Before leaving the room of a client who is confused, the nurse observes that a half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed frame. Which action should the nurse take before leaving the room?

An older adult client presents to the emergency department with abdominal pain due to constipation. The nurse is providing a list of high-fiber foods to the client that the healthcare provider has recommended. Which action should the nurse implement when reviewing the list of foods?

The psychiatric nurse is caring for clients on an adolescent unit. Which client requires the nurse's immediate attention?

A client is admitted to the mental health unit and sits in the corner of the day room. When the nurse begins the admission assessment interview, the client is guarded, suspicious, and resists talking. Which action should the nurse implement?

What goal(s) should the nurse prioritize in the care plan for the client while in the emergency department? Select all that apply.

The nurse is caring for a client with pneumonia who now develops initial signs of septic shock and multi-organ failure. The healthcare provider prescribes a sepsis protocol. Which intervention is most important for the nurse to include in the plan of care?

Click to highlight the statement(s) made by the client that indicate she understood the treatment recommendations and is developing an understanding of her disease. Select all that apply.
1.    Working with an addiction therapist for several months will assist in my recovery.

2.    The Alcoholics Anonymous program would be a great resource, but they do not have meetings when I'm free.
3.    It is not safe for me to drink alcohol, but I am still able to smoke marijuana without problems.
4.    Identifying potential triggers allows me to proactively utilize coping strategies.

5.    Relapse is an expected complication of substance use; thus, prevention strategies and awareness of my emotions are important.
6.    The treatment options for alcoholism are limited to inpatients, with very few resources for outpatients.
 

A client is admitted to a medical unit with a diagnosis of gastritis and chronic heavy alcohol abuse. Which medication should the nurse administer to prevent the development of Wernicke's syndrome?

While completing an admission assessment for a client with unstable angina, which closed ended questions should the nurse ask about the client's chest pain?

Highlight findings that indicate the client is stable and ready to be discharged.

The client returned from appendectomy surgery last night at approximately 2100. The client was admitted for observation due to a delay in waking from anesthesia. The client is currently resting in bed. The incision dressing is dry and intact, and no bleeding is noted. The client tolerated clear liquids post recovery and has advanced to a soft diet. The client ambulated around the unit this morning and tolerated activity well. Bowel sounds are present in all 4 quadrants, and per client report, she has passed flatus. Pain is tolerated with analgesia PO.

A client who underwent an uncomplicated gastric bypass surgery is having difficulty with diet management. Which dietary instruction is most important for the nurse to explain to the client?