A patient has a traumatic brain injury. The nurse assesses the following: Pulse change from 82 to 60 beats/min, Pulse pressure increase from 26 to 40 mm Hg, and Respiratory irregularities. What action by the nurse takes priority?

A patient with a spinal cord lesion at T4 tells the nurse that he has a headache and feels flushed. The blood pressure is significantly elevated to 190/100. The first action by the nurse is to:

When providing care for a client hospitalized with acute pancreatitis who has acute abdominal pain, which nursing interventions would be most appropriate for this client? Select all that apply.

A nursing student learns about modifiable risk factors for coronary artery disease. Which factors does this include? Select all that apply.

Which client warrants immediate intervention by the nurse?a) The client with a heart rate of 56/min and a blood pressure of 110/70.b) The client diagnosed with mitral valve regurgitation who has a thready peripheral pulse.c) The client diagnosed with pericarditis who has chest pain with inspiration.d) The client with a history of atrial fibrillation who has developed slurred speech.The correct answer is: d) The client with a history of atrial fibrillation who has developed slurred speech.Choice A reason: A heart rate of 56/min and a blood pressure of 110/70, while slightly lower than normal, may not require immediate intervention unless accompanied by other symptoms. Bradycardia (a slow heart rate) and this blood pressure reading can be within acceptable limits for some individuals, especially if they are asymptomatic.Choice B reason: Mitral valve regurgitation with a thready peripheral pulse indicates a decrease in cardiac output, which can be concerning. However, it may not require immediate intervention unless the client shows signs of severe decompensation or other critical symptoms. Continuous monitoring and evaluation are essential, but immediate action might not be necessary.Choice C reason: Chest pain with inspiration in a client with pericarditis can be a symptom of the condition itself, which involves inflammation of the pericardium. While pain management and monitoring are important, this symptom alone may not necessitate immediate intervention unless it is severe or accompanied by other alarming signs.Choice D reason: The development of slurred speech in a client with a history of atrial fibrillation is a critical symptom that warrants immediate intervention. Slurred speech can be a sign of a stroke or transient ischemic attack (TI

A nurse cares for a patient who has cirrhosis of the liver. What action would the nurse take to decrease the presence of ascites?

A nurse recognizes that alterations in cardiac output are caused by changes in heart rate, preload, afterload, and contractility. Which interventions are correctly matched to treat the cause of low cardiac output? Select all that apply.a) Low afterload: administer vasopressor.b) Low afterload: administer vasodilator.c) Low right atrial (R

Which treatment best applies to the care of a client newly diagnosed with infective endocarditis?

A nurse is caring for a patient who experienced a cervical spine injury 12 hours ago and is experiencing spinal shock. Which of the following medications should the nurse anticipate giving?

A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?

The nursing care priorities for the patient with burn injuries include wound care, nutritional support, and prevention of complications such as infection. Based on these care priorities, the patient is most likely in which phase of burn care?

A nurse is caring for a patient with a head injury who has developed diabetes insipidus and is receiving vasopressin (Desmopressin). The nurse understands the therapeutic outcome is a decrease in:

The nurse is caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care?

A nurse cares for a patient who has a heart rate averaging 54 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate?

Which instruction would best reduce the symptoms of a client with heart failure and assure more comfort at home?

A patient with angina is receiving Nitroglycerin and begins to complain of a severe headache. What is the most appropriate response from the nurse?

A nurse cares for a patient who is prescribed lactulose (Heptalac). The patient states, "I do not want to take this medication because it causes diarrhea." How would the nurse respond?

A patient is admitted with acute kidney injury and the following assessment cues: K: 6.9 (3.5-5.0) Cr: 3.2 (0.6-1.2) Urine: 300 mL/24 hrs What priority actions should be anticipated by the nurse? Select all that apply.

The nurse correlates which rationale with the administration of aspirin to the client experiencing angina-like chest pain?

A nurse admits a patient who is experiencing an exacerbation of heart failure. Drag and drop in order of priority actions.

The nurse notes that a client with acute pancreatitis occasionally experiences muscle twitching and jerking. How should the nurse interpret the relevance of these symptoms?

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the healthcare provider (HCP)?

The nurse should anticipate which of these dietary measures for a patient admitted with a diagnosis of acute pancreatitis?

A nurse in the emergency room is performing an assessment on a burn victim. She notes his face is a cherry-red color and suspects which of the following problems?