The nurse is doing a neurologic assessment on a client in spinal shock following a spinal cord injury. Which observation indicates that spinal shock persists?

The nurse is caring for a client who has a diminished level of consciousness and who is mechanically ventilated. While performing endotracheal suctioning, the client reaches up in an attempt to grab the suction catheter. What is the best interpretation by the nurse?

While a client is receiving IV vincristine for the treatment of cancer, the nurse observes swelling and pain at the peripheral IV site. The nurse will prioritize what action?

A client has developed diabetes insipidus (DI) after having increased intracranial pressure (ICP) following head trauma. What nursing assessment best addresses this complication?

The nurse is assessing a client being treated for anaphylactic shock. Which assessment is most important to evaluate whether treatment has been effective?

The nurse is caring for a client who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this client?

A client is admitted to the cardiac care unit with an acute anterior myocardial infarction. The nurse assesses the client to be diaphoretic and tachypneic, with bilateral crackles throughout both lung fields. Following insertion of a pulmonary artery catheter by the physician, which hemodynamic values is the nurse most likely to assess?

The nurse is caring for a client with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action?

A client with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The client is admitted to the cardiac critical care unit after the PTCA. Which of the following complications will the nurse monitor the client after the procedure?

A client is admitted to the emergency department (ED) after a diving accident with a suspected cervical spine fracture. The client has a heart rate of 45 beats/minute and a blood pressure of 78/44 mm Hg. What priority interventions would the nurse anticipate?