At 1700 a patient is exhibiting confusion, pallor, decreased urine output and an increase in heart rate. The nurse asks the nursing assistant what the patient’s blood pressure was at 1600 vital sign check. The nursing assistant states, the blood pressure was “90/40” and proclaims she forgot to let the nurse know the abnormal reading. What should the nurse do next?

The nurse is using back channeling as a method of communication during the initial assessment. Which of the following statements best describes this interviewing technique?

A patient verbalizes a pain level of 0 out of 10 but the nursing student notices the patient is grimacing and moaning while moving in bed. What is the nursing student’s most appropriate initial action in response to these observations?

The RN needs vital signs assessed for four clients. Which client should the nurse address and not assign to the CNA?

The nurse is assessing the carotid artery. During auscultation of the left carotid artery the nurse hears a whooshing or blowing sound. What should the nurse report to the physician?

What is the difference between complementary and alternative medical therapy?

A nurse is gathering information about a patient’s habits and lifestyle. Which method of data collection will the nurse use that will best obtain this information?

Which of the following interventions is written the most correctly?

The nurse has completed head-to-toe assessments on several patients. Which assessment finding will the nurse record as normal?

A nurse has formulated a nursing diagnosis/problem of Risk for Infection. Which of the following goals would be the most appropriate?