prescription for parenteral fluid therapy. The guardian asks, "What are the indication that my baby needs an IV?" Which of the following responses should the nurse make?

A nurse is caring for a client who is 4 hr postoperative following a total knee arthroplasty. The client reports a pain level of 3 on a scale from 0 to 10. Which of the following nonpharmacological pain management therapies should the nurse recommend?

A nurse on a postpartum unit is caring for a client.

Vital Signs:

• Postpartum day 3, 0815:
• Temperature 38.2° C (100.8° F)
• Heart rate 104/min
• Respiratory rate 18/min
• BP 108/70 mm Hg
• SaO2 97% on room air

Nurses' Notes:

• Postpartum day 3, 0815:
• Client reports feeling unwell.
• Lung sounds clear but diminished in the bases.
• Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding.
• Uterus firm at 1 cm above the umbilicus and tender to palpation.
• Fundus boggy but firmed with massage.
• Moderate amount of dark brown, foul-smelling lochia noted.
• Surgical incision well approximated with slight edema present no redness or drainage noted.
• No bowel movement since birth, hypoactive bowel sounds.

Diagnostic Results:

• Postpartum day 3, 0900:
• Hemoglobin 11.1 g/dL (greater than 11 g/dL)
• WBC count 33,000/mm3 (5,000 to 10,000/mm3)

A nurse in an emergency department is assessing a client who has major depressive disorder. Which of the following actions should the nurse take first? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

A nurse is caring for a client who received a transfusion of 250 mL of packed RBCs. The nurse should identify that which of the following findings indicates the client is responding positively to the transfusion?

A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate. The client reports that she is experiencing difficulty breathing. Which of the following actions should the nurse take first?

A nurse is admitting a client who is 1 week postpartum and reports excessive vaginal bleeding. The nurse speaks a different language than the client. The client's partner and 10-year-old child are accompanying her. Which of the following actions should the nurse take to gather the client's admission data?