A client with a confirmed hemorrhagic stroke arrives at the emergency department. The nurse notes a systolic blood pressure of 180 mm Hg and observes slight left-sided weakness. Which action should the nurse take next?

A nurse wants to implement an evidence-based protocol to reduce catheter-associated urinary tract infections but feels unsupported by management and unsure how to proceed. Which EBP barrier is this nurse experiencing?

A client on mechanical ventilation is receiving care to prevent ventilator-associated pneumonia (VAP). During assessment, the nurse notes visible secretions in the endotracheal tube, wheezing in the upper lung fields, and an oxygen saturation of 92%. Which priority action should the nurse take?

(see below rhythm) A client with sudden-onset palpitations presents with a heart rate of 176 beats/min. The client is alert, speaking in full sentences, and has a BP of 118/72 mm Hg. The nurse has the client perform coughing and a Valsalva maneuver, but the rhythm remains unchanged. What is the nurse’s priority action? Picture 16 Premature supraventricular tachycardia .png

An unresponsive 79-year-old client is brought to the emergency department during a summer heat wave. Assessment reveals a core temperature of 105.4°F (40.8°C), blood pressure of 88/50 mm Hg, and pulse of 112 beats/min. Which priority action should the nurse implement?

A client receiving mechanical ventilation becomes agitated and suddenly self-extubates. The nurse enters the room and finds the client coughing forcefully, with oxygen saturation dropping to 84%, tachypnea, and use of accessory muscles. What is the nurse’s priority action?

The nurse is preparing a client for the insertion of a radial arterial line. Which action is most important to perform prior to the procedure?

A client is receiving continuous heparin infusion for a pulmonary embolism. The nurse notes the client has new onset of hematuria and a blood pressure of 88/52 mm Hg. Which action should the nurse complete first?

The nurse is caring for a client on a mechanical ventilator when the high-pressure alarm begins to sound. On assessment, the nurse notes an increased respiratory rate, visible secretions in the endotracheal tube, and coarse crackles on auscultation. What is the nurse’s priority action?

The major functions of the liver include all of the following except: