The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?

In assessing a client with ulcers on the lower extremity, which findings indicate that the ulcers are likely to be of venous, rather than arterial, origin?

After initiating a steroid nebulizer treatment for a client with asthma in respiratory distress, which intervention is most important for the nurse to implement?

A patient is admitted to the hospital with symptoms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse?

A client who received 6 units of packed red blood cells 3 days ago for a lower gastrointestinal (GI) bleed is now displaying signs of shortness of breath with occasional stridor and is reporting muscle cramping.

Reference Range:
Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]
Magnesium [Adult: 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L)]
Calcium [9 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]
Sodium (136 to 145 mEq/L (136 to 145 mmol/L)]

Which serum laboratory value should the nurse immediately report to the healthcare provider?

A 70-year-old female presents to the emergency department through triage with a noticeable facial droop and garbled speech. After having a few drinks at a local seafood restaurant, the client's husband noticed his wife's speech became difficult to understand.

Flow sheets

1915

Arrival at emergency department

1920

Vital Signs:

- Temperature: 98.2° F (36.8° C)

- Heart rate: 92 beats/minute

- Respirations: 24 breaths/minute

- Blood pressure: 210/98 mmHg

- Oxygen saturation: 95% on room air

Imaging studies

1935

Head CT scan results:

- No evidence of intracranial hemorrhage

- No evidence of acute disease

Orders

- Obtain CT scan of the head.

- Insert a large bore peripheral IV.

- Start normal saline infusion at 50 mL/hour.

• The nurse administered tPA and conducted neurologic assessments every 15 minutes during the infusion.
• The tPA infusion finished and the nurse performed neurologic assessments every 30 minutes for the 6 hours following the administration.
• The client was noted to be stable with unchanged neurologic assessments.
• The nurse begins to plan care for the client's recovery and identifies interdisciplinary team members who can assist with the client's recovery.

Select the interdisciplinary team members who should assist the client in recovery.

The nurse is teaching a client with cancer about skin care for the portal site receiving external beam radiation. Which client action regarding skin care indicates a need for further teaching?