A nurse case manager is evaluating an 82-year-old client for transition to an independent living facility following hospitalization for community-acquired pneumonia. The client lives alone, has Medicare, and currently has no in-home support services. For each assessment finding, click to indicate whether the finding supports safe transition to independent living or Indicates need for a higher level of care.
Read DetailsScenario: A 40-year-old patient is brought to the emergency department after experiencing a generalized tonic-clonic seizure. The seizure lasted 2 minutes. The patient is now in the postictal phase, presenting as drowsy and confused but arousable. Vital signs: BP 136/84 mmHg, HR 94 bpm, RR 20 breaths/min, SpO₂ 95% on room air. The patient’s partner states this is the second seizure today. Which findings are expected and which require further monitoring or intervention?
Read DetailsA 58-year-old client with end-stage liver cirrhosis secondary to alcohol use is admitted to the medical unit with hepatic encephalopathy. The client is receiving lactulose 30 mL every 6 hours with a goal of 3–4 soft bowel movements per day. Current assessment findings: Client reports difficulty concentrating and is slow to respond to questions Asterixis (flapping tremor) elicited when the client extends the wrists Drowsy and confused; oriented to person and place but not time Slow, irregular respirations with periods of apneic pauses BP: 118/74 HR: 86 SpO₂: 94% on room air Serum ammonia: 142 mcg/dL Which finding is most concerning and requires the nurse’s immediate attention?
Read DetailsA 74-year-old client with a history of heart failure with reduced ejection fraction (HFrEF, EF 28%) is admitted with acute decompensated heart failure. The client presents with worsening dyspnea at rest, orthopnea, and a 3 kg weight gain over the past 5 days. Current assessment: BP: 100/66 mm Hg HR: 108 bpm RR: 26 breaths/min, labored with accessory muscle use SpO₂: 89% on 2 L/min nasal cannula Lungs: coarse crackles throughout bilateral lung fields Cardiac: S3 gallop, JVD to mid-neck Extremities: 3+ pitting edema to mid-calf bilaterally Urine output: 60 mL over the past 4 hours Mental status: alert but anxious IV access is in place, and the provider has written orders for supplemental oxygen, furosemide IV, labs, and imaging. Which intervention should the nurse implement first?
Read DetailsA 76-year-old client is admitted to the telemetry unit for evaluation of a single syncopal episode that occurred yesterday at home. The client has since remained asymptomatic. On admission, the cardiac monitor displays: Regular rhythm HR: 48 bpm One P wave before each QRS complex PR interval: 0.18 seconds QRS duration: 0.08 seconds Current assessment: BP: 110/70 mm Hg RR: 16 SpO₂: 97% on room air Alert and oriented ×3 Denies dizziness, lightheadedness, chest pain, shortness of breath Warm, dry skin; no edema Medication list includes metoprolol 50 mg PO BID for hypertension Which action should the nurse take next?
Read DetailsDiscussion Prompt: In Langston Hughes’s poem “Harlem,” the speaker asks a powerful question: “What happens to a dream deferred?” (Hughes 1). Through a series of vivid images, Hughes suggests different possible outcomes when dreams are postponed or denied. Write a paragraph (8-10 sentences) in which you analyze how Hughes uses imagery and/or figurative language (similes, metaphor, personification) to convey the theme consequences of deferred dreams. Harlem What happens to a dream deferred? Does it dry up like a raisin in the sun? Or fester like a sore— And then run? Does it stink like rotten meat? Or crust and sugar over— like a syrupy sweet? Maybe it just sags like a heavy load. Or does it explode? Hughes, Langston. “Harlem.” The Norton Anthology of American Literature, edited by Kelly Mays, Portable 15th ed., W. W. Norton & Company, 2025, p. 647.
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