Order the steps for completing a blood transfusion.

To prevent autonomic dysreflexia, which nursing action would the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level?

A 55-year-old male was admitted 1 week ago for a left lower leg venous thromboembolism, confirmed by ultrasound. He started to work from home 4 months ago and reports that his activity level has significantly decreased. When admitted, his left lower leg had 3+ edema and was warm and reddened over the calf area. He was immediately started on intravenous heparin therapy, with warfarin (Coumadin) on the same day. The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?

Which potential complication would the nurse identify as a high risk for a patient admitted to the hospital with pancytopenia? Select all that apply.

KB is a 65-year-old man admitted to the hospital after a 5-day episode of "the flu" with symptoms of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. KB was diagnosed with Graves' disease 6 months ago and placed on methimazole (Tapazole) 15 mg/day. His other past medical history includes heart failure and hypertension requiring antihypertensive medications; however, he says that he has not been taking these medications on a regular basis. Vital signs (VS) are 150/90, 124 irregular, 20, 100.2°F (37.9°C). Admission assessment findings are height 5 ft 8 in (173 cm), weight 132 lb (60 kg), appears anxious and restless, loud heart sounds, bounding radial pulses, 1+ pitting edema noted in bilateral lower extremities, diminished breath sounds with fine crackles in the posterior bases, and hyperactive bowel sounds. KB begins to cry when he tells you he recently lost his wife. You notice someone has punched several more holes in his belt so he could tighten it.

Which of KB's assessment findings represent manifestations of hypermetabolism related to the effect of excess circulating thyroid hormone? Select all that apply.

Interpret these clinical findings and determine the nurse's next action.

Clinical Findings:

• Complaints of dizziness and unsteady gait.
• BP: 98/60 mmHg.
• Carbidopa-Levodopa last taken 30 minutes ago.

Which information from a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 80,000/uL. Which action will the nurse take first?

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Mr. Carter, a 35-year-old male, presents to the clinic with complaints of fatigue, nausea, intermittent abdominal pain, and jaundice. He reports that he recently returned from a week-long trip to a rural area in Southeast Asia, where he ate local food and drank untreated water. He denies any history of alcohol use or intravenous drug use. Laboratory results include:

Medications: None reported.

Social History: Works as a teacher, lives alone.

Identify the priority nursing interventions for Mr. Carter. (Select all that apply)

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency (Addison's Disease)?