A nurse is caring for a young adult client in the emergency department.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Compartment Syndrome, Fat Embolism Syndrome, or Deep Vein Thrombosis. Each finding may support more than one disease process.

A nurse is caring for a client at the endocrinologist's office.

The client sees the diabetic nurse educator. Click to highlight the findings that indicate an understanding of the diabetic foot care education the client received. To deselect a finding, click on the finding again.

"I understand that I need to inspect my feet daily. I will dry my feet thoroughly when I get out of the shower. It is important to apply lotion to my feet and especially my toes to keep my skin in good health. That will prevent any sores on my feet. I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board. I will wear closed toed shoes. I am glad I can still go barefoot in the house because I never wear shoes at home. If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself."

A nurse is assessing a client who has a new diagnosis of pericarditis. Which of the following findings should the nurse identify as a manifestation of cardiac tamponade?

A nurse is caring for a young adult client in the emergency department.

For each assessment finding below, click to specify if the assessment finding is consistent with Compartment Syndrome, Fat Embolism Syndrome, or Deep Vein Thrombosis. Each finding may support more than one disease process.

A nurse is preparing to administer enoxaparin 0.75 mg/kg subcutaneously to a client who weighs 69.9 kg (154 lb). The amount available is enoxaparin 60 mg/0.6 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a group of clients. In which of the following scenarios is the nurse acting as a client advocate?

A nurse is assessing a client who has a central venous catheter (CVC) with intravenous (IV) fluids infusing. The client suddenly develops shortness of breath, and the nurse notes that the IV tubing and needleless connector device are disconnected. Which of the following actions should the nurse take first?

A nurse is assessing an older adult client who is receiving 2 units of packed RBCs. Which of the following manifestations should indicate to the nurse that the client is experiencing circulatory overload?

A nurse is preparing a teaching plan for a client who is starting to receive hemodialysis for chronic kidney disease. Which of the following instructions should the nurse include in the teaching?

The nurse has reviewed the nurses' notes Day 2 at 0800 and 1200 and vital signs and laboratory results Day 3 at 0800

The nurse is reviewing the client's electronic medical record. Click to highlight the findings that indicate an improvement of the client's condition. To deselect a finding, click on the finding again.

Day 3, 0800:

• Temperature 37° C (98.6° F)
• Blood pressure 112/56 mm Hg Heart rate 88/min
• Respiratory rate 20/min
• Oxygen saturation 95% on room air (95% to 100%)

Day 3, 0800:

• Haemoglobin 15 g/dL (14 to 18 g/dL)
• Haematocrit 45% (42% to 52%)
• Platelets 100,000/mm3 (150,000 to 400,000/mm3)
• Albumin 3.0 g/dL (3.5 to 5 g/dL)
• Ammonia 160 mcg/dL (10 to 80 mcg/dL)

A nurse is completing an admission assessment for a client who has bacterial meningitis. Which of the following personal protective equipment should the nurse use while caring for the client?