A 70-kg client with septic shock secondary to urosepsis has been receiving aggressive treatment in the ICU for the past hour, including: 30 mL/kg of IV lactated Ringer’s per the Surviving Sepsis Campaign bundle Broad-spectrum IV antibiotics (piperacillin-tazobactam) A norepinephrine infusion titrated to maintain MAP ≥ 65 mm Hg Admission values (1 hour ago): MAP: 58 mm Hg HR: 128 bpm Serum lactate: 4.8 mmol/L Urine output: 15 mL/hr Skin: mottled, cap refill > 4 sec The nurse is reviewing the chart to evaluate the client’s response to treatment. Which documented change best indicates that the client’s condition is improving?

A 34-year-old client with a T4 spinal cord injury sustained 8 months ago is receiving care on a medical unit after being admitted for a urinary tract infection. The client performs clean intermittent self-catheterization every 6 hours at home but has not catheterized in 8 hours due to nausea and fatigue. The client calls the nurse using the call light and reports: “I have a pounding headache, I can’t see right, and my chest feels tight.” Assessment findings: BP: 204/112 mm Hg (baseline 108/68) HR: 52 bpm, regular RR: 20 SpO₂: 96% on room air Skin above the level of injury: flushed, warm, and diaphoretic Skin below the level of injury: pale, cool, with piloerection (“goosebumps”) Client reports blurred vision and nasal congestion Indwelling Foley is not in place; abdomen is palpably distended over the bladder Last bowel movement: 3 days ago What is the nurse’s priority action?

A 67-year-old client presents to the neurology clinic with a 6-month history of progressive hand tremor at rest, stiffness, slowed movement, and a shuffling gait. On examination, the provider notes a pill-rolling tremor of the right hand, cogwheel rigidity, bradykinesia, and a masked facial expression. The provider suspects Parkinson’s disease (PD). The nurse is reviewing the underlying pathophysiology and expected diagnostic findings with the client. Which diagnostic or pathophysiologic finding supports the diagnosis of Parkinson’s disease?

A 72-year-old outpatient client with chronic heart failure with reduced ejection fraction (HFrEF, EF 32%) returns to the cardiology clinic after 2 weeks of therapy with metoprolol succinate (Toprol XL) 25 mg PO daily. The client was initiated on the medication at the last visit as part of guideline-directed medical therapy for HF. Current assessment findings: BP: 88/42 mm Hg (baseline 128/76) HR: 59 bpm, regular RR: 18 SpO₂: 96% on room air Lungs: clear to auscultation 2+ pitting pedal edema bilaterally (was 3+ at initiation) Weight: 1.8 kg decrease over 2 weeks Client reports improved exercise tolerance but has had two episodes of mild dizziness when rising from a chair this week Which assessment finding is most important for the nurse to report to the healthcare provider?

A nurse is precepting a new graduate in the ICU and is reviewing the five major categories of shock. The nurse explains that each shock state has a distinct hemodynamic and clinical profile driven by its underlying mechanism, and that recognizing these patterns is essential for selecting appropriate interventions. Match each type of shock to its most characteristic clinical feature.

A 30-year-old client presents to the neurology clinic for evaluation of symptoms that have developed over the past several weeks: Blurred vision in the right eye with pain on eye movement Numbness and tingling in both legs Unilateral weakness in the left arm Persistent fatigue that worsens in the afternoon Difficulty concentrating at work The provider orders a brain and spinal cord MRI and suspects multiple sclerosis (MS). The nurse is reviewing the expected clinical picture with the client. Based on the underlying disease process of MS, which additional cluster of findings should the nurse expect?

A 72-year-old client is brought to the emergency department by family after vomiting bright red blood and passing melena stools over the past several hours. The client has a history of peptic ulcer disease and chronic NSAID use for osteoarthritis. Assessment findings: BP: 78/48 mm Hg (MAP 58) HR: 132 bpm, sinus tachycardia, thready radial pulse CVP: 2 mmHg RR: 26/min, shallow SpO₂: 93% on room air Skin: pale, cool, diaphoretic Capillary refill: > 3 seconds Mental status: anxious, mildly confused Neck veins: flat The provider suspects hypovolemic shock from the acute GI bleed. Which clinical finding best supports the diagnosis of hypovolemic shock?

A 42-year-old client was recently diagnosed with acute myeloid leukemia (AML) and is being discharged home after initial workup. The client is scheduled to begin induction chemotherapy next week. The nurse has provided discharge teaching on infection prevention, bleeding precautions, nutrition, follow-up, and activity. Before discharge, the nurse asks the client to verbalize key teaching points to evaluate understanding. Which client statements indicate a need for further education? Select all that apply.

A 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 (normal 15–45) Which finding is most concerning and requires the nurse’s immediate attention?

A nurse is completing rounds on a medical-surgical unit and assessing four clients with a history of peripheral artery disease (PAD). Each client reports a different symptom during the assessment. Which client finding requires the nurse’s immediate intervention?