Mr. W. is a 50-year-old client with a history of congestive heart failure who is being seen in the clinic today due to a weight gain of 4 lbs over the last 24 hours.  Upon assessment, 2+ pitting edema is noted in both ankles. Given this scenario, which assessment data will be the nurse’s priority to collect first?

Ms. J. is an 80-year-old client admitted to the emergency department with reports of dizziness and episodes of lightheadedness when she stands up “too quickly”.  She reports “flu-like symptoms (manifestations)” with vomiting and diarrhea for the past 3 days. Given the current scenario, which assessment data will be the nurse’s priority to collect first? (select all that apply)

Mr. W. is a 50-year-old client with a history of congestive heart failure who is being seen in the clinic today due to a weight gain of 4 lbs over the last 24 hours.  Upon assessment, 2+ pitting edema is noted in both ankles.  His blood pressure is currently 158/90. What is the underlying pathophysiology for decreased urine specific gravity in clients with fluid volume excess?

The assistive personnel (AP) reports to the nurse that a client’s urine output for the past 24 hours has been only 360 mL.  What is the nurse’s priority action at this time?

Ms. J. is an 80-year-old client admitted to the emergency department with reports of dizziness and episodes of lightheadedness when she stands up “too quickly”.  She reports “flu-like symptoms (manifestations)” with vomiting and diarrhea for the past 3 days. Upon assessment: Blood pressure is currently 82/48 Heart rate is 110 bpm What is the underlying pathophysiology for the client’s hypotension and increased heart rate?

The client is at risk for poor perfusion related to decreased plasma volume.  Which assessment finding supports this risk?

The nurse is preparing to discharge a client whose calcium level was low but is now just barely within the normal range (9 – 10.5 mg/L).  Which statement by the client indicates the need for additional teaching?

Watch the following video and then answer the following questions:

The nurse is caring for a client with a primary medical diagnosis of acute renal failure secondary to treatment of a urinary tract infection with a nephrotoxic antibiotic.  The client’s morning basic metabolic panel (BMP) reveals the following abnormal data: Na+ 135 mEq/L K+ 6.5 mEq/L Ca+ 7.1 mg/dL Phos+ 5.3 mmol/L Which additional assessment data does the nurse anticipate in clients with hyperphosphatemia?

When is a good time for kangaroo care?