The client with known advanced HIV presents with a cluster of respiratory cues including a wet productive cough and discolored sputum.  The client is 98% on room air and does not appear to be in respiratory distress.  What is the priority action by the nurse at this time?

The client with advanced AIDS is placed on comfort care measures only.  During your assessment, the client is nonverbal but moaning and agitated. The provider does not wish to prescribe pain medication due to the client’s known history of drug abuse.  What is the priority intervention as the nurse?

The client is now inpatient day 2 and has the following assessment; For each client findings, match below to indicate if the finding reflects that client’s condition has improved or is unchanged.

(prior data) Based on the client’s presentation.  What is the priority finding that needs intervention?

The client who is post-op bowel resection is receiving total parenteral nutrition (TPN) and lipids.  Which of the following goals will the nurse include in the plan of care?  Select all that apply.

The nurse is reviewing the medical record of the client who reports drinking three to four glasses of wine each night and taking 3,000 mg of ibuprofen daily.  Which of the following abnormal laboratory values indicate a negative response to these lifestyle choices? Laboratory Reference Range Client Values AST 10-40U/mL 54U/mL WBC 4500-10,000mm/L 7000m/L Serum Albumin 3.5-5.5g/dL 5.7g/dL HCT 35-52% 33% K+ 3.5-5.2 mEq/L 3.5 mEq/L Na 135-145 mEq/L 148 mEq/L _______

Which of the following assessment findings for the client with liver disease requires immediate follow-up with the primary care provider?

The nurse is caring for the client who has a small bowel obstruction with a nasogastric tube (NG) in place.  Which of the following interventions should the nurse include in the plan of care?  Select all that apply.

The client is to receive cefactor 20mg/kg/day in two divided doses.  The medication is available as 125mg per 5mL.  The client weighs 105 pounds.  How many mLs will the nurse administer to the client per dose?  Round to the nearest hundredth place.

The nurse is caring for the client who had a liver biopsy.  Vital signs: blood pressure 95/58, heart rate 110 beats per minutes, respirations 28 breaths per minute.  Which of the following actions should the nurse perform first?