The nurse is assessing a client's pain experience. Which nursing intervention is most effective in determining the severity of a client's pain?

The nurse is performing a routine dressing change for a client with a stage 3 pressure injury that is red with significant granulation. The wound has a gauze dressing covering the area. Which action should the nurse implement?

A client, who speaks very little English, is being seen in the emergency department following an automobile accident. The client's sibling offers to act as an interpreter and asks about the laboratory results. Which response is best for the nurse to provide?

When assessing a client with a serum potassium level of 2.5 mEq/L (2.5 mmol/L), which intervention is most important for the nurse to implement?

Reference Range:
Potassium (K+) 3.5 to 5 mEq/L (3.5 to 5 mmol/L)

To assess a client's dorsalis pedis pulse, the nurse applies firm pressure over the top of the foot between the extension tendons of the great and first toes but does not feel a pulsation. Which action should the nurse take next?

When a home health nurse is administering a 10-day prescription for intermittent infusions of daptomycin to a client with Staphylococcus aureus cellulitis, the client inquires why the pharmacy delivered only a few of the premixed bags and not all of the doses. Which response should the nurse provide to the client?

A client with emphysema tells the nurse that sitting upright in bed makes breathing easier. Which instruction is most important for the nurse to provide the assigned unlicensed assistive personnel (UAP)?

A client with end-stage lung disease is dependent on a mechanical ventilator to sustain life. While the client's spouse is at the bedside, the client pleads in handwritten notes to have the endotracheal tube removed. The spouse tearfully agrees with the request. Which is the priority nursing intervention?

When conducting diet teaching for a client who is on a postoperative clear liquid diet, which foods should the nurse encourage the client to consume? Select all that apply.

The healthcare provider prescribes magnesium hydroxide 4,800 mg PO at bedtime for a patient with constipation. The bottle is labeled, "Magnesium Hydroxide Saline Laxative, USP 400 mg per 5 mL". How many ounces should the nurse instruct the patient to take with each dose? (Enter numerical value only.)

The mother of a child born with Tetralogy of Fallot asks the nurse, "Why did this happen to my baby? What did I do wrong?" Which response by the nurse is most helpful?